Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system.

The majority of studies of the birth spacing-child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18-23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data

Correlates of Spatial Differences in under-five mortality in Nairobi’s informal Settlements

Child mortality in Kenya is often associated with individual level factors including socio-economic status, nutritional status, and poor access to health services. Geographical factors are less documented as important predictors of child mortality in the country. Using a Bayesian geo-additive survival model, this paper examines the factors associated with child mortality in two Nairobi slums, Korogocho and Viwandani, accounting for spatial random effects. It uses longitudinal data for the period 2006-2011 involving 30339 children aged below five years from the Nairobi Urban Health and Demographic Surveillance System implemented in the two slums. In addition to determinants such as mother’s education and age, size of the household and ethnicity, our findings show a certain spatial structure in child mortality risk, with differences between some villages in Viwandani, while no spatial variations were observed in Korogocho. The results call for specific efforts from policymakers to refine child health interventions in Nairobi’s urban slum

Fertility and Household Economic Outcomes among Poor Urban Households in Nairobi informal Settlements, Kenya

We use longitudinal data on 6,324 households from the Nairobi Urban Health and Demographic Surveillance System and a multidimensional poverty index to investigate the effects of birth of additional children on household poverty transitions between 2006 and 2009. Overall we find more households falling into than moving out of poverty, while more households remained in chronic poverty than those who stayed out of poverty over the study period. Having a birth in a household is a significant net predictor of a household falling into poverty and lessens their prospects of moving out of poverty over the observation period. Following the inevitable expenditures associated with infants’ total care, our findings provide compelling quantitative support for anti-poverty interventions that include the promotion of voluntary family planning programs and smaller family size norms as part of the strategies to address persistent poverty among the urban poo

Reaching the Urban Poor with Health Interventions: The Case of Hiv Testing In Nairobi Urban Informal Settlements, Kenya

HIV testing and counseling (HCT) is an entry point to HIV prevention, treatment, and care. In Kenya, national-level data show an astronomical growth in testing. However, national estimates blur sub-group testing differentials and fail to reflect the situation of the most vulnerable groups. We draw on data from 6,035 women and men of reproductive age interviewed in the 2012 Nairobi Cross-sectional Slum Survey and 11,909 women and men interviewed in the 2008/09 Kenya Demographic and Health Survey to compare the levels of HIV testing among residents of Nairobi slums and the rest of Nairobi and Kenya. We found that a greater proportion of Nairobi slum dwellers had been tested for HIV compared with residents in other parts of Nairobi and Kenya as a whole. This counter-intuitive finding may be explained by the specific advantage of slum dwellers over the rest of the country in accessing HIV testing services through mobile clinics and research studies. Relatively disadvantaged sub-groups such as women aged 15-19 years and the never married were most likely to be tested in mobile clinics or research studies. Our findings underscore the importance of targeted interventions to reduce inequities in access to HTC service

Parental education and high school completion in the urban informal settlements in Kenya

A well-established empirical association exists between family background and children’s educational attainment. Studies have shown the importance of parental education for not just children’s educational outcomes but also other behavioral, and health outcomes. In this paper, data collected by African Population and Health Research Center in 2012 across Nairobi’s slums are fitted to a logistic regression to estimate the likelihood of secondary school completion. Even after controlling for influential covariates such as socioeconomic status; parental survivorship; slum area of residence and duration of stay; marital status; and substance abuse the effect of parental education on secondary school completion persists. Among female adolescents compared to male adolescents, parental presence, drug abuse, and migration into the slum compared to birth in the slum were associated with lower school completion. Overall, the study confirms the importance of parental education for adolescent secondary school completion but extends its effects beyond that reported in the literature on SSA, which is that mother’s and father’s education affect the acquisition of literacy and numeracy, math achievement, age for grade, and cognitive development