Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012

This is a “twelve years after” study of population and health dynamics in Nairobi’s informal settlements. The previous study in 2000 was a groundbreaking survey of households living in informal settlements (which house more than half of Nairobi’s population), with a large enough sample to provide accurate population and health statistics for informal settlements in different districts. Possibly for the first time, there was accurate data on infant and child mortality in informal settlements – and that could be contrasted with the aggregate statistics “for urban populations” produced by conventional demographic and health surveys. The new report provides another such assessment, useful both for what it shows for 2012 and for what has changed since the previous survey.

After an introductory chapter, chapter 2 presents detailed statistics on household characteristics (age, sex, education, amenities and durable goods, duration of stay there, employment, and health and general needs). Chapter 3 reports on fertility while chapter 4 is on fertility regulation (including contraception use), chapter 5 on other proximate determinants of fertility and chapter 6 on fertility preferences.

Chapter 7 is on infant and child mortality, including a consideration of mortality differentials by socioeconomic groups. Chapter 8 is on maternal and child health and includes antenatal care, delivery care and characteristics, child vaccination, and prevalence and treatment of cough, fever and diarrhoea. Chapter 9 is on HIV/AIDs and other sexually transmitted diseases with chapter 10 on young people’s socioeconomic status and sexual and reproductive behaviours. Appendices give details on the research design and implementation.

In regard to the primary concerns of those interviewed, concern about unemployment was much less in 2012 compared to 2000 (even though employment opportunities had not increased) but with more concerns about water, sanitation drainage and security. Lack of water, of toilets and of garbage/sewer disposal were among the most important general needs and health concerns raised by respondents for most of the eight administrative divisions.

Between 2000 and 2012, infant mortality declined from 88.2 to 39.2/1000 live births with under-five mortality rates dropping from 136.4 to 79.8. Urban poor children remain disadvantaged when compared to Nairobi as a whole, although the gap between them narrowed. It is also interesting to note the differences in under-five mortality rates between the different districts – from 42.4 to 100.5. The declines in infant and under-five mortality rates can be attributed to a number of factors including the increase in health facility deliveries, improved immunization coverage, improved household access to sanitation and increased access to treatment for child fevers.

Overall, there is a general improvement in access to water, electricity and sanitary facilities among households. However, disparities when compared to non-slum areas in Nairobi have remained. The proportion of households with electricity in slums improved slightly from 17.8 per cent in 2000 to 19.5 per cent in 2012 but this is much lower than in the rest of Nairobi (88.6 per cent in 2008–09). The proportion of households with piped water increased from 21.7 to 27.6 per cent; this remained much lower than for the rest of Nairobi. The proportion of households buying water declined markedly while the proportion using public taps increased. Households using flush toilets increased from 7.3 per cent in 2000 to 46.2 per cent in 2012 but this is far below the 82.0 per cent of households in the rest of Nairobi who use flush toilets. A lack of water to keep toilets clean, the sharing of toilets by many households, and the increasing concern relating to poor drainage may negate any potential health gains from the use of flush toilets.

The use of traditional pit latrines decreased from 78.8 per cent to 44.0 per cent between the two surveys. The quality of housing construction material improved, with a decrease in household structures with mud floors from 30.6 per cent to 15.1 per cent, and an increase in household structures with cemented floors from 69.0 per cent to 79.2 per cent.

The improvement in infant and child survival between 2000 and 2012 was associated with almost all mothers obtaining antenatal care from a health professional and 81 per cent of deliveries being in health facilities. But children born in slums had birth weights that were lower than the average for Kenya and immunization coverage was low.

There were improvements in key malaria indicators, including ownership and use of treated mosquito nets, preventive treatment of malaria during pregnancy, and treatment of childhood fever. The percentage of children under three with watery diarrhoea and diarrhoea with blood in the two weeks preceding the survey were both lower than in 2000: 20.2 compared to 30.8 for diarrhoea and 7.0 compared to 11.3 for diarrhoea with blood. But there was also quite lot of variation between divisions. The prevalence of diarrhoea with blood in the slums was much higher than for Nairobi and the country as a whole.

The report can be downloaded from http://aphrc.org/wp-content/uploads/2014/08/NCSS2-FINAL-Report.pdf