角井信弘

73

特集：合同臨地訓練
Diarrhoea prevelence and risk factors in slums
Kung’u WN1), Musau PM2), Ochieng A3), Wachira EG4), Omol RTA5), Rakwar J6),
Muthwii SM7), Honda Y8), Mudenyo M8), Koyengo G9), Osaki Y10)

ABSTRACT
Objective:

To determine the prevalence and risk factors and associated with diarrhoea in children
below five years.

Design:Cross- sectional survey.

Study Area: Laini- Saba Village of Kibera Slum, Nairobi
Methodology/Subjects: Purposive sampling the households with children aged below five years. 105
households with a total of 170 children were included in the study. Structured questionnaire andobservation check list were used. The respondents were mothers/care takers of the children
Main Outcome Measure: Children who had diarrhoea during the exercise and those who had had
diarrhoea two weeks preceding the study were compared with those without. The prevailingenvironmental conditions, methods of faeces disposal and hygienic parctices were also put intoconsideration.
Results: The socio-demographic information revealed overcrowding with each person occupying
living area of 12.8 sq. feet. Only 58% of the respondents received health information from recognized
health facilities. Prevalence of diarrhoea diseases was at 36% while at least 2 children out of every 100(2%) stood the risk of death due to diarrhoea. 79% of pit latrines were filled up and evidently not inuse. This problem had been aggravated by lack of access roads. Hence the community resulted toother crude unhygienic methods of faeces disposal. High proverty level (77%) had no permanentsource of income.
Conclusions: Diarrhoea is a serious health problem in the overcrowded Kibera slum. There isinadequate source of health information for the slum dwellers. Poor environmental conditions, poor
methods of faeces disposal and high poverty levels expose the community to diarrhoea diseases.
Key Words: diarrhoea, overcrowding, slums, latrines, poverty

INTRODUCTION
Viewed globally, the improvement of child health in thepast fifty years has been tremendous. However inmeasuring this trend there has been both success andfailure. These has encouraged research studies in
epidemiological patterns of diseases, diarrhoea included.
Diarrhoea diseases in children are most common and１）Department of Medical Laboratory Sciences-Microbiology
KMTC, Nairobi. P.O Box 30195
Tel. 725711, 573164- NAIROBI
２）PHO, MTC-MACHAKOS
３）Pharmacy (Chemical Analyst)-KMTC, NBI
４）MLT, Parasitology- MTC, EMBU
５）O.T. KMTC, NBI

associated with considerable morbidity and highly
mortality mainly in developing countries. (UNICEF,Facts and Figures, 1998, Table 1).
In this region, diseases and associated with illiteracy,
poverty, malnutrition, overcrowding and low level ofpersonal and general hygiene. Diarrhoea defined as acondition whereby and individual produces frequentwaterly stools (faeces) in excess of normal in 24 hours６）University of Nairobi７）Kenyatta University８）JICA expert, Information Technology Center, KMTC
KMTC Computer Experts
９）Department of Clinical Medicine, KMTC Nairobi10）Department of Hygiene, Faculty of Medicine, Tottori
University, JapanJ. Natl. Inst. Public Health, 51 (1) : 2002

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Diarrhoea prevelence and risk factors in slums
TABLE 1 Disease Ranking Table of Deaths among the under 5 years of agein developping Countries.
NoCauseNo. in millions

Percentage (%)

1

Acute Respiratory Illness (ARI)

2.2

192

Diarrhoea Diseases

2.2

193

Peri-natal

2.1

184

Non-communicable diseases

1.2

105Measels

0.8

76

DPT & Polio

0.7

6

0.7

67

Other Communicable diseases
including AIDS/TB

8Injuries

0.7

69

Malaria

0.6

510

Others

0.4

4

Total

11.6

100

Source: UNICEF facts & figures in developing countries of deaths among theunder five years of age (1998).

period may lead to dehydration and malnutrition
especially in children. Sometimes this condition may be
accompanied by vomiting resulting in severe loss ofbody fluids and electrolytes.
According to World Halth Organization (WHO 1990), 37%of all diarrhoea diseases in the world occur in Sub-Sahara
Africa.
In Kenya, the Ministry of Health reports of 1992 rates
diarrhoea as the second leading killer of children. The
same report states that on average a Kenyan childexperiences four episodes of diarrhoea per year. The
study carried out by UNICEF in 1994 says that thenumber of episodes increase to twelve bouts per year inthe slums.
It might be possible that child survival in slums areas isthreatened by environmental factors which impact on
the infectious agents leading to higher transmission ofdiarrhoea diseases where such conditions as given earlier
prevail.
Some of the major etiological factors associated withdiarrhoea diseases in children include microbial agents(bacteria, parasites and viruses). These organisms areusually transmitted through food, water, milk etc thathave been contaminated by human faces either directly
or indirectly by for example from hands, flies or utensils
including bottle feeders.

World Bank reprort on child survival 1994, states that anordinary African child under five years of age has fiveepisodes of diarrhoea per year. 10% risk of sufferingfrom diarrhoea on any given day and 14% risk of dying
from severe episode. In the same report, diarrhoea
accounts for 25% of all illnesses of childhood and 15% of
all admissions to health facilities. It is with thisknowledge that the researchers decided to carry out thesurvey in one of the most densely populated slums ofKenya.
Study Significance:
Policy makers, donors, non-governmental organizations
and other researchers will utilize results of this study for
future developments.

METHODOLOGY
Kibera slum is situtated 6 km to the West of Nairobi Cityand estimated population of 300,000 to 500,000 people.
Laini-Sava village with an estimated population of over
40,000 people was randomly selected for the study.
Houses are semi-permanent and some temporarily (mudhouses) walled and iron roofed. The residents are mostly
tenants. The main road to the slum is tarmac but feeder
roads are inaccessible during rainy seasons. Most
homesteads are only accessible through foot paths.
The area has several private clinics as well as traditional

J. Natl. Inst. Public Health, 51 (1) : 2002

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Kung’u WN, Musau PM, Ochieng A, et al.

herbalists. Goverment health facilities are located 2-5kmaway. There is piped water supply but not to every
homestead. The cross-sectional survey of 13th
September to 8th October, 1999 targeted households withchildren aged 0-5 years. 105 households were purposivelyselected. 170 children were included in this study. The
response rate was 98%.
Data Collection Instuments
1. Structured interview questionnaires
Each questionnaire was designed to cover specific area
as per the specific objectives. Some health behaviour has
been classified in the action domain as non-observable
health behaviour (Stephen 1981). Administration of thequestions was done by the 5 investigators. The
respondents were mothers/care takers of children in
every household. The respondents also gave their own
opinions based on the most common health problems
that they faced.
2. Observation Check List
This was designed to assess general environmental
condition and any other observable evidence such aspresence of faeces in the compound, filled-up latrines,
uncollected garbage, open raw sewage, presence ofinsects, cleanliness of the compound etc as dependent
variables (risk factors) associated with diarrhoea.
3. Interview Schedule for corps (community resoucespersons).
This was designed to seek the views of at least one
community leader e,g the chief to highlight the needs ofthe community in general.
Planning
The instruments were pre-tested in the same slum but
different village. 10 households were used. These tools
were adjusted accordingly. Data analysis procedures
involved appropriate tabulations and calculations using
percentages and Chi-square test. This was done throught
Microsoft Exell software applicadtion.
The main objective of the survey was to determine
diarrhoea prevelnce and associated risk factors in underfives in Kibera slums, Kenya.
Children who had diarrhoea during the exercise andthose who had had diarrhoea two weeks preceding thestudy period were included. The number of children who
had suffered diarrheoa was compared the those without
in order to determine diarrhoea frequency. To associate
the risk factors, the number of affected and unaffectedchildren was compared to the prevailing sociodemographic characteristics such as educational
background, household size, knowledge about diarrhoea

management, control and hygienic practices plus generalenvironmental status of the homestead. Tables andpercentages were used.

Results
The socio-demographic information revealed overcrowding as a serious public health problem in the slumwith each person occupying an area of 12.8 sq. ft, far
below the recommended 40sq. ft. Only 58% of therespondents received health information from recognized
health facilities. 48% received this information fromelsewhere. 8.6% had never gone to school, 57.1% had
attained primary educatioin and 32.4% secondary
education. Only 1.9% had attained college education. Of
the 53% who indicated that they boiled drinking water
most expressed that this depended on availability of fuel.
Breast feeding was quite adequate at 95%. Immunization
was at 93% and 7% had partial coverage. Prevalence of
diarrhoea was at 36% while at least 2% of the children
born in Kibera stood the risk of death due to diarrhoea
diseases. The cost of treatment per diarrhoea episoderanged from khs 10-1,000 of which 61% of therespondents could not comfortably afford. 77% of
respondents had no permanent source of income. There
was no sewage or proper drainage system. 79% of pit
latrines were filled-up and evidently not in use resulting
to other crude methods of disposal of feaces such as useof polythene bags. Diarrhoea was ranked first followedby malaria and respiratory illness in the community.

DISCUSSION
Diarrhoea is a major health problem among children
below five years in the overcrowded slums (UNICEF1994). Prevalence rate can be as high as 36% in theKibera slums. Overcrowding imposes strain on facilities
making observation of hygienic practices difficult whichfurther predisposes children to diarrhoea diseases. The
high prevalence rate of diarrhoea diseases in the slum
Table 2 Chi-square test results associating diarrhoea
prevalence with some of the dependent variablesa) Level of Education
YesNoTotalNome268

Primary362662

Secondary112334

College/University011

χ28.9>7.82

This showed a significant relationship with diarrhoea
occurance. Education is hard to change at this level but
knowledge and practices can be changed.

J. Natl. Inst. Public Health, 51 (1) : 2002

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Diarrhoea prevelence and risk factors in slumsb) No. of children per household
Yes

NoTotal

1-2

78

35

63

3-4

1716

33

5-6

44

8

7 and above

011

χ2

1.5<7.82

Does not have statistical significant relationship withoccurrence of diarrhoea. Therefore if living conditions areimproved overcrowding does not contribute to diarrhoea
prevalence among this community.

Ministry of Health for permitting the study to be carriedout. We are very grateful to all the JICA/KMTC experts
without whom the study would not have taken place.
Special thanks to the director KMTC-Mr. WK Boit, Mrs
Kimeu-JICA/KMTC Co-ordinator, Prof. Osawa, Prof.
Takagaki On the same score we thank all heads ofDepartments of KMTC-Nairobi and all MLMT1999
Research groups. We register our gratitude to the chief
and the entire local community of Kibera without whom,
their cooperation this project would not have been areality.

Acronyms
was seen to be directly associated to the knowledge
level, poverty and hygienic practices of the community.
Recommendation
In order to reduce morbidity and mortality rates due todiarrhoea diseases the researchers recommend
・ Regular community health education
・ Latrines promotion
・ Construction of access roads
・Provision of proper sewage and drainage systems aslong as outsanding solutions
・Self-help income generating projects to be initiatedby policy makers/donors/NGO to uplift the living
standards of the communityConclusion
Further research (Analytical) to determine the etiologicalfactors causing diarrhoea among the community should
be carried out.
This research was conducted as a Middle-level
Manpower Training (MLMT) Program of KMTC/JICA
project in 1999 sponsored by Japan International Cooperation Agency.

Acknowledgement
The researchers would like to express their sincere
gratitude to the office of the President through theIM-Information management
JICA- Japan International Co-operation Agency
KMTC-Kenya Medical Training College
MLMT-Middle Level Manpower Training
MLT-Medical Laboratory Technology
MTC-Medical Training Centre
NGO-Non-Governmental Oraganization
OT.-Occupational Therapy
PHO-Public Health Officer
UON-University of Nairobi

References１）Ministry of Health, CDD Programme news. Nairobi,(1992).
２）UNICEF. Facts and Figures-(1998)
３）Holy Bible, Deut. 23: 12-13.
４）World Health Organisation Report. Geneva, (1987, 1988).
５）UNICEF Report. State of the African Child, Nairobi,(1987).
６）Bangladesh-Journal of Diarrhea Diseases Vol. 2 (1984)
７）World Bank Report (1994)
８）Royal Society of Medicine and Hygiene 76: 164-168
９）Jose Mr. Babadilla JR FEB. 1994.
10）Byrne M and Bennet FJ. Community Nursing inDeveloping Countries. Oxford University Press, New York,
1986.
11）Jellifte DB, Stanfield JP, Diseases of Children in Subtropics. 1981.
12）African Child Survival Initiative Combating Childhood
Communicable Diseases, 1991.

J. Natl. Inst. Public Health, 51 (1) : 2002