Influence of household sanitation practices on incidence of waterborne diseases in Ngong Mathare informal settlement, Kenya
Informal settlements often face the problem of inadequate and poorly maintained sanitary infrastructure, which leads to a high incidence of water-borne diseases. In Ngong Mathare, Kajiado County, incidence of waterborne diseases including cholera, typhoid, dysentery and diarrheal infections could be attributed to poor living conditions.
The study sought to assess the influence of household sanitation practices on incidence of waterborne diseases in Ngong Mathare informal settlement. Specifically, the study aimed to examine the influence of sanitation facility and maintenance practices, assess observable personal hygiene indicators and reported handwashing practices, establish the influence of water and waste management practices, evaluate the influence of social cultural practices and analyze incidence and health impact of waterborne diseases through retrospective analysis of health facility records.
A cross-sectional survey design utilizing a mixed methods approach was used. The study population was households of the informal settlement. The total number of households was 2,500 while the population was 8,750 with an average household size of 3.5. A sample size of 345 households was calculated using Yamane’s formula. Participants were selected through stratified systematic random sampling in three zones including riverbank, central and peripheral, while 17 key informants, including health workers and community workers, were purposively selected to collect qualitative data. Quantitative data were collected through structured questionnaires and an observation checklist. Qualitative data were collected using focus group discussions.
Clinical data were obtained through a retrospective analysis of hospital records in the Ngong, Zamzam, and Kenswed Hospitals for the preceding four months (October 2025 to January 2026). Data was analyzed using descriptive statistics, chi-square tests, Pearson correlation and binary logistic regression. The response rate was 97% having (n) as 334 whereby 45.2% of households used unimproved or unsanitary toilets, which was significantly associated with the increased incidence of infectious diseases (r=-0.488,p<0.05;”OR”=0.326,p=0.001).
There was notable significant resource scarcity as 80% of households lacked both soap and water for handwashing (“OR”=0.373,p<0.001). Furthermore, 65% of households did not purify drinking water due to economic difficulties, while 70% disposed of waste into the Ngong River. Hygiene behavior and privacy needs were strongly constrained as the household income was below KES 10000 for 46% with 75% preferring flying toilets over un-lockable shared latrines. Medical records confirmed 479 cases of diarrhea over four months, 66.4%, (n=318) of the total burden, of which involved children under five years of age.
Rehabilitation of infrastructure showed that poor hygiene was a major risk factor and significantly increased the likelihood of transmission (OR = 4.26, on incidence of waterborne p < 0.05). The study demonstrated that a high level of health literacy was undermined by structural and economic barriers, which led to a continuous cycle of new infections.
The study recommends implementation of a community-based health service program and improvement in municipal solid waste collection at Kajiado County Government. This study contributed to the development of community-based health interventions in specific settings, based on the Sustainable Development Goal, especially SDG 6, which aims to ensure availability and sustainable management of water and sanitation for all and SDG 11 which aims to make cities and human settlements inclusive, safe, resilient, and sustainable by 2030.
