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DIRECTORATE OF CAPACITY BUILDING
THE AMREF VIRTUAL NURSING SCHOOL
Community Diagnosis Report: Kibagare informal settlements, Westlands.
Activity Date: June 2010
COMPILED BY:
September 2008 Class,
AMREF Virtual Training School,
P.O .Box 27691-00506, Nairobi.
Tel.6993000
Email:[email protected]
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PREAMBLE
The AMREF Virtual Nursing School has been training nurses through eLearning for close to
three years. AVNS aims to provide nursing students across African countries with increased
access to quality nursing education, thus improving health care. As part of its community
health module, AVNS introduced a practical community diagnosis exercise geared towards
equipping the diploma nurse with the critical skills required to deal with community health
needs, designing community health programmes and implementation through a
participatory community approach. A community diagnosis is a means of examining
aggregate and social statistics in a community in order to determine the health needs of
that community. By means of a community diagnosis, a health worker is able to evaluate the
health status of a community and identify priority health needs, then determine the
required plan of action. AVNS nurses carried out a community diagnosis in June 2010 in
Kibagare informal settlements. This was the third community diagnosis to be carried out by
AVNS students. The students with the help of their trainers analyzed the data and came up
with findings which will inform the organization of the health action day.
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1.0 BACKGROUND INFORMATION
Kibagare village is located in Kitisuru sub-location, Kitisuru location of Kangemi division in
Westlands district within Nairobi province. It is approximately fifteen (15) kilometres from
the city centre on the western side of Nairobi. The village is bordered by Loresho estate on
the North & West, Kyuna estate on the South and Nairobi school, Kabete water treatment
works & Communications Commission of Kenya (CCK) to the East. The village (Kibagare) has
approximately (3,000) three thousand households with a total population of around 15,000
people.
Economically most people in the village are casual labourers engaged in menial jobs for daily
upkeep. A few do small scale business like green groceries, food vendors and water vendors.
The main means of communication in the village is mobile telephone and mass media (Radio
& television) .The main means of transport in the community is public transport, hired taxis
and motorcycle (boda-boda) transport. The village gets its water supply from bore-holes
drilled in the area and piped water from Nairobi water company. The dominant social
practices in the community includes church attendance on weekends, weddings and women
group meetings. The community has a few social amenities including churches and a few
private schools.
The community faces a myriad of problems from poor social-economic problems, poor
environmental sanitation (no latrines, poor drainage system), and lack of enough social
amenities such as hospitals, schools and social halls.
1.1 Objectives of community diagnosis
i. To assess the community health status
ii. To assess the health needs of Kibagare community.
iii. To establish the common communicable diseases in the area
iv. To identify the demographic characteristics of the slum dwellers.
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2.0 FINDINGS
2.1 DEMOGRAPHIC CHARACTERISTICS
Men are less (45%) than women (55%). The most dominant age group is 25-59 yrs (31%).
Most of the residents are Christians (99.4%). Only 34% of household heads had a social net.
Table 1: Age and gender distribution
Out of the 104 household that were randomly selected, 36 % had 1-3 members, 35% had 4-
5 members per household and the rest had over 5 members (27%).
Figure 1 : A bar graph showing the number of individuals living in one house
36%
35%
27%
0% 10% 20% 30% 40%
Less than 3
4_5
More than 5
% of households
No
. o
f fa
mil
y m
em
be
rs
NO. OF FAMILY MEMBERS PER HOUSEHOLD
AGE MALE FEMALE TOTAL
Below 5yrs 10% 10% 20%
6-12rys 8% 10% 18%
13-24 yrs 10% 19% 19%
25-59yrs 16% 15% 31%
Above 60rys 1% 1% 2%
Most of the households (65%) ar
and 7% by others who included grandparents and elder siblings
Figure 2: A pie chart showing heads of house holds
Most residents of Kibagare (63%) have primary edu
education. Respondents with
Figure 3: Level of education
30%
5%
HOUSE HOLD HEADS
30%
LEVEL OF EDUCATION
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Most of the households (65%) are headed by a male (father), 30% are headed by
included grandparents and elder siblings.
showing heads of house holds
(63%) have primary education with very few (6%) with tertiary
secondary education accounts for 30%.
65%
5%
HOUSE HOLD HEADS
Father
Mother
Other
63%
6%
LEVEL OF EDUCATION
Primary
Secondary
Tertiary
father), 30% are headed by a female
with very few (6%) with tertiary
Salaried residents accounts for only 20% mo
employed. Self employment is mainly in form of small businesses
consistent source of income.
Figure 4: Sources of income
2.2 ENVIRONMENTAL HYGIENE AND SANITATION
Most of the compounds were
compounds human waste.
Figure 5: Cleanliness of the compound
20%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Salaried
% o
f h
ou
seh
old
s
MAIN SOURCE OF INCOME
0%
Poor
Fair
Good
CO
ND
ITIO
N
CLEANLINESS OF THE COMPOUND
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Salaried residents accounts for only 20% most of who are casual labourers. 41% are self
Self employment is mainly in form of small businesses. 39% did not mention any
ENVIRONMENTAL HYGIENE AND SANITATION
Most of the compounds were unkempt (71%). There was litter, liquid waste and in some
: Cleanliness of the compound
41%39%
Self Employed Others
SOURCE
MAIN SOURCE OF INCOME
20% 40% 60% 80%
71%
9%
20%
% OF HOUSEHOLDS
CLEANLINESS OF THE COMPOUND
are casual labourers. 41% are self
. 39% did not mention any
(71%). There was litter, liquid waste and in some
80%
52% of the respondents had a latrine that was functional
fit for use and 33.6% of the housed holds did not have a
the latrines were not in use because they have collapsed or are about to collapse
due to poor maintenance.
LATRINE/TOILET STATUS
Present in use
Present not in use
Absent
Table 2: Presence
85% of the households did not have a hand washing facility
Figure 6: Presence of Hand
Most residents (52%) use water in
basin, 4% use running water only and only 2% use running water and soap.
85%
PRESENCE OF HAND WASHING FACILITY
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52% of the respondents had a latrine that was functional but shared
fit for use and 33.6% of the housed holds did not have a latrine. It was observed that
were not in use because they have collapsed or are about to collapse
due to poor maintenance.
LATRINE/TOILET STATUS PERCENTAGE
52
14.4
33.6
Presence and use of latrine.
85% of the households did not have a hand washing facility.
of Hand washing facility
Most residents (52%) use water in a basin and soap to wash hands, 41% use plain water in a
basin, 4% use running water only and only 2% use running water and soap.
15%
PRESENCE OF HAND WASHING FACILITY
Present
Absent
but shared, 14.4% were not
latrine. It was observed that
were not in use because they have collapsed or are about to collapse
a basin and soap to wash hands, 41% use plain water in a
basin, 4% use running water only and only 2% use running water and soap.
Present
Absent
Figure 7
Most households (70%) discard solid waste in the compound, 4% bury,, 4% use
compost pit while 16% use other methods like recycling
METHOD OF DISPOSAL
Burn
Rubbish pit
Compost pit
Scattering
Others
Table 3: Methods of solid waste disposal
The main source of water is piped water (87%).
they are located at different sites in the village.
and river. Most residents (73%) do not use any form of water purification before
drinking only a few boil (15%) and use chemical (12%). The chemical that is
commonly used is chlorine. Other ways included filtering and decantation.
Running water with soap
Running water only
soap and water in a basin
Water in a basin
Me
tho
d o
f h
an
d w
ash
ing
8
7: Methods of hand washing
(70%) discard solid waste in the compound, 4% bury,, 4% use
compost pit while 16% use other methods like recycling.
PERCENTAGE
4
6
4.
70
16
Methods of solid waste disposal
The main source of water is piped water (87%). The water taps are
they are located at different sites in the village. The other sources included borehole
residents (73%) do not use any form of water purification before
drinking only a few boil (15%) and use chemical (12%). The chemical that is
commonly used is chlorine. Other ways included filtering and decantation.
0% 10% 20% 30% 40% 50% 60%
Running water with soap
Running water only
soap and water in a basin
Water in a basin
2%
4%
52%
41%
Proportion (%)
(70%) discard solid waste in the compound, 4% bury,, 4% use
The water taps are communal and
The other sources included borehole
residents (73%) do not use any form of water purification before
drinking only a few boil (15%) and use chemical (12%). The chemical that is
commonly used is chlorine. Other ways included filtering and decantation.
60%
Figure 8: Methods of water purification
2.3 MATERNAL CHILD HEALTH
All most all the respondents (99%) knew about modern family planning methods
and the same proportion use family planning
facilities (68%). The 34% who
traditional birth attendants or they assist self.
Figure 9: Place of delivery
0%
10%
20%
30%
40%
50%
60%
70%
80%
Boiling
% o
f h
ou
seh
old
s
METHODS OF WATER PURIFICATION
68%
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thods of water purification
MATERNAL CHILD HEALTH AND NUTRITION
All most all the respondents (99%) knew about modern family planning methods
and the same proportion use family planning. Most residents deliver in health
facilities (68%). The 34% who deliver at home are either assisted by relatives,
traditional birth attendants or they assist self.
: Place of delivery
Boiling Chemicals Others None
Methods
METHODS OF WATER PURIFICATION
34%
Home
Health facility
All most all the respondents (99%) knew about modern family planning methods
Most residents deliver in health
deliver at home are either assisted by relatives,
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The immunization coverage was 74%. Most children are weaned before time (54%).
Figure 10: Age at weaning
The main source of food is the market with starch being the most easily accessed type of
food. Most residents use smoking method of food preservation. Charcoal is the most
common fuel that the residents use. Half of the residents take less than three meals per day.
On general examination, 9% of the respondents were undernourished.
NO. OF MEALS
One(1)
Two(2)
Three(2)
% OF HOUSE HOLDS
22% 28% 50%
Figure 11: Number of meals per day.
2.4 ACCESS TO HEALTH FACILITIES
Walking is the most common means of transport to health facility. The only other mode of
transport is road in which most residents use public vehicles.
54%
45%
0% 10% 20% 30% 40% 50% 60%
Below 6
At 6 and above
% of children
Ag
e i
n m
on
ths
Figure 12: Means of transport
3.5 EPIDEMIOLOGY
62% of the respondents reported to have had illness in their family in the last 2 weeks.
Respiratory infections, diarrhoeal diseases and Malaria are the most common diseases.
Figure 13: Illness in the house hold
DISCUSSION
The demographic characteristics show that the f
This can be attributed to the time the data collection was d
evening. Many men, Kibagare
gone to work. In addition, the rations also reflect the national proportions (National census
2008). The proportion of Christians also is similar to the finding of the 2008 census.
According to the findings very few house
attributed to two factors. First
56%
MEANS OF TRANSPORT
0%
20%
40%
60%
80%
Present
62%
% o
f h
ou
seh
old
s
Status of illness
PREVALENCE OF ILLNESS
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62% of the respondents reported to have had illness in their family in the last 2 weeks.
Respiratory infections, diarrhoeal diseases and Malaria are the most common diseases.
: Illness in the house hold in the Last 2 weeks.
The demographic characteristics show that the female respondents were more than men.
This can be attributed to the time the data collection was done; mid morning to mid
Kibagare being a patriarchal society as the findings show, may have
the rations also reflect the national proportions (National census
2008). The proportion of Christians also is similar to the finding of the 2008 census.
According to the findings very few house hold heads have a social net. This may be
First, most of the heads are men who are not expected culturally
94%
0.8%
MEANS OF TRANSPORT
On foot
Public vehicle
Private vehicle
Absent
38%
Status of illness
PREVALENCE OF ILLNESS
Present
Absent
62% of the respondents reported to have had illness in their family in the last 2 weeks.
Respiratory infections, diarrhoeal diseases and Malaria are the most common diseases.
e more than men.
one; mid morning to mid
ty as the findings show, may have
the rations also reflect the national proportions (National census
2008). The proportion of Christians also is similar to the finding of the 2008 census.
hold heads have a social net. This may be
the heads are men who are not expected culturally
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to form social groups like females are. The other factor is that Kibagare is an urban slum and
therefore people may be reluctant to form social groups due to the high migration rate as
well the weak social associations that characterize most urban slums.
The modal class for family size is 1-3. This relates well with the high awareness and
utilization of family planning. However it is important to note that the most dominant age
group is 24-59 years; this can change future trends as it means most families are in the
expansive stage.
Most residents of Kibagare have attained primary level of education. This may be associated
with the low economic status (only 20% are salaried) but also to the accessibility of schools
having only private schools in the slum. On the other hand, the low level of education could
also be contributing to the low economic status as most of the residents cannot get
professional jobs.
Even though most respondents reported to have a latrine, these latrines are shared by
several households. Sharing of latrines is a risk factor to transmission of diarrhoeal diseases
and other faecal oral transmitted diseases. This is made worse by the poor methods of hand
washing the community uses and also the failure to purify water for drinking. All these can
be the contributing factors to the high prevalence of diarrhoeal diseases as reported by the
respondents.
The method of waste disposal (crude tipping) explains why most compounds were not
clean. The congestion of houses and overcrowding of people in the slum may make waste
generation to be higher than it is possible to dispose it bearing in mind the social economic
status of the community. However, cheaper methods like controlled tipping can be pursued.
The high utilization of family planning and the high immunization coverage together with
the health seeking behaviour of Kibagare community can be linked to the accessibility of the
health centre. The health centre is located approximately 5km from the slum and
considering the main mode of transport (walking) most people can access the health
services. However, in case of mothers in labour it may be cumbersome to walk to the health
facility no wonder a good number (34%) have home deliveries.
CONCLUSION
There are many health problems facing Kibagare slum that requires multisectorial approach
and rigorous community participation.
RECOMMENDATIONS
1. There is need for health education on the following:
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• Proper waste disposal
• Water purification
• Management of diarrhoea
• Proper hand washing technique
2. The local government authority and other partners should work to provide proper
means of waste disposal e.g. controlled tipping.
3. Advocacy for skilled birth attendance needs to be intensified.