Heavy traffic and congested pedestrian streets. Welcome to the city under the sun. Nairobi. As a Nairobian, or a visitor-alike, you learn soon enough how to jump over neatly arranged oranges on the dusty streets, how to dodge potholes, how to save your skin from the always speeding matatus. Always alert. Always awake. These are skills that we Nairobians have learned to navigate this city.
But amidst this melee, when the dust settles — quite literally — in the evening, the bustling city slowly hums down (save for a few night joints and clubs). It goes quiet, it is as if to recharge ahead of another action-packed day tomorrow.
Where did all the people go?
According to the national census, Nairobi County has a population of over 3 million people living on about ten thousand square kilometers of land. This means that there are approximately 30 individuals living in a space the size of a football field. Crowded? Well, keep reading, it gets worse.
In 2017, the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) by the African Population and Health Research Center surveyed about 32,000 individuals in Korogocho covering a surveillance area of about 0.97 km2. This means that Korogocho alone is ten times as congested as the city of Nairobi itself.
To put it into perspective, Korogocho has over 170 people for every space equal to a football field. This is overcrowded!
The NUHDSS seeks to understand the link between rapid urbanisation, poverty and health. Since 2002, these longitudinal surveys have tracked individuals and families in two informal settlements: Korogocho and Viwandani.
Africa has been experiencing the fastest urban population growth rates in the world (3.44 percent between 1995 and 2015), Kenya’s figures in 2016 were 4.2368 percent. The unplanned urbanisation has led to the rapid increase of slum populations with about 60-70 percent of Nairobians living in informal settings. That is at least three in four people live in an area that covers a little more than a quarter of the city.
The population of the city can be summed up into a two-part statement: “So many people live on so little space, yet very few people live on very large space.”
Back to that question: where do all the people go? Informal settlements.
While it is difficult to keep track of this population owing to their constant migration, it is estimated that by 2030, one out of four urbanites in Kenya will be a slum-dweller.
The NUHDSS also tracks health, education, pregnancy outcomes and vaccinations, deaths, economic capabilities of the residents and fertility preference. It is clear that overcrowding in these settlements pose great risks to the residents – especially on their health and socio-economic wellbeing.
Congestion also means that the spread of communicable and infectious diseases is often quick and devastating, with households typically comprising of four to eight people sharing a single room. It is thus not surprising that from 2003 to 2012, the NUHDSS reported that tuberculosis was the leading cause of death in these settlements, followed by injuries, then HIV/Aids. On top of that, the psychosocial effect of overcrowding is the loss of dignity for the adults and poor development for the children.
This is coupled by the fact that, the infrastructure of informal settlements and the crippling poverty of its residents have an impact on the decisions about cooking fuels and household lighting, which affects their health. For example, the prolific use of kerosene lamps and firewood contributes to respiratory tract and eye problems. These reflect findings from the NUHDSS that slum residents in Nairobi have a high mortality burden from preventable and treatable conditions.
There is no official record on the number of slums or the surface area that slums cover, the data collected by the NUHDSS provides a good reference point to understand the population dynamics in informal settlements and the public health challenges abound. However, this data in itself means nothing for some of these slum residents.
Since 2012, the specialised studies that are nested on the NUHDSS platform have shifted from observation to intervention research, involving both government and development partners.
The country has made significant strides in reducing child mortality, improving maternal health and many other health challenges. Despite the milestones achieved so far, the urban poor still remain as the weakest link in the national pursuit in health and well-being.
In 2012 it was estimated that in Korogocho and Viwandani, out of every 1000 children, around 16 of them will die before the age of five. Children still die from preventable diseases and women from child-birth related complications. The number is comparably significant in informal settlements.
It is unfortunate that even in urban areas, people still die of avoidable deaths. The NUHDSS has made bold commitment in highlighting some of the health challenges faced by the urban poor. But we are taking it further by engaging with policy makers who can use some of the evidence from specialised studies such as the NUHDSS to address some of these challenges.
Henry Owoko, Field Interviewer, African Population and Health Research Centre.