Water and Sanitation: Key Factors Associated with Women's Physical and Mental Health in Informal Settlements in Nairobi, Kenya

Background and purpose: In lower- and middle-income countries (LMICs) nearly half of the population has suffered from diseases associated with poor sanitation and/or water-related diseases. Myriad studies have linked poor water and sanitation (W&S) to communicable diseases like diarrhea and typhoid, but only recently have studies begun to link lack of adequate W&S to gender-specific health consequences for women. Without private and hygienic toilets, for example, women may suffer from vaginal and/or urinary tract infections (UTIs) and hemorrhoids associated with defecating in the open; using unclean, shared toilets; and/or retaining their urine/feces to avoid frequent calls of nature. Furthermore, women, particularly those living in informal settlements, risk exposure to violence/harassment when having to go outside their home to find a place to urinate/defecate and, consequently, suffer higher levels of psychosocial stress. Despite new studies suggesting a link between inadequate W&S and mental and physical health consequences for women, there is very little research focused on this issue. The purpose of this study is to help reduce the gap by exploring this link in informal settlements in Nairobi, Kenya.

Method: Data were collected as part of a 2018 study focused on women’s physical and mental health outcomes in Mathare Valley Informal Settlement in Nairobi, Kenya. A sample of 552 female residents were randomly selected to participate. Linear and logistic regressions were used to explore associations between women’s access to W&S and a number of physical and mental health outcomes, including a Kiswahili version of the Short Form Health Survey (SF-36), the Kessler Scale of Psychological Distress (K10), the Patient Health Questionnaire Depression Scale (PHQ-9), suicidal ideation/attempts, and several gender-specific conditions linked to inadequate WASH. Socio-demographic characteristics were also included as covariates.

Results: Using a toilet, as opposed to bags/buckets/open defecation, was associated with higher mental health, social functioning, and general health scores, and lower psycho-social distress. Using a toilet was also associated with lower odds of recent yeast infections. Relying on a public tap/well, compared to a private tap, was associated with energy, mental health, and social functioning scores and lower psycho-social stress. Relying on an outside tap/well was associated with higher energy and mental health scores. Finally, relying on vendors/tankers/burst pipes was significantly associated with lower general health scores and higher odds of experiencing major depressive disorder and yeast infections.

Conclusion and Implications: Goal 3, to ‘ensure healthy lives and promote well-being for all at all ages,’ of the Sustainability Development Goals highlights the need for better research and interventions that recognize the different health outcomes and needs of women and their associated risk and protective factors in all contexts. Particular attention needs to be paid to these issues in informal settlements where the population is expected to double in the next 30 years. Findings from this study seem to point to a critical link between women’s access to W&S and their physical and mental health in informal settlements in Kenya—a link that should not be ignored when proposing future social- and health-related theories and interventions in these settlements.