An Equality-sensitive Approach to Delivering Socio-economic Rights during Crises: A Focus on Kenya

This chapter discusses how the dire situation of vulnerable groups in Kenya is exacerbated in times of crises, such as the Covid-19 pandemic. Loss of employment, food shortages, and the high cost of living, coupled with the lack of equality-sensitive interventions by the government, have led to a rise in the number of Kenyans living in absolute poverty. This is despite the fact that Kenya's 2010 Constitution contains multiple provisions on the protection of the socio-economic rights of vulnerable groups, with Article 20(5)(b) going even further to require the prioritization of the needs of vulnerable groups when implementing the socio-economic rights in Article 43 of the Constitution, to ensure their widest possible enjoyment. The chapter argues that, as much as Kenya's laws provide the necessary legal framework and impetus for applying equality-sensitive approaches to delivering socio-economic rights and to avoid reinforcing inequality in times of crisis, they are not implemented by those in charge. The challenge, therefore, is the lack of application of actual laws in practice to facilitate the implementation of socio-economic rights to address the adverse effects of crises and their aftermath. In the final analysis, the chapter emphasizes that the needs of the most vulnerable in society should be prioritized when the state is implementing initiatives to respond to crises. This is what is constitutionally mandated in Kenya. To achieve this may mean the enactment of laws to best tackle contempt of court orders and blatant disregard of the law. © The several contributors 2022. All rights reserved.

Differential COVID-19 Vaccination Uptake and Associated Factors among the Slum and Estate Communities in Uganda: A Cross-Sectional Population-Based Survey.

Vaccination against COVID-19 remains one of the ultimate solutions to the ongoing pandemic. This study examined and compared the completion of primary COVID-19 vaccination series and associated factors in the slum and estate communities of Uganda. This was a cross-sectional survey conducted among 1025 slum and estate residents. Logistic regression models were fitted. Of the 1025 participants, 511 were slum residents and 514 were estate residents. Completion of COVID-19 vaccination was 43.8% in the slum community and 39.9% in the estate community (p = 0.03). Having more knowledge about COVID-19 was positively associated with completing COVID-19 vaccination in both communities. Perceived benefits and cues to action also had a positive association, but only among the slum residents. However, perceiving people infected with COVID-19 as having a high death rate, perceived barriers such as serious side effects and long distances, and depressive symptoms had negative associations with vaccine uptake among the slum community, but not in the estate community. Addressing barriers to vaccination, strengthening and utilizing the various cues to action, engagement of religious and cultural leaders, and continued community education and sensitization tailored to the needs of each community are potentially vital strategies in raising vaccination rates. Consideration of socioeconomic impact-alleviation strategies, especially among the urban poor, would also be beneficial.

Livelihood, WASH related hardships and needs assessment of climate migrants: evidence from urban slums in Bangladesh.

Bangladesh, being the world's most climate-vulnerable country, is affected by plenty of climate-related hazards every year, mostly along its south-western coast. As a consequence, many people relocated from these regions' worst-affected neighborhoods to Khulna city, and began to live as slum dwellers. They faced a variety of issues in these informal settlements, particularly regarding water, sanitation, and hygiene (WASH) facilities and livelihood options, but no research has been conducted in Bangladesh. With an emphasis on WASH services and livelihood prospects, this study therefore aimed to provide a comprehensive understanding of the challenges/hardships and needs of climate migrants living in urban slums in both general and COVID-19 contexts. Qualitative methods were applied to collect data from the climate migrants of slums in five wards (3, 12, 17, 21, and 30) of the Khulna City Corporation. Nine focus group discussions and four key informant interviews were conducted to collect the data from primary (community people) and secondary (local government and non-government and community-based organizations officials) stakeholders. The thematic analysis was used to analyze the data. The findings revealed that climate migrants experienced significant water scarcity, insufficient drainage systems, a lack of toilets, tube wells, and bathing facilities, inadequate hygiene management, a lack of core skills required for urban jobs, low payment, and an income shortage. Similarly, sustainable drinking water sources, sanitary toilets with WASH blocks, personal hygiene materials and awareness building, skill development for diverse livelihood opportunities, and income-generating capacity development were their top priorities. Overall, the findings of this study provided a holistic overview of the challenges/hardships and needs of climate migrants in urban slums regarding WASH services and livelihood opportunities. The authorities should intervene and develop policy initiatives to alleviate the hardships and meet the needs of climate migrants.

Unintended socio-economic and health consequences of COVID-19 among slum dwellers in Kampala, Uganda.

BACKGROUND: To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-economic and health consequences due to the COVID-19 pandemic and the mitigation measures among slum dwellers in Kampala to inform the on-going and future pandemic response strategies. METHODS: This was a mixed methods cross-sectional study conducted in Bwaise I and Bwaise III slums of Kawempe division, Kampala Uganda from October to December 2020. We used systematic sampling to randomly select 425 household heads for the face-to-face quantitative interviews. We also conducted six focus group discussions (FGDs) with slum dwellers and used photovoice among eight Community Health Workers (CHWs) to document unintended socio-economic and health consequences. Quantitative data were imported into STATA version 14.0 for analysis, while qualitative data were analysed thematically using NVivo version 12. Modified Poisson regression analysis was conducted to establish factors associated with impact on access to food. RESULTS: Most respondents reported limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); drop in daily income and wages (86.1%; 329/382) and loss of employment (63.1; 125/198). Twenty five percent of the respondents (25.4%; 86/338) reported domestic violence as one of the challenges. Seven themes emerged from the qualitative findings on the impact of COVID-19 including: limited access to food; negative impact on children's rights (child labour and teenage pregnancies) and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services. CONCLUSION: The slum dwellers of Bwaise I and Bwaise III experienced several negative socio-economic and health consequences of COVID-19 and its prevention measures that severely affected their wellbeing. Children experienced severe consequences such as child labour and teenage pregnancies among the girls. Response activities should be contextualised to different settings and protocols to protect the vulnerable groups in the community such as children and women should be developed and mainstreamed in response activities.

Anxiety and Insomnia Among Urban Slum Dwellers in Bangladesh: The Role of COVID-19 and Its Associated Factors.

Background: Although mental health is an important part of health and wellbeing, very little is known about the impact of the COVID-19 pandemic on the mental health of marginalized communities like urban slum dwellers. Our study estimated the prevalence of generalized anxiety disorder and insomnia among the residents of the informal settlements of Dhaka, Bangladesh, during the COVID-19 pandemic. Methods: A cross-sectional phone-based survey was conducted from October to November 2020 among adult residents of five informal settlements of Dhaka city randomly chosen from an existing Urban Health and Demographic Surveillance Systems (UHDSS) run by icddr,b. Data on Generalized Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI) were collected. A multinomial logistic regression was performed to assess the associated factors of anxiety and insomnia. Results: Of the total 586 participants, the prevalence of mild to severe anxiety and insomnia were 53% and 43%, respectively. As per the multinomial regression analysis, participants with mild anxiety were significantly more likely to be older (>50 years) and afraid of COVID-19 infection. Likewise, participants with moderate/severe anxiety were significantly more likely to share less household facilities (e.g., toilet, kitchen, water) (OR: 2.23; 95% CI: 1.31-3.79), to have difficulties in food availability (OR: 2.76; 95% CI: 1.10-6.93), to be afraid of self (OR: 5.27; 95% CI: 2.82-9.88), and to worry about the family members (OR: 2.26; 95% CI: 1.23-4.17) getting infected. Participants with mild insomnia were significantly more likely to share fewer household facilities and be afraid of being infected with COVID-19 infection. Moreover, participants with moderate/severe insomnia were significantly more likely to be female (OR: 1.90; 95% CI: 1.02-3.56), to receive food aid (OR: 0.50; 95% CI: 0.29-0.88), to be afraid of self (OR: 3.85; 95% CI: 1.81-8.19), and to worry about someone like friends or neighbors (OR: 2.45; 95% CI: 1.07-5.58) getting infected with COVID-19. Conclusions: We found elevated prevalence of both anxiety and insomnia among the urban poor of Bangladesh in the context of COVID-19. This indicates the importance of integrating mental health in the mitigation and recovery efforts related to similar crises for the urban poor in the future.

Knowledge, attitudes and practices associated with the COVID-19 among slum dwellers resided in Dhaka City: a Bangladeshi interview-based survey.

BACKGROUND: The emergent COVID-19 has impacted unprecedentedly to all classes of people. Slum-dwellers' knowledge, attitudes and practices (KAP) toward COVID-19 are currently poorly understood. The present study aimed to investigate the KAP toward COVID-19 among slum dwellers resided in Dhaka City, Bangladesh. METHODS: A cross-sectional offline survey was carried out enrolling 406 slum dwellers (53.2% male; mean age = 44.9 years [SD = 12.1]; age range = 18-85 years) between August and September, 2020. The face to face interview was conducted to collect data from six selected slum areas in Dhaka City using convenience sampling. The questionnaire consisted of informed consent along with questions concerning observational checklists, socio-demographics and KAP. RESULTS: A sizeable minority were observed without wearing face masks during the survey periods (18.2%) and a vast portion (97.5%) without any hand protection. The mean scores of KAP were 6.1 ± 2.6 (out of 17), 12.3 ± 1.7 (out of 14) and 9.8 ± 1.6 (out of 12), respectively. Moreover, the KAP were strongly and positively correlated with each other. CONCLUSIONS: The findings revealed that the majority of slum dwellers in Bangladesh have limited knowledge of COVID-19. Poor practices (i.e. face mask and hand protection) were directly observed during the survey. The findings suggest the immediate implementation of health education programs and adequate interventions.