Iddi Samuel, Akeyo Dennis, Bagayoko Moussa, Kiwuwa-Muyingo Slyvia, Chikozho Claudious, Kadengye Damazo T
Department of Statistics and Actuarial Science, University of Ghana, Legon-Accra, Ghana.
African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
Glob Epidemiol. 2021 Mar 5;3:100050. doi: 10.1016/j.gloepi.2021.100050. eCollection 2021 Nov.
Access to improved water, sanitation, and hygiene (WASH) services at the household level remains a good strategy to improve the health and well-being of individuals. Informal settlements, such as urban slums, are at risk of the spread of diseases due to the relative lack of access to safe, clean drinking water and basic sanitation, as well as poor hygiene. Global initiatives, such as the Sustainable Development Goals (SDGs) adopted by the United Nations, are aimed at transitioning households and communities from unimproved to sustained improved states of WASH services. To deepen understanding of the time dynamics between states of WASH services in the Nairobi Urban and Demographic Surveillance System (NUHDSS), this study employs the multi-state transition model to assess the influence of potential risk factors on these transitions. Results indicated that study sites, wealth tertile, age of household head, poverty status, the ethnicity of household head, household ownership, and food security were associated with household transitions of WASH services. There was a lower probability for households to transition from unimproved to improved toilet services than the reverse transition, but a higher chance for households to transition from unimproved to improved water and garbage services. The estimated average time that households spent in the unimproved and improved states before transitioning were, respectively, 35 months and 9 months for toilet services, 7 months and 66 months for water services, and 16 months and 19 months for garbage services. Thus, households tend to remain longer in the unimproved state of toilet and garbage services, and when in the improved states, they transition back relatively faster compared to water services. In conclusion, sanitation services in Nairobi informal settings remain largely unsatisfactory as transitions to improved services are not sustained. It is therefore important for governments, policy-makers, and stakeholders to put in place policies and interventions targeting vulnerable households for improved and sustained WASH services.
在家庭层面获得改善的水、环境卫生和个人卫生（WASH）服务仍然是改善个人健康和福祉的良好策略。非正规住区，如城市贫民窟，由于相对缺乏安全、清洁的饮用水和基本卫生设施，以及卫生条件差，面临疾病传播的风险。全球倡议，如联合国通过的可持续发展目标（SDGs），旨在使家庭和社区从未改善的WASH服务状态转变为持续改善的状态。为了更深入地了解内罗毕城市和人口监测系统（NUHDSS）中WASH服务状态之间的时间动态，本研究采用多状态转换模型来评估潜在风险因素对这些转换的影响。结果表明，研究地点、财富三分位数、户主年龄、贫困状况、户主种族、家庭所有权和粮食安全与家庭WASH服务的转换有关。家庭从不改善的厕所服务转换为改善的厕所服务的概率低于相反的转换，但家庭从不改善的水和垃圾服务转换为改善的服务的机会更高。估计家庭在转换前处于未改善和改善状态的平均时间，厕所服务分别为35个月和9个月，水服务为7个月和66个月，垃圾服务为16个月和19个月。因此，家庭往往在未改善的厕所和垃圾服务状态下停留更长时间，而当处于改善状态时，与水服务相比，它们转换回未改善状态的速度相对较快。总之，内罗毕非正规住区的卫生服务在很大程度上仍然不能令人满意，因为向改善服务的转变没有持续下去。因此，政府、政策制定者和利益相关者制定针对弱势家庭的政策和干预措施以改善和持续提供WASH服务非常重要。
