Factors influencing discharge of raw sewage in water sources in Mukuru slums, Nairobi (Kenya)

Globally, access to basic sanitation and hygiene remain a challenge and a significant number of people still practice open defecation which lead to million tons of sewage discharge into water sources. Access to basic sanitation services in Kenya is also low and people continue to consume faecally contaminated water. This study assessed factors influencing raw sewage discharge into Kenyan water sources, focusing on social norms, health effects, and coping strategies. Using a descriptive cross-sectional design, data were collected through questionnaires and interviews. Findings showed that 96.1% of respondents disposed of raw sewage into water sources. Key societal norms influencing the disposal included communication, cooperation, coordination (43.8%, p=0.0002), belief in proper sewage disposal (85.1%, p=0.046), social networks (46.4%, p=0.000), and community pressure (46.4%, p=0.000). Waterborne diseases were reported at 77.9%, including diarrhoea (93.4%), vector-borne diseases (83%), skin irritations from mosquito bites (83.6%), and respiratory illnesses (92.3%). Additionally, 94.4% of the respondents reported flu, 85.1% experienced anxiety, and 83.8% had skin infections due to rashes. Pour flush toilets were used by 49.4%, but many residents demonstrated lack of knowledge on sewage treatment (80%) and disposal systems (76.2%). Household relocation (43.5%, p=0.044) and sanitation negligence (79.1%, p=0.030) were significant factors that influenced the practices. The study concluded that societal norms, coping strategies and health related issues impacted and influenced sewage disposal practices, impacting environmental sustainability, sanitation systems and public health outcome. The study recommends community engagement and accountability approaches on sustainable sanitation practices and future studies on climate change impacts on sanitation infrastructure.