Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study
Loading...
Date
2025-10-28
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Nature
Abstract
Background
Diarrheal diseases are prevalent among children under five years of age in slum areas. We evaluated the effect of safe water delivery plus water, sanitation, and hygiene (WASH)-Behavior Change Communication (WASH-BCC on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya.
Methods
We designed a quasi-experimental study, with the intervention as safe water delivery plus WASH-BCC. The intervention arm consisted of 2 slum villages that received safe water plus WASH-BCC, while the comparison arm comprised 2 slum villages that did not receive the intervention. The primary outcome was diarrheal disease in a child under five years of age in the past 2 weeks in both study arms, defined as the passage of ≥ 3 watery stools in the past 24 h. Data were collected at the baseline and endline from a random sample of eligible households in the villages. Propensity score weighting was used to achieve similarity in measured covariates between both arms. Binary logistic regression analysis, adjusting for propensity-score weights, was utilized to estimate the causal effect of the intervention, reported as odds ratio (OR) and 95% confidence interval (CI).
Results
We analyzed data from 1,876 participants in a 1:1 ratio and found 382 (20.4%) children under five years of age had diarrheal disease at the endline. Diarrheal disease prevalence declined in the intervention villages (33.3% baseline vs. 23.5% endline) but increased in the comparison villages (15.7% baseline vs. 17.5% endline). We found a 31% decline in diarrheal disease in the intervention villages relative to the comparison villages (OR 0.69, 95% CI 0.55–0.86). In a difference-in-differences analysis, the decline was 11.4%. The findings remained robust in a sensitivity analysis.
Conclusion
The intervention significantly reduced diarrheal disease prevalence in children under five years of age in the slum setting. Therefore, there is a need to expand the intervention to the remaining areas to reduce diarrheal disease morbidity and mortality.
Description
Keywords
Access to safe water, Behavior change communication, Diarrheal disease, Slum, Kenya
Citation
Izudi, J., Muchiri, E., Musyoka, D., Simiyu, S., Tumwebaze, I. K., Mbaya, N., ... & Abajobir, A. (2025). Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study. BMC Public Health, 25(1), 3641.