Estimating burden of diarrhoea associated with water, sanitation and hygiene among the under fives in residential environs of Nairobi, Kenya
Nyangetiria, Akunga Daniel
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This study aimed to quantify the burden of childhood diarrhoea morbidity and mortality of the under five children in Nairobi city using household data and hospital records. The main objective of this study was to estimate the diarrhoea disease burden of children aged less than five years associated with Water, sanitation and hygiene in Nairobi using available mortality and morbidity information. The study used a crosssectional, non interventional approach. For estimating childhood diarrhoea disease burden, the study area was categorized into four exposure residential environs with differentiated by WASH and SES characteristics. The delineation gave four residential environs namely ISLI, HDLI, MDHI and LDHI. The parameters considered included access to improved water and sanitation and diarrhoea (case fatality, incidence rate, incidence duration, and prevalence) so as to calculate DALYs. Also household hygiene knowledge and practice were assessed, sanitary inspections conducted and water samples collected that were analysed for total and faecal coliform counts, turbidity, and conductivity. Data obtained were subjected to relevant statistical tools including descriptive statistics, relative risk estimates, regression analysis, and multivariate methods. The results of the study show ISLI and HDLI environs were receiving significantly low and unreliable amounts of water (<201cd/person/day) as well as inadequate sanitary facilities. The results also revealed that the microbiological quality of water in ISLI and HDLI residential environs was generally poor due to poor water handling practices and poor sanitary conditions within the surroundings. Overall, household water storage showed a significantly higher contamination (33.2%) than household tap water supplies (4.7%). These factors influenced a high childhood diarrhoea burden observed in this study. For diarrhoea the study identified a distinct pattern of childhood morbidity. The annual Disability adjusted life years for children under the age of five years in Nairobi study area were approximately 106DALYs/1000 person years (ISLI=223; HDLI=98; MDHI=56 and LDHI--47). This means that children loose approximately 10% of their quality life to diarrhoea with ISLI and HDLI losing 22.3% and 9.8% respectively compared to 5.65 and 4.7% for MDHI and LDHI respectively. The diarrhoea patterns observed emphasized the role of socioeconomic, educational, water supply and sanitation factors on diarrhoea morbidity and mortality in the Nairobi study area. Some of the most important factors that contributed to diarrhoea morbidity were parental education (p= ().013), household water consumption rates (p<0.001), household income (p=0.008), rind access to sanitation facilities (p<0.001). The optimal WASH and SES conditions in this study were for MDHI. There is need therefore to improve children's living conditions to match the MDHI residential environs for children's diarrhoea and Health outcomes to be significantly reduced. To this end, multi-stakeholder involvement and strengthening of the institutional mechanisms responsible for providing water and sanitation will be key to providing improved access to water and sanitation in the city of Nairobi especially in the ISLI and HDLI residential areas of Nairobi. This should be enhanced by legislating mandatory construction of improved ventilated pit latrines, focusing on improving sanitation aspect of water distribution points, and provide health promotion on the significance of household hygiene among others.