Nairobi Urban HDSS, Kenya

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Brief Description

Nairobi, which is the capital city of Kenya, is a typical sub-Saharan Africaurban centre, characterized by population explosion amidstgrowing and chronic urban poverty and declining livelihood opportunities in the city. In the past 50 years, the population of Nairobi grew almosttwelve-fold, from around 293,000 inhabitants in 1960 to about 3.4 million in 2010. Yet, over the years, little has changedby way of infrastructure development, which led to the majority of residents—currently estimated at 60 to 70 per cent of the city’s population—to live in informal settlementsor slum like conditions.Evidence from the first ever Cross-Sectional Slum Survey conducted in Nairobi (NCSS) by APHRC in 2000 revealed that slum residents have the worst health outcomes of any group in Kenya (including rural residents); they have limited access to basic facilities such as water and sanitation, or opportunitiesfor life such as education and employment, and that they endure the complete absence of the public sector and law enforcement agencies in their daily lives. These conditions not only expose slum residents to poor health outcomes but also foster violence and social unrest, which ultimately can easily spread beyond a single neighborhood to endanger most residents of the city.

It was against this background that APHRC established the Nairobi Urban Health Demographic Surveillance System (NUHDSS) – the first urban-based surveillance system in Africa –in 2002 in two slums communities (Korogocho and Viwandani) in Nairobi city. The main goal of NUHDSS was to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor in sub-Saharan Africa. The surveillance involves visits to all households in the study sites three times a year and continuously updating information on pregnancy and pregnancy outcomes, births, migration, episodes of morbidity, health-seeking behavior,mortality and causes of death. The surveillance system also collects data on livelihood sources, vaccination status for under fives, marital status, and school attendance, but only on annual basis.Currently we are following over 67,000 individuals, residing in over 22,000 households.

In the past eight years, a number of innovative research activities nested on the NUHDSS have placed issues related to reproductive and general heath conditions, access to educationamong the urban poor and the associated inequities in both the policy and program agenda of African governments, international organizations and non-governmental stakeholders. For example, in 2009, APHRC’s NUHDSS-nested a research on free primary education that led to the refinement of Kenya’s Free Primary Education (FPE) program. Specifically, it led to the inclusion of poor informal schools in the FPE capitation. Other NUHDSS-nested studies that continue to inform government and NGO agenda include the Menstrual Cups Study, NCDs, and the Nairobi Urban Health and Poverty Partnership (NUHPP).

The NUHDSS is a member of the INDEPTH Network.

Completed Key Projects as of June 2011

Project Name Funder Grant Period

Nairobi Urban Health Equity Gauge Rockefeller Foundation

2001 - 2003

Exploration of the Impact of HIV/AIDS on the Family and Economic Situation of the Elderly in Poor Urban Areas

National Institute for Aging through the University of Colorado

2002 - 2004

Migration Dynamics in Urban Slum Settlements

Andrew W. Mellon Foundation

2002 - 2004

Refining the Evidence base for program and policies on child health, food security and education among

Rockefeller Foundation

2004 - 2005

the urban poor in sub-Saharan Africa

Strengthening intellectual foundations for research on sexuality and education in sub-Saharan Africa

Ford Foundation 2004 - 2006

Identifying and Targeting the Poor for Waivers of Service Fees at District Hospitals in Kenya

World Bank 2005 - 2006

Adolescent Safe Motherhood WHO 2002 - 2003

The social, economic and health context of HIV/AIDS in informal urban settlements of Africa

Rockefeller Foundation

2005 - 2008

Assessing Comprehensive Care program for people living with HIV/AIDS in two Nairobi slums

Rockefeller Foundation

Aug 2005 - Jul 2006

Averting preventable maternal mortality: Delays and barriers to the utilization of emergency obstetric care in urban poor areas of Nairobi city, Kenya

World Bank 2005 - 2006

Addressing the health of children in urban poor areas through improved home-based care, personal hygiene and environmental sanitation, and healthcare services

EU 2005 - 2006

Assessing circumstances and reasons associated with primary school enrolment, retention, dropout, and progression among slum and non-slum residents in Nairobi

William and Flora Hewlett Foundation

2004 - 2007

Assessing different types of programs and targeting methods for interventions addressing orphans and vulnerable children: A case study using household data from Nairobi slums

The Rockefeller Foundation through the Small Grants Program of the World Bank

2006 - 2008

Study on Global Ageing and Adult Health

WHO/INDEPTH 2006 - 2007

Migration dynamics and social economic status in rural and urban

University of the Jun 2006 - Nov 2007

informal settlements in Africa Witwatersrand

Verbal Autopsy Symptom level data coding for determining cause of death

INDEPTH Network 2009

Unwanted Pregnancy IPAS Jul 2009 - Jul 2010

Realizing rights: Improving sexual and reproductive health for poor and vulnerable populations

UK Government’s Department for International Development (DFID)

2005 - 2010

Build partnerships beyond the health sector to address urban health vulnerabilities in the slums of Nairobi, Kenya

Rockefeller Foundation

Oct 2008- July 2010

Urbanization, poverty and health dynamics in sub-Saharan Africa

Wellcome Trust Jan 2006 -Dec 2010

Spatial analysis of contraceptive use in Kenya

University of North Carolina

Apr 2010 - Dec 2010

UN Habitat – Health Promoting Schools project

United Nations Bodies

Nov 2009 - Oct 2010

Toilet construction pilot project in Viwandani

World Toilet Association

Jan 2008 - Apr 2009

Ongoing Key Projects

Project Name Funder Grant Period

Expanded Education Research Program Hewlett Foundation Mar 2008-Dec 2011

Indicator development for surveillance of urban emergencies

OFDA October 2010 –September 2011

Assessment of the linkages between socioeconomic status, perceived personal risk, and risk factors for cardiovascular and related non-communicable diseases in a population of slum dwellers in Nairobi, Kenya

Wellcome Trust Jan 2008 – Dec 2010

Improving the lives of diabetics in Nairobi’s slums through access to

World Diabetes Foundation

Mar 2009 – Feb 2012

quality health care

Fertility, FP, Child Health and Survival and Economic Outcomes

INDEPTH Network May 2010-July 2011

Using DSS data to collect and report on HIV/AIDS related mortality: Verbal Autopsy

USAID Nov 2008 - Oct 2011

Masculinities and sexuality project Ford Foundation 2009-2011

Funders

Over the years, funding for the NUHDSS came from various organizations including the Rockefeller Foundation, USA, the Wellcome Trust, UK, and the William and Flora Hewlett Foundation, USA, but currently the surveillance work is fully funded by the Centre itself. Work on nested studies were supported by the following organizations: Wellcome Trust; Rockefeller Foundation; William and Flora Hewlett Foundation; European Commission; Ford Foundation; Department for International Development (DFID), UK; Government of Kenya; World Health Organization (WHO); Bill and Melinda Gates Foundation; Doris Duke Charitable Foundation; Ford Foundation; Global Fund; Google.Org; International Union of the Scientific Study of Population (IUSSP);Packard Foundation; International Development Research Centre (IDRC);USAID;World Diabetes Foundation; World Toilet Association;IPAS; National Institute of Health;Packard Foundation; Carnegie Corporation;International Conference on Urban Health (ICUH); INDEPTH Network;Institute of Development Studies (IDS), Sussex, UK; Institute of International Education (IIE);International Planned Parenthood Federation (IPPF);MacArthur Foundation; National Institute of Drug Abuse (NIDA); and the United Nations bodies.

Collaborators

The following institutions have collaborated (or continue to collaborate) with staff working on the NUDHSS or studies nested with in NUDHSS: London School of Hygiene and Tropical Medicine; Jhpiego; London School of Economics (LSE); City Council of Nairobi; Guttmacher Institute, New York; University of Southampton, UK; African Development Bank (ADB); Agincourt Health and Population Unit, SA;Canadian Coalition for Global Health Research;EU; Finnish Embassy in Nairobi; Government of Kenya; Ifakara Health Institute, Tanzania; Kenya Medical Research Institute (KEMRI); National Coordinating Agency for Population and Development (NCAPD), Kenya; Panos London; Swiss Tropical Institute, Switzerland; the UN bodies;Macro International; University of Colorado, USA; Concern Worldwide; Population Council; AMREF-Kenya; London School of Hygiene and Tropical Medicine (LSHTM); University of Loughborough, UK.

Key 2010 Publications

1. Beguy D, Bocquier P, Zulu E. Circular Migration patterns and determinants in Nairobi slum settlements, Demographic Research, 23 (20), 549-586.

2. Beguy D., C. Kabiru, E. Zulu, A. Ezeh. Timing and sequencing of events marking the transition to adulthood in two informal settlements in Nairobi, Kenya. Journal of Urban Health.

3. Bocquier P.H., Beguy D, Zulu E, Muindi K, Yé, Y. Do migrant children face greater health hazard in slum settlements? Evidence from Nairobi, Kenya, Journal of Urban Health.

4. Clark, S. Kabiru, C.W., R. Mathur (2010). Relationship Transitions among Youth in Urban Kenya, Journal of Marriage and Family, 72 (1), 73-88

5. Essendi, H., S. Mills, Fotso, J.C. Barriers to Formal Emergency Obstetric care Services' Utilization. Journal of Urban Health.

6. Ezeh, A., I. Kodzi, J. Emina. Reaching the Urban Poor with Family Planning Services, Studies in Family Planning, 41: 109–116

7. Ezeh, A., Izugbara, C, Kabiru, C.W., Fonn, S., Kahn, K., Manderson, L., Undieh A.S., Omigbodun, A., Thorogood M. Building capacity for public and population health research in Africa: the consortium for advanced research training in Africa (CARTA) model, Global Health Action.

8. Faye, O. (2010). Basic Pensions and Poverty Reduction in sub-Saharan Africa. The WDA-HSG Discussion Paper Series on Demographic Issues, 2010/2

9. Izugbara, C and Ngilangwa, D. (2011) Women, poverty, and adverse maternal outcomes in Nairobi, Kenya. Women and HealthBMC Women’s Health 2010, 10:33

10. Kabiru, C.W., D. Beguy, C. Undie, E. Zulu and A. Ezeh. Transition into first sex among adolescents in slum and non-slum communities in Nairobi, Kenya, Journal of Youth Studies, 13(4), 453-471

11. Kabiru, C.W., N. Luke, C. Izugbara, E. Zulu. The Correlates of HIV Testing and Impacts on Sexual behavior: Evidence From a Life History Study of Young People in Kisumu, Kenya, BMC Public Health, 10:412

12. Kimani-Murage, E.W., P. Holding, J. Fotso, A. Ezeh, N. Madise, E. Kahurani, E. Zulu. Food Security and Nutritional Outcomes among Urban Poor Orphans in Nairobi, Kenya. Journal of Urban Health.

13. Kodzi I.A., Gyimah S.O., Emina J., Ezeh, A.C. Religious involvement, social engagement and subjective health status of older residents of informal neighborhoods of Nairobi. Journal of Urban Health.

14. Kowal P, Kahn K, Ng N, Naidoo N, Abdullah S, Bawah A, Binka F, Chuc NT, Debpuur C, Ezeh A, Xavier Gómez-Olivé F, Hakimi M, Hirve S, Hodgson A, Juvekar S, Kyobutungi C, Menken J, Van Minh H, Mwanyangala MA, Razzaque A, Sankoh O, Kim Streatfield P, Wall S, Wilopo S, Byass P, Chatterji S, Tollman SM. (2010) Ageing and adult health

status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. Global Health Action. 2010 Sep 27; 3.

15. Kyobutungi C and Ezeh A. (2010) “Chronic disease care in urban informal settlements: Nairobi case study”. In Vlahov D, Boufford, J. I, Pearson C. E, and Norris L (Eds). Urban Health – Global Perspectives

16. Kyobutungi, C, Egondi T and Ezeh A. (2010) the health and wellbeing of older people in Nairobi’s slums. Global Health Action Supplement 2, 2010

17. Mutisya, M., B. Orindi, J. Emina, E. Zulu, Y. Ye.( 2010) Is the Death Rate Among Under-Five Children in Nairobi Slums Seasonal?” Tropical Medicine & International Health. 15: 132–139

18. Ndugwa RP, Cleland J, Madise NJ, Fotso JC, Zulu EM(2010). Menstrual pattern, sexual behaviors and contraceptive use among pospartum women in Nairobi slums. Journal of Urban Health.

19. Ndugwa, R., C. Kabiru, J. Cleland, D. Beguy, T. Egondi, E. Zulu, R. Jessor (2010). Adolescent Problem Behavior in Nairobi’s Informal Settlements: Applying Problem Behavior Theory in sub-Saharan Africa. Journal of Urban Health.

20. Ng N, Kowal P, Kahn K, Naidoo N, Abdullah S, Bawah A, Binka F, Chuc NT, Debpuur C, Egondi T, Xavier Gómez-Olivé F, Hakimi M, Hirve S, Hodgson A, Juvekar S, Kyobutungi C, Van Minh H, Mwanyangala MA, Nathan R, Razzaque A, Sankoh O, Kim Streatfield P, Thorogood M, Wall S, Wilopo S, Byass P, Tollman SM, Chatterji S. (2010) Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO-SAGE Study. Global Health Action. 2010 Sep 27: 3

21. Ngware, M., M. Oketch, A. Ezeh.Quality of Primary Education Inputs in Urban Schools: Evidence from Nairobi. Education and Urban Society2011 vol. 43 no. 1 91-116

22. Oketch M., M. Mutisya, M. Ngware, A. Ezeh (2010). Why Are There Proportionately More Poor Pupils Enrolled in Non-state Schools in Urban Kenya In Spite of FPE Policy? InternationalJournal of Educational Development, 30:23-32.

23. Oketch, M., M. Ngware(2010). Free Primary Education Still Excludes the Poorest of the Poor in Urban Kenya, Development in Practice, 20:4-5

24. Oti, S.O., C. Kyobutungi (2010). “Verbal Autopsy Interpretation: A Comparative Analysis of the InterVA Model versus Physician Review in Determining Causes of Death in the Nairobi DSS”, Population Health Metrics, 8:21

25. Shann, F., H. Nohynek J. Scott, A. Hesseling, K.Flanagan on behalf of the Working Group on The Nonspecific Effects of Vaccines, (2010). “Randomized Trials to Study the Nonspecific Effects of Vaccines in Children in Low-Income Countries”, The Pediatric Infectious Disease Journal, 29:5 (457-461)

Key Previous Publications

1. Ziraba, A. K, S. Mills, N. Madise, T.Saliku, J.C.Fotso(2009). “The State of Emergency

Obstetric Care Services in Nairobi Informal Settlements and Environs”. BMC Health Service Research, 9:46.

2. Bazant, E.S, M.Koenig, J.C.Fotso,S.Mills (2009). “Women’s Use of Private and Government HF for Childbirth”.Studies in Family Planning, 40(1):39-50.

3. Izugbara, C. O, C.Kabiru, E. Zulu (2009). “Urban Poor Kenyan Women and Places of Delivery”. Public Health Reports, 124: 585-589.

4. Izugbara, C. O, A. Ezeh, J.C. Fotso(2008). “The Persistence and Challenges of Homebirths”.Health Policy and Plan, 24: 1-10.

5. Fotso, J.C, A. Ezeh, N. Madise, J. Ciera(2007). “Progress towards the Child Mortality Millennium Development Goal in Urban sub-Saharan Africa”.BMC Pub Health, 7:218.

6. Fotso, J.C, A. Ezeh, H. Essendi(2009). “Maternal Health in Resource-poor Urban Settings: How Does Women’s Autonomy Influence Utilization of Obstetric Care Services?”Reproductive Health 2009, 6:9.

7. Ziraba, A. K., N. Madise, S. Mills, C. Kyobutungi, A. Ezeh(2009). “Maternal Mortality in the Informal Settlements of Nairobi City: What do we Know?”Reproductive Health Journal, 6:6.

8. Fotso, J.C., A. Ezeh, N. Madise, A. Ziraba, R. Ogollah (2009). “What Does Access to Maternal Care Mean Among the Urban Poor? Factors Associated with Use of Appropriate Maternal Health Services in the Slum Settlements of Nairobi, Kenya”.Maternal and Child Health Journal. 13 (1) 2009, pp. 130-137.

9. Fotso, J.C., A. Ezeh, R. Oronje(2008). “Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?”Journal of Urban Health, 85 (2) 2008 pp. 428-442.

10. Beguy, D., C. Kabiru, E. Nderu and M. Ngware(2009). “Inconsistencies in Self-reporting of Sexual Activity among the Young People in Nairobi, Kenya”.Journal of Adolescent Health,45(6), 595-601.

11. Mudege N. N., E. Zulu, C.Izugbara(2008). “How Insecurity Impacts on School Attendance and School Dropout among Urban Slum Children in Nairobi”.International Journal of Conflict and Violence 2008(1), pp. 98-112.

12. Mudege, N. N., A. Ezeh(Winter 2009). “Gender, Aging, Poverty and Health: Survival Strategies of Older Men and Women in Nairobi Slums”.Journal of Aging Studies, Vol. 23 (4).

13. Kyobutungi, C, A. Ezeh, E. Zulu, J. Falkingham (May 2009). “HIV/AIDS and the Health of Older People in the Slums of Nairobi: Results from a Cross Sectional Survey.”BMC Public Health, 9:153.

14. Chepng’eno, G., A. Ezeh(2007).“Between a Rock and a Hard Place: Perception of Older People Living in Nairobi City on Return Migration to Rural Areas”. Global Ageing: Issues & Action, 4(3): 67-78.

15. Ye, Y, N. Madise, R. Ndugwa, S. Ochola, R. W. Snow (July 2009). “Fever Treatment in the Absence of Malaria Transmission in an Urban Informal Settlement in Nairobi, Kenya.” Malaria Journal, 8:160.

16. Kyobutungi, C., A. K. Ziraba, A. Ezeh, Y.Ye (2008). “The Burden of Disease Profile of Residents of Nairobi’s Slums: Results from a Demographic Surveillance System”. Population Health Metrics 2008, 6: 1.

17. Ye, Y., E. Kimani-Murage, J. Kebaso, F. Mugisha (2007). “Assessing the Risk of Self-Diagnosis Malaria in Urban Informal Settlements of Nairobi using Self-Reported Morbidity Survey”,Malaria Journal, 2007 6:71.

18. Undie, C., J. John-Langba, E. Kimani(Spring 2006). “The Place of Cool Waters: Women and Water in the Slums of Nairobi, Kenya”.Wagadu: A Journal of Transnational Women’s and Gender Studies, 3.

Policy Briefs

1. Assessing the impact of the Health Promoting Schools initiative in Nairobi’s informal settlements No: 24, 2010

2. Creating Healthy Schools. Implementing a Health Promoting Schools initiative in Nairobi’s informal settlements No: 23, 2010

3. Use of menstrual cup by adolescent girls and women. Potential benefits and key challenges No: 22, 2010

4. Attitudes towards and acceptability of, menstrual cups as a method for managing menstruation. Experiences of women and schoolgirls in Nairobi, Kenya No: 21, 2010

5. Experiences and problems with menstruation among poor women and schoolgirls in Nairobi, Kenya No: 20, 2010

6. Does Free Primary Education Policy Affect Overage Enrolment? Evidence from Urban Kenya. No: 19, 2010

7. Improving Mathematics Performance in Kenya: How Better Teacher Subject Knowledge Contributes to Academic Attainment. No: 18, 2010

8. Low and High Performing Schools in Kenya: Do Teaching Styles Make a Difference? No: 17, 2010

9. Social Capital and Academic Achievement in Kenya: Better School Performance through Improved Relations between Students, Teachers and Parents. No: 16, 2010

10. Civil Society Organizations in Informal Settlements and their Capacity to Deliver Services. No: 15, 2010

11. The Maternal Health Challenge in Poor Urban Communities in Kenya. No: 12, 2009

12. Protecting In-School Adolescents from HIV/AIDS, STIs and Unwanted Pregnancy: Evidence-based Lessons for Programs and Policy. No: 11, 2009

13. Attendance, Attitude towards Schooling, and Grade for Age in the Slums of Nairobi: Does Orphan Type matter more than Orphanhood? No: 10, 2009

14. Factors associated with Low Achievement among Students in Nairobi’s Informal Neighborhoods. November 2008

15. Determining Appropriate Entry Point for Health Promoting Schools Intervention in Nairobi’s Informal Settlements. November 2008

16. Factors Affecting Transition to Secondary Education in Africa. November 2008

17. Do Household Characteristics matter in Schooling Decisions in Urban Kenya? November 2008

18. Pupil School Mobility in Urban Kenya. November 2008

19. What Quality of Primary Education are Children in Urban Schools Receiving? Evidence from Nairobi. November 2008

20. Why are there Proportionately more Poor Pupils Enrolled in Non-State Schools in Urban Kenya in spite of FPE Policy? November 2008

21. The burden of Disease among Residents of Nairobi’s Informal Settlements. April 2008

22. African countries must slow population growth to realize meaningful development. September 2008

23. Inventory of Interventions to enhance Transition from Primary to Secondary School for Children Living in Poor Urban Settings. November 2007

24. Strategies for Universalizing Primary Education in sub-Saharan Africa. November 2007

25. The Missing 10%: HIV/AIDS and Primary Education in sub-Saharan Africa. November 2007

Nairobi urban HDSS holds medical camps in Korogocho and Viwandani– the Centre’s sites in Nairobi providing free health services to the residents of these informal settlements in Nairobi.

Nairobi urban HDSS engages with policy makers from Nigeria and Kenya during a health conference organised by the centre