Determinants of health inequalities among adults in Korogocho informal settlement, Nairobi, Kenya
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Date
2014-09-12
Authors
Eboreime-oikeh, Imesidayo Omua
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Abstract
Dearth of actionable evidence of the magnitude, determinants, and mediators of health
inequalities in deprived communities has hampered efforts to eliminate invidious health
inequalities. The objectives of this study, which set out to bridge the knowledge gap,
were to assess the magnitude of health inequalities, identify the determinants of health
inequalities, and determine which material, psychosocial, and behavioral factors mediate
health inequalities in Korogocho, an informal settlement in Nairobi, capital city of
Kenya. Eligible, consenting adults were selected from each of Korogocho informal
settlement's nine villages, for this cross-sectional, field-based study, through multi-stage
mixed cluster sampling. The independent variables comprised demographic, socioeconomic,
and environmental determinants while the mediating variables were material,
psychosocial, and behavioral factors. Differences in the prevalence of the dependent
variables: self-rated health status and self-reported chronic health conditions, were the
indicators of health inequalities. Health inequalities were measured in three dimensions:
health disadvantage, health gap, and social health gradient using prevalence difference,
odds ratio, and concentration curves respectively. Complementary qualitative data were
collected from six focus group discussions and key informant interviews. The study
population comprised 719 adults aged 25 to 59 years, mean age 34.20 ± 8.68 years with
188 (26.1%) males. Ngomongo village respondents had the highest prevalence of poor
self-rated health status (44.3%) while Grogan B village respondents had the highest
prevalence (29.7%) of self-reported chronic health conditions. Compared to Korogocho
informal settlement, Ngomongo village (Odds ratio [OR], 2.22; 95% CI, 1.44 to 3.44; P =
0.0003) and Kisumu Ndogo village (OR, 1.76; 95% CI, 1.06 to 2.93; P = 0.029)
respondents suffered significant health disadvantage. Varying magnitudes of health gaps
and gradients were detected in the villages except in Highridge village where the
magnitude of health inequalities was not statistically significant. Social health gradients
were most marked within Gitathuru and Kisumu Ndogo villages but not across
Korogocho informal settlement. From binary logistic regression, older age (45 to 59
years), female gender, lack of access to health care, and village of residence were the
significant determinants of health inequalities. Significant mediators of health inequalities
were alcohol intake, lack of voluntary physical exercise, having multiple, concurrent
sexual partners, and unprotected sex. Mediators contributed between 10.5% and 14% in
females and between 30.3% and 40.4% in males, to health inequalities. The qualitative
interviewees attributed ill-health mainly, to environmental pollution, poor sanitation, and
poverty. To conclude, despite mass deprivations and concentrated poverty, disaggregated
data showed significant magnitudes of health inequalities within and across some villages
of Korogocho informal settlement. Most of the identified determinants and mediators of
health inequalities were socially constructed and therefore remediable. This study
provides needed policy-relevant evidence, which is based on local priorities and should
help stakeholders to target policies and design interventions such as social protection,
gender mainstreaming, environmental regeneration, and health promotion to eliminate
health inequalities and hence leverage aggregate population health. Future large scale,
longitudinal studies that incorporate life-courses perspectives are recommended to further
validate the findings of this study in other deprived communities in Africa and globally.
Description
Department of Community Health, 286p. 2014, RA 418.3 .K4E2