Academic journal article Journal of Health Population and Nutrition

Healthcare-Use for Major Infectious Disease Syndromes in an Informal Settlement in Nairobi, Kenya

Academic journal article Journal of Health Population and Nutrition

Healthcare-Use for Major Infectious Disease Syndromes in an Informal Settlement in Nairobi, Kenya

Article excerpt


During 1950-2008, the proportion of the world's population living within cities grew from 33% to 50% (1). The number of cities with >10 million people grew from 3 to 20 over the past 30 years; 15 of these 'megacities' were in the developing world (1). The urban population in sub-Saharan Africa is expected to triple between 2010 and 2050 to >1.2 billion people (2). This process of massive urbanization has been ongoing in many developing countries, including in sub-Saharan Africa where urbanization rates, often linked to extreme poverty (3), are the highest in the world (4). Perceived opportunities for improving the family status and for education have led many people to leave rural settings in favour of urban living environments which can be more challenging and less familiar (5). Since urban areas often cannot address the demands of an expanding population with strengthened infrastructure, the new residences are frequently seen within informal settlements, often referred to as slums, where the density of population is high, and sanitation, availability of clean water, and health services are low (5).

Due to various adverse conditions prevalent in informal settlements, transmission of pathogens that cause infectious diseases may be facilitated, resulting in life-threatening syndromes, such as severe pneumonia, diarrhoeal disease, and febrile illnesses. To identify the emerging pathogens, characterize their epidemiology and the burden of disease, and assist in identifying priorities for the prevention of diseases, the International Emerging Infections Program (IEIP) of the Centers for Disease Control and Prevention (CDC), in collaboration with the Kenya Medical Research Centre (KEMRI), established a surveillance for key infectious disease syndromes and their aetiologies. This surveillance takes place in two villages--both within Kibera, an informal settlement, representing one of the largest contiguous slums in sub-Saharan Africa (6). The area is characterized by high density of population, poor sanitary conditions, and limited access to safe water (7).

Healthcare-use patterns determine whether a clinic- or hospital-based surveillance is adequate to define the incidence of diseases or whether more active approaches, such as periodic home-visits, are needed to identify a substantial proportion of illnesses. To better understand the healthcare-seeking patterns of the population under surveillance, we carried out a healthcare-use survey (HUS) within the Kibera surveillance area. Such studies can help interpret data from disease-surveillance systems, especially among people for whom delivery and quality of health services are poor (8). They provide baseline information about syndromes of substantial morbidity and mortality and can yield a method to extrapolate the burden of disease using the proportion of illnesses missed when surveillance is dependent upon attendance at a health facility. Such data improve precision in estimates of disease-incidence rates when relying on clinic-based surveillance. We set out to estimate the proportion of people with pneumonia, diarrhoea, or febrile illness symptoms, who seek care inside and outside the Kibera informal settlement and to define the places where care is sought. We also sought to characterize factors associated with specific healthcare-seeking behaviours and to identify key barriers to accessing care.


Study site

The HUS and a census, used for defining the HUS study area, were conducted in July 2005 within Gatwikira and Soweto villages of Kibera (located in Nairobi, Kenya) before the population-based surveillance for infectious disease syndromes was initiated by the KEMRI/CDC in November 2005. Tabitha Clinic, managed by a collaborating partner--Carolina for Kibera--is the field/referral clinic for the surveillance project and is located in the centre of the surveillance area; the area of the surveillance villages is 0. …

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