11 research outputs found
Open Defecation Practices in Lodwar, Kenya: A Mixed-Methods Research
No full textBackground: As of the year 2014, about 2.5 billion people globally lacked access to improved sanitation. The situation is even worse in the sub-Saharan African countries including Kenya. The practice of open defecation (OD) peaks beyond 72% of the population in Turkana County, Kenya, despite various interventions to end it. Methods: This article reports on both qualitative and quantitative aspects of a cross-sectional study. A partially mixed sequential dominant (quantitative) status was used to understand various socioeconomic factors associated with OD practice in Lodwar’s human settlements, Turkana County. Simple random sampling technique was chosen to select participants for this study with the sample drawn from various administrative units of Lodwar. Standardized questionnaires, focus group discussions, and key informant interviews were used to collect data. Results: The quantitative findings revealed that culture was the leading factor as to why people practiced OD with a frequency of 44%. The findings further revealed that poverty was the major influencing factor for latrine ownership among the households (frequency 27%). Pearson χ 2 tests revealed that there was a significant association between latrine presence and education level of the household head (χ 2 = 107.317; P < .05), latrine sharing (χ 2 = 403; P < .05), and occupation of the household head (χ 2 = 74.51; P < .05). The quantitative findings showed that culture was by far the most common factor that contributed to the OD practice with a theme intensity of 31.1%. Further analyses identified 5 major cultural aspects that were associated with OD practice. This included sexual immorality, OD as a common habit, nomadic pastoralism, bride’s dignity and mixing of feces. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (theme intensity 31.3%) followed closely by nomadic pastoralism kind of life among the residents that limit latrine construction (theme intensity 28.1%). Conclusions: In addition to cultural aspects, high poverty levels influence latrine adoption and consequently OD practices. Future sanitation interventions addressing OD should assess and factor in these cultural aspects in such communities to come up with appropriate eradication measures which have otherwise been difficult to solve through poverty eradication and sanitation campaigns that have been in existence
Women of the New Walden: Gender in Sound Culture, Now and Then
No full textSonic diversity in the midst of wilderness, as original and untamed, can confound and discomfort the novice listener who becomes overwhelmed by its plethora of mysterious languages. Transcendentalist Margaret Fuller, author of Summer on the Lakes (1844), expressed sensory overload when she was confronted with the sights and sounds of Niagara Falls. Sound permeates our life, from conception, birth, and varied sonic spheres of influence that penetrate our physical space. Sound acknowledges its relevance as a cultural influence within the socialization of the individual. For instance, high-powered car stereos and subwoofers swimming in bass overtones have become associated with masculinity. This paper investigates the idea of sound as culture, and how gender, ethnicity, space and other factors create a multiplicity of sonic spheres of influence that impact our perception of events. An on-going listening study that explores the intersection of gender, sound, and cultural (as well as physical) space will be discussed. Personal stories emerge as sound weaves a narrative (as soundscape) that is composed of the memories and daily impressions of women. It is a return to Merchant\u27s Eden, Fuller\u27s Summer on the Lakes, and Thoreau\u27s Walden
Development of a protocol for using geo-trackers to identify zoonotic enteric pathogen transmission pathways in a pilot study in Kenya
No full textAbstract Humans and animals can be exposed to fecally-transmitted pathogens in both private and public domain environments. Animals may also acquire pathogen infections from these two environments and transmit them to humans through different pathways. Evidence on how often and where interactions occur between the two environments could improve the effectiveness of public health programs for preventing zoonotic disease transmission and response to disease outbreaks. This study aimed to develop a protocol for using geo-trackers to measure the spatial-temporal movement and interaction between animals and children in households and public areas in low- and middle-income categories of urban neighbourhoods in Kenya. It also aimed to identify opportunities and challenges for the scale-up of these methods’ for surveillance of other zoonotic diseases of public health significance. One commercial geo-tracker device with the best technological performance and usability that met pre-defined criteria for the study context was identified. Community engagement meetings were then conducted to gather input on a proposed study protocol. Afterwards, infants and animals were geo-tracked in 10 households in urban informal settlements of Kibera and Jericho, Nairobi over two consecutive weeks with iterative improvements to protocols. The effectiveness of the geo-tracking exercise was evaluated through in-depth interviews with Community Health Volunteers (CHVs) and infant caregivers. Animal and infant behaviour and battery reliability of the geo-trackers were also monitored; and observed opportunities and challenges in implementing the protocol during the exercise were documented. Community members were receptive and accepted the use of geo-trackers on animals and children. In pilot testing, there was no change of behaviour from 10 infants tracked. Discomfort was observed for up to 30 min after the placement for some of the seven animals tracked, but the animals quickly adjusted. The battery for all geo-tracker devices lasted for the 24-h geo-tracking period. Some caregivers and CHVs were concerned whether the geo-trackers could record personal information. It was shown that geo-tracker devices can be successfully deployed to study animal-child interactions and movement in different categories of urban neighbourhoods. Recommendations have been made on the lessons learnt from the study to help scientists who would use geo-trackers for future community-based human and animal research. One Health impact statement Assessing human and animal risks of acquiring enteric infections from environmental contamination, or contributing to pathogen contamination of the environment requires understanding spatial-temporal patterns of human and animal movement between private households and the community. Movement of domestic animals is relevant for understanding household-community spatial patterns of pathogen transmission because animal ownership and contact with humans is common, and free-roaming animals carrying enteric pathogens can spread diverse faecal pathogens between environments. The community-based participatory research approach of this study evaluated implementation feasibility from the lens of technical usability and reliability of geo-tracking devices, as well as social acceptability and ethics related to using such devices for the community-based study of human and animal subjects in urban settings. Evidence and recommendations from this study will be useful to anyone interested in understanding human-animal-environment interactions and their contributions to infectious disease transmission
Determinants of access to basic handwashing facilities and handwashing with soap in low-income areas of four Kenyan cities.
No full textHandwashing with soap is an effective public health measure against infectious disease and is enabled by availability of handwashing facilities, soap and sufficient water. However, access to handwashing facilities in low-income urban areas is often low, which hinders effective handwashing with soap. We assessed access to basic handwashing facilities and handwashing with soap practices in low-income areas across four cities in Kenya. A cross-sectional survey was conducted and observations made at household level to assess availability of basic handwashing facilities. Respondents demonstrated how they usually washed hands and observations were made on whether hands were washed with soap or not. Multivariable logistic regression models were used to assess determinants of access to basic handwashing facilities and of handwashing with soap across the cities. Results show that most handwashing facilities were basins (77%) and customised containers (4.6%). Less than half of respondents (40%) reported always using soap during handwashing and 59% reported sometimes using soap. Those with secondary education had higher odds of having basic handwashing facilities (Adjusted Odds Ratio (AOR)-1.92, P = 0.02, CI 1.14- 3.24) while those without any compound enclosure had lower odds of having handwashing facilities (AOR = 0.42, P = 0.00, CI 0.28-0.62). Respondents with a handwashing facility (AOR = 69.52, P = 0.00, CI 42.88-112.73) and those with a water point in their compound (AOR 2.4, P = 0.00 CI: 1.43-3.98) had higher odds of handwashing with soap. Across the cities, residents from Mombasa had lower odds of having handwashing facilities (AOR = 0.47, P = 0.01 CI 0.28-0.80) and of handwashing with soap (AOR-0.19; P = 0.00; CI 0.08-0.42) compared to those from Nairobi. These results buttress the important role played by water and the presence of a handwashing facility in promoting handwashing with soap. Interventions in low-income areas should focus on increasing access to conditions such as consistent supply of water to promote adequate and sustained handwashing with soap
Enablers and barriers of handwashing with soap in low-income settlements of Mombasa, Kenya
No full textHandwashing with soap (HWWS) is an effective public health preventive measure. Review studies indicate that interventions on handwashing with soap reduce the risk of diarrhoeal diseases by approximately 30% and respiratory tract infections by up to 17% (Ross, Bick, Ayieko, et al., 2023; Wolf, Hubbard, Brauer, et al., 2022). Studies have also shown that HWWS, combined with interventions on water and sanitation, results in improved growth outcomes among children under five (Bekele et al., 2020; George, Monira, Zohura, et al., 2021; Hasan, Asif, Barua, et al., 2023).
The World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) Joint Monitoring Program (JMP) estimated that by 2022, 75% of the global population had access to basic handwashing facilities (HWFs) measured by the presence of a handwashing facility with water and soap within the premises (UNICEF and WHO, 2023a). Access to a basic HWF is an indicator for HWWS, as studies have confirmed HWWS at critical times increases as a result of the presence of a HWF (Jetha, Bisserbe, McManus, et al., 2021; Mbakaya et al., 2020; Okello, Kapiga, Grosskurth, et al., 2019; White, Thorseth, Dreibelbis, et al., 2020; Wolde, Abate, Mandefro, et al., 2022).
These JMP estimates indicate that Sub-Saharan Africa (SSA) had the lowest regional coverage of basic HWFs by 2022, with only 30% of the population having access to basic HWFs (UNICEF and WHO, 2023b). This limited coverage may indicate or lead to inadequate HWWS. In addition, significant disparities in access exist between urban and rural areas of Africa, with urban areas exhibiting higher access (32%) than rural areas (17%) (UNICEF and WHO, 2023a,b). Despite this advantage, urban areas of Africa have significant proportions of the population residing in Low Income Areas (LIAs) which are characterised by several challenges including intermittent water supply, high costs of water, lack of handwashing facilities, and a higher risk to hygiene related health outcomes (Beard & Mitlin, 2021; Corburn, Vlahov, Mberu, et al., 2020; Kisaakye et al., 2021).
Research studies examining hindrances (barriers) and enablers of HWWS in LIAs of Africa are limited. However, studies conducted in LIAs in other regions have identified financial resources, availability of water and soap, and the presence of dirt on the hands as factors that promote HWWS (Kalam, Davis, Islam, et al., 2021; Khan, Chakraborty, Brown, et al., 2021; Rahman, Nizame, Unicomb, et al., 2017).
Similar to other African countries, studies examining the enablers and barriers for HWWS in LIAs in Kenya are limited, with most of the available studies focusing on food hygiene or COVID-19 related knowledge regarding HWWS (Austrian, Pinchoff, Tidwell, et al., 2020; Davis, Cumming, Aseyo, et al., 2018; Mumma, Simiyu, Aseyo, et al., 2019; Robinson & Howland, 2022; Watson, Okumu, Wasonga, et al., 2024).
This study builds on a prior survey in LIAs of Kenyan cities that examined determinants of access to basic HWFs and of HWWS (Simiyu et al., 2025). The study indicated a lower likelihood of access to basic HWFs and of HWWS among residents of Mombasa compared to residents in low-income areas of other cities in Kenya (Simiyu et al., 2025). This study, therefore, explores the barriers and enablers of HWWS in the low-income settlements of Mombasa and identifies intervention strategies for improvement of HWWS within these areas
Development of a handwashing with soap intervention in low-income settlements of Mombasa, Kenya
No full textIntroduction
Interventions to improve handwashing with soap have shown mixed effects on behaviour which may be due to contextual differences in different settings. Low-income settings have complex socio-economic conditions which requires local contextual adaptation to support intervention adoption. Detailing the development of an intervention can inform other researchers and practitioners on best practices, and it enables replicability and scalability.
Methods
This study adopted the Trials of Improved Practices (TIPs) approach and incorporated co-creation and co-design of interventions with stakeholders. A total of 56 participants were randomly selected and an initial survey was conducted. The development process entailed stakeholder engagements and educational activities. Educational activities were delivered through household-level visits and community dialogue sessions. Qualitative data were collected throughout the process using in-depth interviews. A survey was conducted after the educational activities to assess availability of handwashing facilities and handwashing with soap practices. Logistic regression was used to estimate the effect of independent variables on availability of handwashing facilities and on handwashing with soap, and McNemar’s test was used to evaluate if the interventions improved handwashing practices. Qualitative data were analysed thematically, and the findings explained the process and the effect of the interventions.
Results
Initial survey results showed that 59% of handwashing facilities were not at a fixed location, and only 21% of respondents reported handwashing with soap. Households with a fixed handwashing facility had 5.3 times higher odds of handwashing with soap compared to households with mobile handwashing facilities (
P
= 0.02 CI 1.32–21.23). Participating households made improvements by designating handwashing facilities at the compound level and separate handwashing facilities at the household level. Access to fixed handwashing facilities increased from 10 to 77%, and reported handwashing with soap among respondents significantly increased from 21 to 64% after the education activities (McNemar's
X
2
(1) = 12.46;
P
= 0.00). This improvement in handwashing was attributed to the educational visits and practical demonstrations and was motivated by improved hygiene conditions in the households.
Implications
Households can improve reported handwashing with soap if they are provided with the necessary skills for making improvements. This approach could serve as a model for future public health initiatives aimed at improving hygiene practices in similar settings
Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children
No full textObjective Diarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness and adequacy of Kenya’s policies, frameworks and action plans for diarrheal management and prevention. The study seeks to identify policy and practice gaps that need to be filled to strengthen diarrhoea treatment and prevention among under-5 children in Kenya.Design Our study is a landscape analysis, which seeks to identify the gaps in the current Kenya diarrheal policy, frameworks and action plans. The critical questions included their comprehensiveness, the availability of elaborate treatment, management and prevention solutions, together with updatedness, building on evidence from extant literature on key pathways to infection relating to man-animal environmental interaction, which are critical in enteric infection prevention initiatives.Data sources We conducted an internet search of databases of Government of Kenya’s Ministry of Health; relevant websites/publications of international organisations and groups (Centre for Disease Control and Prevention, UNICEF and WHO) and published and grey literature (Google searches, Google Scholar and PubMed).Eligibility criteria Included are publicly available key national diarrheal policy frameworks, plans, strategies, laws, institutional frameworks and operational guidelines that inform pertinent questions on the adequacy of policy and practice and preventive policy updates and actions. Further, peer-reviewed and grey literature on diarrheal morbidity and mortality and diarrheal prevention and management are included. The analysis excluded any information that was not referenced on the internet nor obtained from the internet.Data extraction and synthesis The review team extracted the key provisions of the policy guidelines guided by a checklist and questions around the adequacy of existing national policies in addressing the determinants, prevention and treatment interventions of enteric infections and diarrhoea among under-5 children in the country. The checklist covered Kenyan background and diarrhoea situation analysis, policy objectives, policy strategies and policy implementation.Results The analysis identified a corpus of strategies for the management of diarrhoea at multiple levels: health facilities, communities and households. The policies highlighted advocacy, health communication and social mobilisation, as well as logistics management and prevention strategies. However, the triangulation of evidence from the policy provisions and extant literature identified critical policy gaps in diarrhoea prevention and management in Kenya, particularly the lack of focus on zoonotic pathways to enteric infection, environment-pathogen linkages and operationalisation of the roles of social determinants of health and related services. The policy documents had limited focus on rapid diagnosis, vaccine development and deployment, together with weak funding commitment towards implementation and unclear pathways to funding responsibilities.Conclusion Policies are central to guiding programmatic actions towards effective enteric and diarrhoea prevention and management measures in Kenya. This study shows the need for policy updates to reflect pathways to enteric infections not covered in the current policy guidelines. Further, there is a need to strengthen the treatment and management of infection through rapid diagnosis, vaccine development and deployment, and strong funding commitment towards implementation together with clear funding responsibilities. Together, these will be vital in strengthening the current policy provisions and addressing other pathways to the prevention of enteric infections relating to zoonotic, environment-pathogen linkages and social determinants of health in Kenya and other low-income and middle-income countries.Trial registration number NCT05322655
Spatial–Temporal Patterns in the Enteric Pathogen Contamination of Soil in the Public Environments of Low- and Middle-Income Neighborhoods in Nairobi, Kenya
No full textPublic spaces in countries with limited societal development can be contaminated with feces containing pathogenic microbes from animals and people. Data on contamination levels, spatial distribution, and the diversity of enteric pathogens in the public settings of low- and middle-income neighborhoods are crucial for devising strategies that minimize the enteric infection burden. The objective of this study was to compare spatial–temporal differences in the detection rate and diversity of enteric pathogens in the public spaces of low- and middle-income neighborhoods of Nairobi, Kenya. TaqMan array card (TAC) molecular assays were employed to analyze soil samples for 19 enteropathogens, along with a selective bacterial culture for pathogenic Enterobacteriaceae. An observational assessment was conducted during every site visit to document the hygienic infrastructure and sanitation conditions at the sites. We detected at least one pathogen in 79% (127/160) and ≥2 pathogens in 67.5% (108/160) of the soil samples tested. The four most frequently detected pathogens were EAEC (67.5%), ETEC (59%), EPEC (57.5%), and STEC (31%). The detection rate (91% vs. 66%) and mean number of enteric pathogens (5 vs. 4.7) were higher in low-income Kibera than in middle-income Jericho. The more extensive spatial distribution of pathogens in Kibera resulted in increases in the detection of different enteric pathogens from within-site (area < 50 m2) and across-site (across-neighborhood) movements compared to Jericho. The pathogen detection rates fluctuated seasonally in Jericho but remained at sustained high levels in Kibera. While better neighborhood conditions were linked with lower pathogen detection rates, pathogenic E. coli remained prevalent in the public environment across both neighborhoods. Future studies should focus on identifying how the sources of pathogen contamination are modified by improved environmental sanitation and hygiene and the role of these contaminated public environments in enteric infections in children
Protocol for the PATHOME study: a cohort study on urban societal development and the ecology of enteric disease transmission among infants, domestic animals and the environment
No full textIntroduction Global morbidity from enteric infections and diarrhoea remains high in children in low-income and middle-income countries, despite significant investment over recent decades in health systems and water and sanitation infrastructure. Other types of societal development may be required to reduce disease burden. Ecological research on the influence of household and neighbourhood societal development on pathogen transmission dynamics between humans, animals and the environment could identify more effective strategies for preventing enteric infections.Methods and analysis The ‘enteric pathome’—that is, the communities of viral, bacterial and parasitic pathogens transmitted from human and animal faeces through the environment is taxonomically complex in high burden settings. This integrated cohort-exposure assessment study leverages natural socioeconomic spectrums of development to study how pathome complexity is influenced by household and neighbourhood infrastructure and hygiene conditions. We are enrolling under 12-month-old children in low-income and middle-income neighbourhoods of two Kenyan cities (Nairobi and Kisumu) into a ‘short-cohort’ study involving repeat testing of child faeces for enteric pathogens. A mid-study exposure assessment documenting infrastructural, behavioural, spatial, climate, environmental and zoonotic factors characterises pathogen exposure pathways in household and neighbourhood settings. These data will be used to inform and validate statistical and agent-based models (ABM) that identify individual or combined intervention strategies for reducing multipathogen transmission between humans, animals and environment in urban Kenya.Ethics and dissemination The protocols for human subjects’ research were approved by Institutional Review Boards at the University of Iowa (ID-202004606) and AMREF Health Africa (ID-ESRC P887/2020), and a national permit was obtained from the Kenya National Commission for Science Technology and Innovation (ID# P/21/8441). The study was registered on Clinicaltrials.gov (Identifier: NCT05322655) and is in pre-results stage. Protocols for research on animals were approved by the University of Iowa Animal Care and Use Committee (ID 0042302)
