Household air pollution in Nairobi's slums: A long-term policy evaluation using participatory system dynamics.

58% of Nairobi's population live in informal settlements in extremely poor conditions. Household air pollution is one of the leading causes of premature death and disease in these settlements. Regulatory frameworks and government budgets for household air pollution do not exist and humanitarian organisations remain largely inattentive and inactive on this issue. The purpose of this paper is to evaluate the effectiveness of potential indoor-air related policies, as identified together with various stakeholders, in lowering household air pollution in Nairobi's slums. Applying a novel approach in this context, we used participatory system dynamics within a series of stakeholder workshops in Nairobi, to map and model the complex dynamics surrounding household air pollution and draw up possible policy options. Workshop participants included community members, local and national policy-makers, representatives from parastatals, NGOs and academics. Simulation modelling demonstrates that under business-as-usual, the current trend of slowly improving indoor air quality will soon come to a halt. If we aim to continue to substantially reduce household PM2.5 levels, a drastic acceleration in the uptake of clean stoves is needed. We identified the potentially high impact of redirecting investment towards household air quality monitoring and health impact assessment studies, therefore raising the public's and the government's awareness and concern about this issue and its health consequences. Such investments, due to their self-reinforcing nature, can entail high returns on investment, but are likely to give 'worse-before-better' results due to the time lags involved. We also discuss the usefulness of the participatory process within similar multi-stakeholder contexts. With important implications for such settings this work advances our understanding of the efficacy of high-level policy options for reducing household air pollution. It makes a case for the usefulness of participatory system dynamics for such complex, multi-stakeholder, environmental issues.

Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study.

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.

Vulnerability to food insecurity in urban slums: experiences from Nairobi, Kenya.

Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.

Polygyny and reproductive behavior in sub-Saharan Africa: a contextual analysis.

In this paper I examine the effect of polygyny on aggregate reproductive behavior. I argue that within countries there exist different polygyny regimes, each exhibiting a unique reproductive pattern. Using the 1988/1989 Kenya Demographic and Health Survey (KDHS1) data, I identify three distinct regimes: low-polygyny, mid-polygyny, and high-polygyny regimes. The results of the bivariate and multivariate analyses reveal strong differences in reproductive preferences and behaviors across polygyny regimes. High-polygyny regimes, for instance, maintain a value orientation that favors and encourages high reproductive performance. The force of this pronatalism operates equally for men and women; but whereas men in this regime attain their reproductive goals by marrying multiple wives, women attain theirs by maximizing their reproductive capabilities. This maximization occurs through early initiation of sexual/reproductive activity, universal marriage and minimal interruption of marriage, nonuse of contraception within a union, and a positive attitude toward high fertility.

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.

Reproductive preferences and behaviour: how men and women compare.

PIP: Data from the Demographic and Health Surveys completed by 1993 were analyzed to compare the ideal family size, desire for another child, and contraceptive attitudes, use, and intentions among currently married men with those expressed by currently married women. Monogamous men reported mean ideal family size of 4 or fewer children in Kenya, Rwanda, North Africa, and Asia. Tanzania reported 7.4, while the rest of east Africa reported fewer than 6. Ideal sizes in west Africa ranged from 8 in Burkina Faso to 13 in Niger. Polygynous men reported much higher family sizes. In Bangladesh and Burundi, men and women had the same ideal size. In Rwanda, women wanted 0.1 more children, and in all other countries the preferences of men exceeded those of women (in most cases by less than 0.2). Desire for another child was consistent with the findings on ideal family size, and contraceptive approval among men was very high, ranging from less than 65% in most west African countries to 90-97% in other African countries and Ghana. Women were more likely to approve of contraception, but only small differences in approval rates were found, except in Mali, where women approved 3 times as often as men, and Pakistan, where 10% more men than women approved. Men generally reported greater use of contraception than women, and current use was lowest in countries where most men had unfavorable attitudes towards family planning (FP). Women were more likely to express intention to use a method than were men except in Burundi, Niger, and Malawi. These data indicate that men's reproductive preferences and desires in Pakistan, Tanzania, and all of west Africa except Ghana may constitute a challenge to FP program success.^ieng

The influence of spouses over each other's contraceptive attitudes in Ghana.

To what extent do spouses influence each other's reproductive goals? This question was investigated in Ghana with particular reference to family planning attitudes. Two mechanisms were identified as plausible explanations for why an individual's characteristics may affect a partner's beliefs and behavior. Quantitative evidence from the Ghana Demographic and Health Survey and qualitative information from focus-group research in Ghana were used in the analysis. Results from both data sources show that spousal influence, rather than being mutual or reciprocal, is an exclusive right exercised only by the husband. The study attributed the limited impact of family planning programs in Ghana and most of sub-Saharan Africa to the continued neglect of men as equal targets of such programs.

PIP: Quantitative information from 1010 matched husband-wife pairs derived from Ghana Demographic and Health Survey (DHS) data collected in 1988 and qualitative information from focus group research in Ghana were used in the analysis. 2 possible mechanisms that might affect a spouse's beliefs and/or behavior include the selection effect and the dominance effect. These 2 effects together comprise the spousal influence effect, which measures the extent to which an individual influences a spouse's reproductive attitudes. The distribution in the Ghana DHS of the individual variables for husbands and wives that were used in the regression analysis indicated that 60% of the men had some form of formal education, but only about 43% of their wives had gone to school. Among 54% of couples, both spouses approved of family planning (FP) and 21% disapproved of it. 49% of uneducated and 54% of educated wives of uneducated men, respectively, approved of FP. For husbands with primary education, this proportion rose to 62 and 82% for uneducated and educate wives. The net of the effects of education or being married to a man who wanted no more children increased a woman's odds of contraceptive approval by as much as 80%. For uneducated wives, the probability of contraceptive approval for those married to uneducated husbands was 0.48, compared with 0.65 for those married to husbands with only primary education. The corresponding probability for educated wives was 0.69 and 0.82, respectively. The probability of contraceptive approval among men with secondary or higher education increased from 0.84, if their wives were uneducated, to 0.88, if their wives had some formal education. Results from both data sources showed that spousal influence, rather than being mutual or reciprocal, was an exclusive right exercised only by the husband. The limited impact of FP programs in Ghana and most of sub-Saharan Africa was attributable to the continued neglect of men as equal targets of such programs.

Serological and cultural examination for human leptospirosis in Plateau State, Nigeria.

In a serological examination of 710 serum samples collected from human volunteers in Plateau State, Nigeria, 128 (18.0pc) had leptospiral antibody titres of 1:100 and above. The prevalence of antibodies to individual serovars were: hardjo 28 (21.9pc), pomona 18 (14.1pc), canicola 17 (13.3pc), grippotyphosa 15 (11.7pc), pyrogenes 13 (10.2pc), icterohaemorrhagiae 12 (0.4pc) and autumnalis 8 (6.3pc). There was no statistical difference in the prevalence rate of leptospirosis in the different local government areas (p greater than 0.05; X2). Among the occupational groups examined, the abattoir workers were particularly at risk with a prevalence rate of 29.5pc. A leptospiral variant of strain Hardjoprajitno was also isolated from the midstream urine of an abattoir worker who was apparently healthy. The isolation of Leptospira interrogans serovar hardjo in man is the first such report in Nigeria.

A new leptospiral serovar in the Pyrogenes serogroup isolated in Nigeria.

Five leptospiral strains were isolated from bovine kidneys during a cultural survey for pathogenic leptospires in Nigeria. Preliminary test results indicated that the five strains were identical and serologically heterologous to the other members of the Pyrogenes serogroup. Further examination of the strains by the cross-agglutinin absorption test, factor analysis and restriction endonuclease analysis confirmed that the strains constitute a new serovar. It is therefore proposed that this strain be recognised and designated as serovar nigeria, type strain Vom.

Serological prevalence of bovine leptospirosis in Plateau State, Nigeria.

Serum samples obtained from 1.537 cattle in the 14 local government areas (LGAs) of Plateau State of Nigeria were screened for the presence of leptospiral antibodies using 13 serovars in a modified microscopic agglutination test (MAT). Two hundred and twenty-two (14.4 p.100) of the cattle tested had leptospiral antibody titres of 1:100 or higher to one or more of the test antigens. The prevalence rates of antibodies to individual serovars were: hardjo (35.6 p.100), pomona (11.7 p.100), pyrogenes (11.7 p.100), canicola (9.5 p.100), grippotyphosa (7.7 p.100), bratislava (5.9 p.100), icterohaemorrhagiae (5.9 p.100), ballum (4.5 p.100), autumnalis (3.6 p.100), bataviae (2.3 p.100) and tarassovi (1.8 p.100). The serological prevalence of bovine leptospirosis in the various local government areas of Plateau State of Nigeria differed significantly (P less than 0.05; X2).

Humoral antibody response to glutaraldehyde-treated antigens of Dermatophilus congolensis.

Glutaraldehyde-treated whole cell antigens (GA.WcA) of Dermatophilus congolensis induced in guinea pigs immunological memory in contrast to cell wall antigens treated similarly (GA.CwA). However, GA.WcA could not induce a secondary response in animals primed with untreated WcA while GA.CwA on the other hand did stimulate a secondary response in animals primed with untreated CwA. Primary antibody production was induced by both GA.CwA and untreated CwA to a similar level in their respective hosts but it was the secondary response that was found similar in response to GA.WcA and untreated WcA. However, both untreated WcA and CwA induced primary and secondary antibody production in their respective hosts though these responses were considerably higher in guinea pigs given untreated CwA. This study showed that both untreated and GA-treated antigens of D. congolensis are capable of stimulating antibody production in guinea pigs but they differ in their levels of stimulation.

Prevalence of antibodies to Dermatophilus congolensis in sheep and goats in Nigeria.

A serological survey on dermatophilosis was carried out amongst sheep and goats in Kaduna State of Nigeria. Sera were obtained from slaughter animals and from sheep kept on an isolated ranch. The percentage of seropositive animals was 28.0 in slaughter sheep, 0.0 in sheep kept on the ranch, and 23.2 in slaughter goats. The high prevalence of D. congolensis antibodies among small ruminants compares well with the level of prevalence reported of cattle of cattle and calls for a concerted government effort for the control of the disease.