Health report for women and children in Kenya.

1. www.ficcs.net
2011
Stacy Harris
FICCS (Foundation for International Cardiac
and Children’s Services) www.ficcs.net
8/29/2011
Health Report: Young Women
and Girls in the Slums of Kenya

2. [2]
TABLE OF CONTENTS
1. OVERVIEW 4
2. INTRODUCTION 5
3. POVERTY 5
4. MALNUTRITION 6
5. INADEQUATE HOUSING 7
6. HEALTHCARE SERVICE DELIVERY 7
7. HYGIENE 8
8. POOR SANITATION 8
9. TOILETS 9
10. LACK OF CLEAN WATER 10
11. SEXUALLY RELATED PROBLEMS 11
12. COMMUNICABLE DISEASES 12
13. PATHOGEN SOURCES 12
Human excretion
Animal excretion
Dry sanitation reusable’s
Hands
Waterborne sewage
Non recycling latrines
Flies
Soil
Food
Water
Drinking water
Humans
14. DIARRHEA 13
15. CHOLERA 14
16. MALARIA 15

3. [3]
17. INSECURITY 15
18. RISKS OF INSECURITY 16
19. GENDER INEQUALITY 16-17
20. SOLUTIONS 18
21. CHALLENGES 19
22. COMMON ILLNESSES 20
Colds
HIV/AIDS
STD’s
Hepatitis
TB
Pneumonia
Cardiac Problems
Diabetes
High Blood Pressure (Hypertension)
Asthma
Malnutrition
Psoriasis
Malaria
Diarrhea
Post Natal Complications
Typhoid
Sexual Assaults
Road Accidents
Still Births
Menstruation Problems
Foot and Back Problems
Stress Related Disorders (Depression)
Migraine Headaches
23. HEALTH STATISTICS IN KENYA 21
24. IMPACT 22
25. RESEARCH 22-23
26. CASE STUDIES 23-26
29. CONCLUSION 26

4. [4]
OVERVIEW OF HEALTHCARE REPORT ON THE STATUS OF HEALTHCARE FOR WOMEN AND
GIRLS IN THE SLUMS OF KENYA
Subjects: 100 women (ages 18-23) living in slums of Nairobi, Kenya
Duration: 2 – 3 years (in progress)
Methods of Observation: Medical examinations; Home visits; Training; Health workshops; Food,
hygiene and basic medical needs support
Educational Objectives: 1. Determine how healthcare is delivered in the slums
2. Determine how poverty impacts healthcare
3. Determine the impact of gender inequality in education, access to
healthcare and general well being
4. Understand roles of non profit organizations in alleviating some of
the pressure on health services in the slums and bridging the gap in
health inequality
5. Understand how people cope with illness in the slums
Goals: To provide preventative healthcare and hygiene training which will help
boost self-esteem, well-being and confidence and ultimately empower
young women in the slums of Kenya.
Lessons Learned: Lack of education is a major hindrance as 70% of the women have not
completed 8th
grade and a bulk of this group only has a 3rd
grade
education. When people are introduced to things they were otherwise
ignorant of, they respond in overwhelmingly positive manners.

5. [5]
A. Introduction
Over the course of the past year and a half, FICCS (Foundation for International Cardiac and Children’s
Services) has been monitoring and evaluating the state of healthcare for young women in the slums of
Kenya. 100 women ages 18-23, who live in the slums, were provided with medical supplies, basic
medical training and medical check ups. As a result, FICCS has provided a report on the status of
healthcare in the slums of Kenya and how it affects the ability of young women to become independent
and empowered.
Women and children have traditionally been left behind in African society and it is most evident in the
delivery of healthcare services. This lack of services, poor environmental conditions and gender
inequality has led to many Kenyan women and children dying from easily preventable diseases. Lack of
knowledge of hygiene and sanitation practices combined with extreme poverty has created slum areas,
most numbering in the hundreds of thousands, whereas, diseases can flourish and multiply with
simplicity.
B. Poverty
Poverty in slums is more pronounced and has led to poor hygiene and sanitation, increase in diseases
and infections, lack of proper nutrition and a lack of security and safety. The most basic needs of every
human being are housing, employment, food, toilet availability and water accessibility; unfortunately
these are not available for slum dwellers due to extreme poverty.
Women are mostly affected by poverty in slums because as housewives, they are responsible for the
upkeep of the family, taking care of the children, determining the nutritional status of the
family, managing and budgeting the household income, ensuring proper hygiene and sanitation.
In order for women to fulfill their roles in the family such
as child bearing, maintaining the family, bringing up the
children, they should maintain their health status
and practice good healthy behaviors because as the
women goes so goes the entire family. The income level of
women between 18-45 years of age is way below the
poverty line. This makes it next to impossible for a woman
to be able to meet the needs of her household in the slums
as well as maintain good health.
Poverty also leads to the spread of diseases due to the lack
of money to access treatment or to purchase medicine.
The lack of employment opportunities in the slums, which has led to poverty, is the main reason there is
a lot of informal stores selling anything from fries to tires, but the majority of these businesses operate
without a valid license and must deal with corrupt government officials.
Slums are overcrowded and heavily polluted

6. [6]
C. Malnutrition
Due to extreme poverty, the average slum dwellers earns between $ 1 – 2 USD per day, there is too little
money to feed oneself let alone feed an entire family. Thus, slum dwellers rely on the cheapest source
of proteins consequently leading to extremely poor diets. Maize (corn) is the main food eaten in the
slums and rural areas. If they are lucky, they will have some greens or possibly beans to go along with
the maize and meat is simply out of the question. However, maize has very little nutritional value as it
only fills the stomach, but does not provide the much needed nutrients to sustain the human body.
As a result, people living in the slums never get the proper nutrition and end up underdeveloped both
physically and mentally. All you have to do is visit a hospital in Nairobi and you will see the results.
Children are born underweight and there problems are only beginning. Food security is a huge problem
in Kenya because as prices keep going up, the slum dwellers are forced to cut back on what little they
have. Children routinely pick through garbage piles and eat what they can find and the food which they
eat is usually grown adjacent to raw sewage or garbage
dumps. Malnutrition is a direct result of poverty and in the
end is a direct link to inadequate healthcare in the slums of
Kenya.
Malnutrition not only stunts development but it also causes
other problems, including emotional problems. When a
child should be concentrating on their big exam, oftentimes
they are more worried about weather or not they will have
dinner that evening. The constant search for food wears on
a person and is one of the leading contributors of children
in the slums leaving school. Girls are especially vulnerable
because even at young ages they are given the responsibility of taking care of their siblings. It is common
to see a pre teen girl, who should be in school, carrying her little sister on her back searching for a meal
or a way to make some money to buy a meal.
Children suffer both physically and mentally

7. [7]
D. Inadequate Housing
Houses are either wooden shacks or tin sheets which are
extremely hot in the summer and extremely cold in the
winter. The average home is a one room residence with on
average five family members. There is no electricity or
clean water, nor is there any form of sanitation as trash
piles 10 feet high and water is piped alongside raw sewage.
Water is in extreme shortage as residents must fetch water
every day for their daily needs such as cooking. Poverty in
the slums is evident through the structures of the houses
the residents live in which are often constructed of
cardboard, corrugated tins, mud, thatch and plastics. They
are mostly single rooms which are about six feet by nine feet and are partitioned by only a curtain. This
single room is used as a living room, kitchen, bathroom as well as a bedroom where both parents and
children sleep together. People living in poverty are the most overcrowded because of the cost of
housing and the large family sizes.
E. Healthcare Service Delivery
The Ministry of Health (MOH) in Kenya is responsible for providing health care to the people living in the
slums. Kenyatta National Hospital, the biggest referral hospital in East and Central Africa, is the main
referral hospital for all Kenyans. Other health care facilities in the slums include: health clinics,
dispensaries, maternity homes, nursing homes, medical
centers, laboratories and radiological services, and dental
clinics which are owned by non profit organizations and
private individuals.
However, most of the private facilities operate illegally,
thus leading to malpractice and poor quality of health. The
demand for health care services is due to HIV/AIDS,
malaria, tuberculosis, malnutrition, respiratory infections,
cardiovascular diseases, prenatal diseases and accidents.
Houses are only one room
Most rely on services in the slums

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F. Hygiene
Hygiene is commonly known as cleanliness or conditions
and practices that serve to promote or preserve health. A
population that does not take into consideration hygiene is
at risk of infection and illness. Improved housing, improved
nutrition and improved hygiene are the essential
components for the war against infectious diseases.
Many people living in slums areas practice personal
hygiene such as brushing teeth and bathing the body
although not as frequent as it is desired due to a lack of
resources, such as water. This lack of resources results in
poor hygiene levels as toilets cannot be washed and there is not enough water to shower.
G. Poor Sanitation
There are various ways of maintaining cleanliness and hygiene conditions that prevent diseases and
infections. Poor surrounding conditions lead to low quality of health. Simple tasks such as garbage
collection can improve community health.
Access to a latrine or a toilet does not automatically mean good hygiene or sanitation. Access to a toilet
is neither the same as its hygiene practices in the West due to several mitigating factors. A successful
sanitation programs improves overall health in a community, it is sustainable at community and
institutional levels, and it is cost effective and does not bring environmental risks.
The lack of sanitation poses a major security risk for women and girls in the slums. Where there are no
latrines, girls and women have to wait until darkness arises, for them to look for a place to defecate.
Sometimes they need to walk long distances and are either raped or mugged. Rapid population growth
combined with accelerating rural-urban migration of the poor and the under employed rural dwellers is
increasing the slum populations. Due to rural-urban migration, the number of slums in Kenya's capital,
Nairobi, is increasing uncontrollably because of the influx of those seeking refuge from extreme poverty
and environmental degradation in the countryside.
Overpopulation in the slums leads to fewer water supplies and due to the already short water supplies,
garbage collection, excreta disposal, drainage, and electricity supply, the levels of sanitation in this area
are reduced next to zero. Kibera alone has nearly one million people crammed into tiny plots literally
one on top of another. The lack of sanitation facilities is considered a big problem by the women in the
slums, but it is very difficult to improve the situation because of several related issues.
Food is prepared outside

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First, there is no space for latrines as the compounds are
built up to capacity and available empty spaces are
becoming encroached. Secondly, latrines are considered
the responsibility of the landlord in this area and because
the landlord usually does not live in the area, he is not
interested in improving the latrine situation. Ensuring
proper sanitation is the responsibility of the women as
they are mostly at home doing the household chores.
Also, the lack of toilet facilities may trigger the tenants to
construct a latrine for them, but they fear to do so as the
landlord might increase their rent.
H. Toilets
Pit latrines are built next to houses and they are hardly 20 feet deep and when you look closely you can
see rats, worms and flies. These crawling creatures find their way into the houses and kitchens thus
contaminating food and water. Most of the diseases that prevail in the slums are a result of poor
toileting. Poor toileting is the cause of all sanitation and hygiene related diseases and infections.
Blocked drainage which leaves stagnant, is a breeding ground for mosquitoes, leading to the spread
of malaria and typhoid.
Toilets located beyond 50 yards from the house make women feel insecure for themselves and for the
safety of the entire family especially children. In addition, there is a tendency to waste time when a
person visits the toilets, and there are long waiting periods due to many users, which leads to
incontinence. Long walks to the toilet leads to people relieving themselves in buckets, plastic bags
and bushes. In the slums, very few people have toilets less than 50 yards from their house and women
still feel insecure at night when they go to toilets. Toilets within 10 yards of reach, pose bad odor due to
poor construction, insufficient cleaning and lack of ventilation. Bad odor attracts flies which spread
diseases through food and water contamination.
Raw sewage is everywhere

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In the slums, when the pt latrines are located far from the
residential areas, the residents defecate in plastic bags
which they later throw in ditches, on the road side or as far
away as possible. This form of toileting is commonly
referred to as 'the flying toilets' in Kibera. Piles of the
polythene bags used for defecation land on roofs and
attract flies. Some of them block the drainage systems
while others burst from pressure impact. Some times when
they land in open water systems they get washed away
and people even get hit by the plastic bags when they are
tossed into the air. During the rainy season, the excretion
is often washed away into houses and children swim in the water which leads to diseases such as
typhoid, skin disorders, diarrhea and malaria. Women and children are the most vulnerable
to infections related to hygiene during the rainy season when water systems become contaminated.
I. Lack of Clean Water
Water is one of the most vital natural resources for all life on Earth, and it is a basic need to all human
beings. Clean water prevents infection from many diseases. Due to poverty and poor living
conditions in the slums, water availability is a major problem. Poor women bear the burden of unpaid
chore of fetching water and are excluded from many opportunities to create wealth from water. To
make matters worse, the water they fetch is not free, thus there are economic limitations to getting
water. This time consuming and extremely laborious chore of fetching water leads many young girls to
leave school early. Slum dwellers face the problem of inadequate water supplies to clean the home,
prepare the food, wash the utensils, do the laundry and bath. The deprivation of water and sanitary
facilities results in severe water-borne diseases which is
the main concern for slum dwellers.
The Lack of clean and safe water supplies leads to
unhygienic food, poor sanitation, increase in diseases;
poor nutrition and overall poor health. Since water is a
very rare commodity for slum dwellers, they often drink
rain water which is usually trapped by gutters on the roof.
Rain water is usually safe for drinking if it is boiled before
consumption and stored in clean containers but due to the
ignorance of the slum dwellers, they fail to boil the water,
thus the water becomes a hazard in their life.
Most sewage in the slums are dug so shallow that when it
rains they fill up and overflow Nairobi River, which is usually the residents´ only source of water, thus
polluting the water. Due to the lack of water, the slum dwellers are forced to use the polluted water for
basic needs leading to diseases which can lead to death which can easily be prevented. The rising
Pit latrines are shared by hundreds of people
Water is polluted with trash, sewage and feces

11. [11]
problem of poor sanitation presents the most dehumanizing aspect of the daily battle for survival for the
slum dwellers. The poor pay an intense price for the lack of clean water and sanitation, in disease and
filth.
There usually no water in the slums and you may find only one tap that needs to provide water to a
thousand residents. Since water from that one tap is not even enough for everyone, women spend the
whole day and night queuing to get some water and even sometimes they end-up going home with
empty containers.
Women face problems with water accessibility, cost and quality. They also have inadequate access to
water points, which are often located far from their houses. The landlords also ration water such that it
is only available on specific days of the week and at specific times.
J. Sexually Related Problems
The lack of privacy and extremely close quarters is the main reason that sexual problems arise in the
slums. This is due to the fact that houses are very small and congested, thus the bedroom, the kitchen
and the sitting room are separated only by curtains. The children grow up getting exposed to sexual
practices and the parents do not have any privacy of their own. Through this, children get to know much
more about sexuality even before they are the age of 5. Pit latrines also double as bathing areas and you
are partially exposed while bathing and in some cases you can see the people as they walk by. Taking a
bath at night is literally out of the question.
Prostitution is very common in the slums and women are mostly the ones involved in this trade. Most
women are forced to be prostitutes because of lack of employment and that they simply do not have
any other means of earning a living to support themselves as well as their families. Children grow up
experiencing this kind of behavior and are exposed to sexual activities at a very tender age. Due to being
naive and a lack of sufficient knowledge, a number of children, especially the girls, take up
prostitution as soon as they turn teenagers.
Availability of pornographic materials, such as movies and
magazines, is also a huge contribution to sexual practices
in the slums. They are numerous cheap and affordable
video rooms which cost less than 5 cents and in addition,
drugs and homemade alcohol are readily available, leading
to even further devolution into deviant sexual behaviors.
Young adults and even children whether employed or not
can easily raise the amount to afford to watch a
pornographic movie or buy a magazine.
Exposure to these kind of sexual practices in the slums
leads to a rise in sexually transmitted diseases (STDs) such
Criminals are rarely caught due to overcrowding

12. [12]
as HIV/AIDS, gonorrhea, syphilis, herpes etc. Young girls also get impregnated forcing them to drop out
of school in order to raise their children. Young girls who are not ready to become parents often opt for
abortion which is illegal in Kenya and extremely dangerous. Majority of the girls who undergo abortion
are at a high risk of infection, infertility or even death because the people carrying out the procedure
lack the skills and knowledge required to carry out the procedure safely.
K. Communicable Diseases
Health hazards are directly related to poverty, a polluted and stressful environment, social instability
and insecurity. People living in the slums are more vulnerable to communicable diseases and
malnutrition. Women of child bearing age and children are particularly at risk.
The risk factors for diseases in the slums are water, sanitation and hygiene. They act in competing and
complementing transmission pathways for causing diseases. Fecal and oral diseases are a major
problem and human and animal excretion negatively affects human health through various
transmissions pathways.
Communicable diseases are spread through physical contact with infected individuals, liquids, food,
body fluids, contaminated objects, airborne inhalation, or through vector borne spread. Most of the
diseases in the slums are a result of the lack of high personal hygiene standards and enough pit latrines
to be used by everyone. The spread of infections from one person to another are frequent due to the
overcrowding and congestion situation in the slums. Women face the problem of communicable
diseases related to the unsanitary living environments, the lack of water and inadequate nutrition.
The most common communicable diseases in the slums are cholera, malaria, and diarrhea.
L. Pathogen sources
Human excretion
Animal excretion
Dry sanitation reusable’s
Hands
Waterborne sewage
Non recycling latrines
Flies
Soil
Food
Water
Drinking water
Humans
Poor sanitation is the main cause of disease

13. [13]
M. Diarrhea
Diarrhea poses a huge risk for slum dwellers because of the lack of proper sanitation and hygiene. Most
slum dwellers are unemployed and poverty is a major problem. This is why the inhabitants of the slums
run indecent businesses to earn a living such as roasting corn, selling food stuffs such as chips, mandazis,
samosas, prostitution and even gambling. The methods used to prepare these foods are poor and very
unhygienic. People usually cook the food besides the roadside where dust, flies, sewages and all kinds
of dirt surround them. Most people tend to buy these kinds of foods because they are cheap and they
forget the low hygienic measures carried out when preparing the food. Rarely will you ever see anyone
wash their hands before preparing food.
This leads to the spread of diarrhea time and time again. The poor drainage also makes the slums muddy
and unwalkable during the rainy seasons. This has several consequences including increase in breeding
sites for mosquitoes, filth, foul smell and diseases such as diarrhea. The lack of washing hands with soap
and water before handling food, eating leftover foods as well as a dirty food storage surrounding is also
a major contributor of diarrhea among children.
Lack of safe and treated drinking water is one of the main causes of diarrhea. Most water in the slums is
contaminated because water systems are broken and they are built next to sewages. The combination
of poor sanitation services and inadequate water resources has led to increases in communicable
diseases which poses a threat to the community at large. Children of less than 10 years of age are at
high risk of contacting cholera as their hygienic levels are very low and often need a grown-up person
like a mother or elder sibling to take care of them. The health and nutrition of these children is very low
as most of them only take one meal per day, if they are lucky.
It is estimated that 50% of these children facing such conditions are at a high risk of low resistance level
to infectious diseases which results to risks of high mortality. Poor sanitation leads to spread of diseases
in slum settlements thus increasing diarrhea incidences. Diarrhea is a serious health problem in the
overcrowded the slums since there is scarce health information for the slum dwellers and poor
environmental conditions, poor methods of feces disposal and high poverty levels expose the
community to diarrhea diseases.

14. [14]
N. Cholera
Cholera is often transmitted by consumption of contaminated food and drinks. The risk of infection can
be reduced by taking hygienic precautions. Slum dwellers face the risk of Cholera infections because of
the poverty levels which lead to inadequate sanitation and lack of clean drinking-water. In the slums,
people rarely wash hands thoroughly with water and soap before handling food and after visiting the
toilet. Cholera is a disease killing many people in the slums
which can be easily prevented.
Women face the challenge of Cholera because no matter
how much they try to clean their houses or cook food in a
hygienic environment, they still face the same constant
problem. This is because they live next to blocked drainage
systems or overflowing toilets in which germs and toxins
breed. Furthermore, their children pick up anything edible,
thus they fall ill and spread the disease to all the members
of the family. Due to lack of water, women use rain water
for basic needs though it is often unhealthy because when
people excrete in paper bags and it rains, it mixes with this water therefore leading to unsafe
collected rainwater as it is mixed with the stool that people throw anywhere. This continues to spread
cholera infections in the community.
Due to the fact that the pit latrines are located next to water pipes, when the pipes burst, which is a
regular occurrence, the sewage contaminates the water during repair. The people end up drinking that
water which is basically a mixture of feces and urine thus they end up getting Cholera. Despite the
women's high level of understanding the importance of providing appropriate diets for their families,
poverty hinders them to accomplish this thus the immune system of especially their children is lowered
leaving them vulnerable to catching infections. The shortage and contamination of water supplies and
the lack of sanitation and suitable sewerage disposal make cholera one of the most common health
problems in the slums.
Food preparation is unhygienic

15. [15]
O. Malaria
Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected
mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cell (WHO,
2008). Nahlen et al. indicate that the World
Health Organization (WHO) estimates the worldwide
malaria morbidity burden as being between 300 million and
500 million clinical malaria cases a year.
The common occurrence of malaria in the slums is
associated with stagnant water that provides ground for
mosquito breeding. The slum dwellers are aware of malaria
as a disease but are handicapped by lack of adequate
knowledge on symptoms, cause, predisposing factors, and
prevention and control measures. Mosquitoes breed in
stagnant water, around bushes and also in areas were refuse
is disposed poorly.
The women find malaria to be a big burden on their families because they spend a lot of money to buy
medication and if a member of the family is sick they have to be absent from work to take care of the ill
family member. Inadequate provision for drainage increases the risk of malaria in the slums as its
mosquito vector breeds in these flooded areas and ditches. Lack of accessibility to affordable mosquito
nets and treatment to those affected by malaria in the slums is a also a challenge. Many are so poor
they turn their free government mosquito nets into chicken coops.
P. Insecurity
Insecurity is the state of being subject to danger, injury or a
feeling of anxiety. Living in the slums of Nairobi, one faces
insecurity of the highest degree. All slum dwellers undergo
insecurity but the major insecurity each one of
them experiences is Human insecurity. Human insecurity in
any given community is the core reason that food insecurity,
health insecurity, violence insecurity, job insecurity
among others is present.
Women and young girls often feel insecure as they are
vulnerable to rape, sexual harassment and even physical
harassment. Human insecurity in the slums is prevalent due to the lack of lighting (no power), lack of
security (no police) and a rise in criminal activities which often go undetected. In addition, the slums
Trash and stagnant water breed mosquitoes

16. [16]
dwellers of are at risk of their houses catching fire, collapsing or even been broken into because of poor
housing conditions in this area. Most people living in slums illegally and attaining a house contract with
their landlord is very difficult, thus they live in the fear of been evicted of thrown out at any given
moment.
Q. Risks of insecurity
Lack of water, hygiene and sanitation
Easily preventable diseases
Poor housing conditions
Risks of fire, floods and collapse
Lack of security at residence
Fear of being evicted at any time
Poor education and illiteracy
Limited choice of jobs
Lack of justice
Lack of human rights
Inability and desire to help slum dwellers
No recognition of human dignity
R. Gender inequality
Gender inequality is well defined as to women not having same rights, privileges and opportunities
unlike men. In the slums, gender inequality is more evident in the sense that women are more or less
considered as housewives and anything involving money, property, decision making and many more is
the responsibly of the men who in this case are always the heads of a household. Although many urban
women enjoy equality in education and professional life, the majority of women in the slums
are discriminated in this field mostly because the society is controlled on a patriarchal system.
Most rapid gender assessments note that women are silenced on menstruation issues. Men look at
menstruation issues as rather personal women issues that are filthy and should not be talked about by
decent people. By silencing women, the need is therefore ignored and menstruation is therefore used to
condemn and exile women. The women concern is how this silence has to be broken and women
brought into designing toilets. The African woman bears the burden of taking care of children, the
disabled, the aged and household chores. Toilets are designed without consulting their users
mainly women who have to take the people they care for to the toilet. It is therefore, difficult for
women to fit in the narrow toilets with young children, the disabled or the elderly. Many African girls of
menstruation age drop out of school hence loosing the opportunity for education and better lives.
Due to gender inequality, toilets are designed in public locations where women can be observed by
anyone and where their movements can be monitored. The toilet doors face footpaths or streets
Crime and illegal activities are rampant with
hundreds of thousands of people living in extremely
close quarter

17. [17]
exposing women to the public. Often the doors of the toilets do not close completely, and sometimes
there is no water to wash their hands or to flush. There is nowhere to dispose sanitary products; hence
women have to walk out, hiding the used sanitary items. Women face male violence, which is usually
domestic violence, and choose not to reveal this to anyone, because, in many cases no one will believe
them, and they are afraid that if their husbands hear they reported the matter, they may be chased
away from their homes.
Gender inequality has caused women in the slums to be
over submissive to men and this has lead to women having
no say and, thus, a man is left in control. Young girls also
face discrimination because their education is less valued by
the members of the community in comparison to the boys.
They are often forced to work; as house girls, thus their
education level attainment is limited. Lack of education
therefore affects girls and continues until they are grown
women in the society. Most girls are fortunate to reach 8th
grade as many drop out around 3rd
grade to take care of
their families and find food.
Female-headed households in the slums often lack support especially from their male partners, who are
unemployed, because the men feel jealous of successful women. Slum dwellers, who often migrate
from rural to urban areas, usually come with their traditional beliefs and practices from the countryside.
Some of these practices are related to family roles; beliefs related to diseases, food and lifestyle mostly
affect women. If these traditional beliefs are not followed effectively, they are attributed to violation of
cultural codes, social ethics and taboos. Many of these rituals deny the woman rights within her
community.
Women are tied down by these beliefs, because they are consequently in fear of being rejected and
disowned by the community and family. They are forced to comply with the traditional beliefs which in
many cases can be done away with as they are outdated. Women follow their beliefs blindly and often
impose things like early marriage on their girls.
Girls are given less priority than boys

18. [18]
S. Solutions
The Ill-health of people living in the slums is largely due to lack of education, overpopulation and
extreme poverty. Nurses are the primary healthcare providers for people in the slums and are looked
upon for advice and consultations on one’s well being. They have a major influence in a community
where doctors are too few for the masses of people. They also provide links to government funded
health programs and become the advocate for proper healthcare in the slums.
Nurses, therefore, are the main avenue for promoting healthcare knowledge in the slums. Nurses can
train, teach and possess the knowledge and understanding to handle specific medical interventions.
They can also recognize social and environmental problems such as poor sanitation which ultimately
leads to poor health.
Since women and children are the most affected, education can be done during visits to health care
centers, women group’s and schools where nurses provide education, health awareness and basic
medical and hygiene training for this most vulnerable group of people. However, Kenya and the rest of
sub Sahara Africa have an extreme shortage of nurses. Nurses in Africa do not have the qualifications in
the west, but they have enough knowledge to deal with the cases in the slums. Only a handful of nurses
at the major hospitals in Nairobi actually have a BSS in Nursing, the remaining have either 3 year
diplomas or in some cases a certificate. In spite of the lower standards, there is still a large shortage of
nurses (it is estimated at 66,000) to cover Kenya, ultimately resulting in fewer nurses for the slum
communities.
Health promotion in the community involves nurses focusing on places where people spend most of
their days. Nurses need to meet people in these areas to and interact with them, for example, in market
places, health care centers and religious centers and any other place where people gather. Since
identifying the problems of the women and girls is not the only solution, nurses need to be involved in
community activities because at the end of the day, poor hygiene and sanitation is a community
problem. Diseases spread rapidly in the slums so at the end of the day no matter how much a woman
protects the hygiene of her family, she too can succumb to a communicable disease, which is out of her
control.
In order to make a difference in the slums there has to be behavioral changes among the community.
Education, training and health awareness program implemented in the slums can utilize existing
community based programs and schools to effectively develop and implement programs designed to
promote sanitation and hygiene practices. Consistent awareness of a situation will cause people to
change their behaviors. Most are ignorant of their situation and often do the same thing their mother
did years ago. For instance, many do not boil their water even though the government has mandated
that water be boiled before drinking. This simple lack of understanding has caused many to go to the
hospital, in some cases it causes death in infants, and in addition, it is a huge burden on an already
overburdened healthcare system.
Environmental conditions also play a significant factor in the health of women and children in the slums
of Kenya. The prevalence of water borne diseases due to lack of clean drinking water, poor waste

19. [19]
management as debris is thrown everywhere and toilets pose and even bigger sanitation problem
spreading raw sewage everywhere. Improving one’s health status must include education programs to
teach and train community members in environmental infrastructure and the dangers of environmental
negligence. By simply once a week cleaning an area, a community will have tremendous long term
benefits. The flies alone from the garbage piles will drive an average person away.
Maintaining proper sanitation and hygiene both individually and as a community requires informing the
population at large about changes and adjustments they need to make in their daily lives. Ensuring
toilets are clean, waste is disposed of properly, drinking water is clean and boiled, maintaining proper
body hygiene and observing proper cooking methods are
a few of the daily changes which will have to occur.
Improvements in sanitation and hygiene require a lot of
education, training and hands on assistance.
The nurse’s involvement in promoting proper hygiene and
sanitation in the slums is crucial to the awareness of the
community as a whole. The young women and girls
routinely take their new found hygiene knowledge and
share it with their friends and families. Training one can
easily turn into 10 receiving information they would
otherwise never have access to. Community health
nurses also promote awareness through posters, education, organizing walks and community events.
Such events attract a lot of people and they nurses are able to reach a larger group of uninformed
people seeking knowledge about healthcare. Too many slum dwellers wait for the government to
improve their lives, yet at they end of the day, they are the ones who will have to empower themselves,
starting with their own bodies and their personal and community health.
T. Challenges
They hygiene and sanitation challenges in the slums of Kenya can be described as poor at best. The lack
of basic services and access to sanitation facilities or clean water causes an added burden on the
overwhelmed healthcare system. Due to the lack of waste collection services, poor rain water systems,
it is nearly impossible to pass at times during the rainy season, poor infrastructure and the complete
absence of electricity leads to many easily preventable diseases.
Substandard and inadequate houses have been built in slums with temporary materials which are
unsuitable for weather conditions such as straw roofs, mud, earthen floors and plaster. Children often
sleep on dirt, or muddy floors, and there is a lack of ventilation which causes breathing problems when
people cook inside using charcoal.
Overcrowding and congestion result to too little space per person, expensive housing rates. The
cohabitation of different families and more single rooms leads to the spread of communicable diseases.
One room-unit in the slums is often shared by five people whom they use for cooking, sleeping and
living.
Volunteer nurses keep the girls healthy

20. [20]
The lack of basic services, visible and open sewers, the lack of pathways, the uncontrolled dumping of
waste and polluted environments, result in unhealthy living and hazardous living conditions. Houses may
be built in dangerous locations which are unsuitable for a human settlement; for example, near waste
disposal sites. Extreme poverty is the overwhelming factor that contributes to these hazardous
conditions. These socioeconomic conditions cause slum communities to be alienated and often
discriminated against. They are essentially displaced communities with no ability to care for their daily
hygiene and sanitation needs.
U. Common Illnesses in Slums of Kenya
All the following factors lead to increase in mortality rates, especially among children.
Colds
HIV/AIDS
STD’s
Hepatitis
TB
Pneumonia
Cardiac Problems
Diabetes
High Blood Pressure (Hypertension)
Asthma
Malnutrition
Psoriasis
Malaria
Diorreaha
Post Natal Complications
Typhoid
Sexual Assaults
Road Accidents
Still Births
Menstruation Problems
Foot and Back Problems
Stress Related Disorders (Depression)
Migraine Headaches

21. [21]
V. Health Statistics in Kenya
World Health Organization 2009 latest statistics
Country Profile
Total Population 39,802,000
Gross national income per capita (PPP
international $)
1,560
Life expectancy at birth m/f (years) 58/62
Probability of dying under five (per 1 000
live births)
84
Probability of dying between 15 and 60
years m/f (per 1 000 population)
358/282
Total expenditure on health per capita (Intl
$, 2009)
68
Total expenditure on health as % of GDP
(2009)
4.3
Child Malnutrition Chart (WHO statistics)
The UN report on Kenya says you are lucky to turn
FIVE due to the poor living conditions

22. [22]
W. Impact
The impact of proper sanitation and hygiene in slums shows how improved quality of life is achieved
through various ways. Awareness and access to sanitation and hygiene leads to the reduction of child
mortality and combats diseases of maternal health as well as increases in the economic output and,
hence, eradicates poverty. As a result of poverty eradication, women's empowerment as well as gender
equality is achieved. In addition, universal primary education is attained and quality of life is improved
which combats diseases.
X. Research
Research shows that people living in the Nairobi slums have a much higher incidence of morbidity and
mortality than those living in other parts of Nairobi and the rural areas of Kenya. Unhealthy and
dangerous environments, poor nutrition and unhealthy lifestyles are significant contributory factors.
Health problems are exacerbated by the lack of accessible, affordable, quality health care.
Orphans: The number of single (one parent) orphaned children in the urban slum Nairobi was
found to be 4.5%. 77.1% was due to parental death due to HIV/AIDS.
Infant Mortality: The main causes of childhood mortality for the under fives in Nairobi slums
are pneumonia, diarrheal diseases and still births, accounting for 60% of deaths in the under
fives. Research has also shown that the urban poor fare worse than their rural counterparts on
most indicators, for example the prevalence of diarrhea among children in the slums was found
to be 32%, compared to 13% in Nairobi as a whole and 17% in rural areas. The childhood
mortality rate in Kenya was 115 per 1000 births for Kenya in 2003 and 151 per 1000 for the
slums in Nairobi.
Maternal Mortality: Maternal mortality ratios in Kenya are about 560 deaths per 100,000 live
births or 1 in 178. In the Nairobi slums the ratios increase to 706 per 100,000 (or 1 in 142). This
compares with 13-14 deaths per 100,000 (1 in 7300) in developed countries with fully developed
health services. A study in the Nairobi slums between 2003 and 2005 showed that only 21% of
the 29 maternal deaths after delivery had the support of a health professional.
Adult Mortality: Verbal autopsy suggested 24.7% of (adult) deaths were due to an AIDS related
illness. Among the rest of the population (5+ years) AIDS and TB combined accounted for about
50% of deaths. Interpersonal violence injuries (homicide) are the second most common
followed by road traffic accidents. Malaria accounts for only a small proportion of mortality in
children and adults (3.5%). The prevalence of malaria in the Nairobi slums is lower than other
areas because of the high altitude and colder climate.
HIV/AIDS: There is a high prevalence of HIV/AIDS in Kenya’s slums and informal settlements. It
is estimated that the HIV/AIDS prevalence rate in Kibera is 14 per cent – almost double the
national rate. This high prevalence has been attributed to a host of factors, including lack of

23. [23]
access to essential services such as health services. There is also a high risk of HIV/AIDS infection
in the slums and informal settlements as a result of gender-based violence; domestic violence,
sexual assault and rape.
Gender Based Violence: "…violence against women in the slums is rampant…and emerges as
perhaps the strongest cross-cutting theme…" (Women, Slums and Urbanisation: Examining the
Causes and Consequences, 2008, COHRE (Centre on Housing Rights and Evictions) - cited by
Amnesty International
Y. Case Studies
Hawkers Market Girls Center, Nairobi, Kenya (Group A): 40 young women were given access to
basic medical supplies and healthcare and hygiene training. This group was given all their
medical supplies to take home for their personal usage.
Kibera Girls Center, Nairobi, Kenya (Group B): 60 young women were given access to
healthcare training and basic medical supplies. This group was not given supplies to take home;
however an abundance of medical supplies were made available for them at the girl’s center.
Individual Case Studies (Subject X): Jane,22, not her real name, was given access to all the
amenities which are not available in the slums including, clean water, 3 meals per day, daily
shower, proper housing and healthcare and access to hygiene care. Jane lived with the Program
Director for 2 years (and counting), as she is a typical slum dweller with the entire negative
impacts of the socioeconomic and poor environmental conditions. There were immediate
results which prove that given a chance to get out of the slums, their health and overall well
being will be greatly improved. These are some of the results:
Weight Gain: This is the most notable and immediate improvement. Within 30 days,
Jane, due to a proper diet, has gained incredible amounts of weight, she used to be
extremely skinny, and the weight gain has made her more confident about herself and
her health. Her biggest struggle in life used to be getting her daily meal, now she has
access to proper food (including meat which is a luxury in the slums) and this simple
improved diet is the major contributing factor to all her health gains.
Clean Skin: Jane had a serious skin problem, which is common in the slums due to dirty
water or in some cases, no water. Her face used to be covered with spots and her body
was riddled with rashes, again, this is very common in the slums. After several months
of clean water, eating properly and access to hygiene products such as lotion, Jane’s skin
has cleared up and she even smiles a lot more and no longer has to worry about people
asking what is wrong with her skin.
Fainting Spells: Jane had a serious medical problem as she used to faint on a regular
basis. This caused me to question the decision to have her live with us and take care of
our child, however, this is also a common problem in the slums, but no one pays any

24. [24]
attention to this problem. I do not know what happened over the course of the past 2
years, but Jane has not fainted in several months, compared to fainting weekly when
she first moved in. I assume that her fainting spells going away is directly related to her
improved way of living.
Menstruation Problems: Again, another problem overlooked in the slums is
menstruation cycles. Jane, as well as many other women in the slums, had serious
menstruation problems, which she said she has always had them. However, with proper
healthcare assistance and hygiene care, including sanitary pads, as most use toilet paper
or whatever is available which in itself can cause problems, Jane’s menstruation cycle
has dramatically improved and she is not on a normal menstruation cycle. She used to
have extended cycles which would last for weeks at a time and were very painful.
Breathing Problems: In addition to the fainting spells, Jane also had a difficulty
breathing at times, which made us all nervous. The slums have every imaginable
pollutant ranging from raw sewage to toxic fumes from cars and trucks. When you walk
into a slum, the first thing you notice is the smell, which literally takes your breath away.
Once Jane was moved out of the slums it was only a matter of months before she
stopped having all the breathing problems. We thought she had asthma, which is also
common in the slums, but it was merely breathing in toxic fumes on a daily basis.
Colds: Once again, Jane had an extreme propensity to colds which occurred on a
regular basis. Her constant sneezing and sniffling again questioned her ability to care
for our children. However, due to her new diet, good living conditions and access to
medicines, Jane no longer has colds on a regular basis. In the slums, women and
children literally have colds for months as the environmental conditions and lack of
healthcare services keep slum dwellers in perpetual cold cycles, especially the children.
Contrary to our assumptions, it gets very cold in the slums at night and when the rainy
season comes around it gets even colder.
Migraine Headaches: Jane, like many slum dwellers, also experienced severe migraine
headaches. They would be so bad at times that all she could do is lay down and wait for
them to go away. Now she has access to proper medicine and gets good rest on a daily
basis and has less stress in her life so I am glad to say she has dramatically reduced her
migraine headaches. I cannot say they have completely gone, but now she does not
worry about them like she used to.
Stomach Problems: Jane, like most slum dwellers, also had problems with her stomach,
ranging from diarrhea to stomach pains. This caused her to spend lots of time in pain,
but like all the rest, they just bear through the pain and go about their daily business.
Now, Jane is pain free and her stomach, once again due to improved diet and living
conditions, is feeling much better. She used to visit the clinic on a regular basis but now
she no longer has to go. Simple drugs like antacids make a world of difference.
Stress Related Problems: The daily stress of living in the slums can make anyone go
crazy. Jane used to sew clothes for a living as she is your typical statistic making $1 per
day. Stress ranges from will I eat today to where will I sleep? No longer having these

25. [25]
burdens, Jane closed down her business and soon after many of her physical problems
dissipated. In addition, not only has her stress been dramatically reduced, Jane has also
been able to save money and even send money to her relatives still living in the slums.
In Africa, unlike the west, the children are expected to take care of the parents and this
alone can be very stressful. She actually left our home for several months, she has since
returned, to take care of her brothers and parents. In Africa, a woman is supposed to
take care of her family first and everything else, including her dreams, is second. After
only 3 months away from our home upon her return, Jane had all the same problems
she had from the beginning. Once again she was extremely skinny, she had skin
problems and her stomach and fainting spells returned. Fortunately, Jane is back with
us and doing well.
***All statistics are based on girls participating in FICCS programs***
Education Levels (100 Women Ages 18-23)
Graduated High School
Advanced Diploma
graduated 8th Grade
8th Grade or below

26. [26]
***All statistics are based on girls participating in FICCS program***
Z. Conclusion
Healthcare for young women and girls in Kenya still remains an obstacle. Easily preventable
diseases continue to plague young women and girls, especially female related problems. Access
to healthcare services is minimal at best and the quality of medical care is lacking. Women and
girls suffering from poor sanitation and extreme poverty routinely are subject to minor illnesses
that untreated turn into major illnesses. These medical conditions put an extreme burden on
the already over stretched medical system and also place a burden on the families and
communities at large, both financially and emotionally.
Although the healthcare outlook for women and girls in the slums of Africa looks bleak, there is
a light at the end of the tunnel. With the proper infusion of training, health awareness,
education and community participation, simple diseases which are now major burdens on the
impoverished society can be greatly reduced. The more people learn how to prevent diseases
and treat simple illnesses, the healthier a community will become. Health is both physical and
emotional, thus a healthier community is a more productive community which in the end will
lead to a more prosperous community. It is easier and cheaper to prevent a disease that it is to
cure that very same disease. As billions of dollars are spent on HIV/AIDS and other
communicable diseases, far less money could be spent on training women and girls to prevent
these often fatal diseases which plague the poverty stricken areas of Africa.
Access to Healthcare Services in the Slums
Advanced Medical Care
Clinic Services
Community Services (non
profit)
HomeBased Healthcare