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Background Air quality in Africa has remained a relatively under-researched field. Most of the African population is dependent on biomass for cooking and heating, with most of the combustion happening in low efficiency stoves in unvented kitchens. The resulting high emissions are compounded by ingress from poor outdoor air in a context of poor emissions controls. The situation is dire in slum households where homes are crowded and space is limited, pushing households to cook in the same room that is used for sleeping. This study assessed the levels of particulate matter with aerodynamic diameter £ 2.5 microns (PM2.5) in slum households and people's perceptions of and attitudes towards air pollution and health risks of exposure in two slum areas, Viwandani and Korogocho, in the Nairobi city. Methods The study employed both qualitative and quantitative methods. For the quantitative study, we used structured questionnaires to collect data about the source of air pollution among adults aged 18 years and above and pregnant women residing in the two study communities. We used the DustTrak™ air samplers to monitor the indoor PM2.5 levels in selected households. We also collected data on community perceptions on air pollution, annoyance and associated health risks. We presented hotspot maps to portray the spatial distribution of perceptions on air pollution in the study areas. For the qualitative study, we conducted focus group discussions with adult community members. Groups were disaggregated by age to account for different languages used to communicate with the younger and older people. We analysed the qualitative data using thematic analysis. Results Household levels of PM2.5 varied widely across households and ranged from 1 to 12,369μg/m3 (SD=287.11). The household levels of PM2.5 levels were likely to exceed the WHO guidelines given the high levels observed in less than 24 hours of monitoring periods (on average 10.4 hours in Viwandani and 11.8 hours in Korogocho). Most of the respondents did not use ventilation use in the evening which coincided with the use of cookstove and lamp, mostly burning kerosene. The levels of PM2.5 varied by the type of fuels, with the highest emissions in households using kerosene for cooking and lighting. The PM2.5 levels spiked in the evenings and during periods of cooking using charcoal/wood. Despite these high levels, residents perceived indoor air to be less polluted compared with the outdoor air, possibly due to the presence of large sources of emissions near the communities such as dumpsites and industries. The community had mixed perceptions on the health impacts of air pollution, with respiratory illnesses perceived as the main consequence while vector or sanitation related diseases such as diarrhoea was also perceived to be related to air pollution. Conclusions With poor housing and reliance on dirty fuels, households in slums face potentially high levels of exposure to PM2.5 with dire implications on health. To address the poor perception on air pollution and knowledge gaps on the health effects of air pollution, education programs need to be developed and tailored. These programs should aim to provide residents with information on air quality and its impact on the health; what they can do as communities as well as empower them to reach out to government/stakeholders for action on outdoor sources of pollution such as emissions from dumpsites or industries. The government has a larger role in addressing some of the key pollution sources through policy formulation and strong implementation/enforcement.

SummaryAlthough desired family size is often different from actual family size, the dynamics of this difference are not well understood. This paper examines the patterns and determinants of the difference between desired and actual number of children (unmet fertility desires) among women aged 15–49 years using pooled data from the 1990, 1999 and 2003 Nigeria Demographic and Health Surveys (NDHSs). The results show that more than two-thirds of the sample have unmet fertility desires (18.1% have more while 52.4% have fewer than desired). It was found that early and late childbearing increased the odds of unmet fertility desires. Also, women with low levels of education, from poor households, rural residents as well as those who had experienced child death were at a higher risk of unmet fertility desires in the multivariate context. The study highlights the policy and programme implications of the findings.

Abstract Background The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. Methods The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Results Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. Conclusions The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Surging amounts of waste are reported globally and especially in lower-income countries, with negative consequences for health and the environment. Increasing concern has been raised for the limited progress achieved in practice by diverse sets of policies and programmes. Waste management is a wicked problem characterised by multilayered interdependencies, complex social dynamics and webs of stakeholders. Interactions among these generate unpredictable outcomes that can be missed by decision makers through their understanding and framing of their context. This article aims to identify possible sources of persistent problems by focussing on what captures, shapes and limits the attention of stakeholders and decision-makers, drawing on the attention-based view from organisation theory. The theory describes the process through which issues and opportunities are noticed and how these are translated into actions, by focussing on the influencers at the individual, organisational and context scale. Views on issues and opportunities for waste management were collected in a series of fieldwork activities from 60 participants representing seven main types of stakeholders in the typical lower-middle income Kenyan city of Kisumu. Through a thematic analysis guided by the attention-based view, we identified patterns and misalignment of views, especially between government, community-based organisations and residents, which may contribute to persistent waste problems in Kisumu. Some point to detrimental waste handling practices, from separation to collection and treatment, as the main cause of issues. For others, these practices are due to a poor control of such practices and enforcement of the law. This study's major theoretical contribution is extending the application of attention theory to multi-stakeholder problems and to non-formalized organisations, namely residents and to the new field of waste management. This novel lens contributes a greater understanding of waste issues and their management in Africa that is ...