Thesis:

Health-seeking behavior during covid-19 among slum dwellers in railways informal settlement, Mombasa county, Kenya: a cross- sectional study

Severe Acute Respiratory Syndrome of Covid Virus (SARS-CoV-2) commonly known as corona virus (COVID–19), was discovered as a new viral class of Coronaviridae family when a cohort of people in Wuhan Province in China were suspected to present with pneumonia-like symptoms which confirmed to be novel coronavirus. Preventive measures and vaccination are the main approaches to controlling spread of COVID-19 while early disease stage health-seeking behavior (HSB) of patients is an important link to achieving infection prevention and control. Slums present with increased population rate, inadequate access to clean water, small informal dwellings and sharing of unhygienic sanitation facilities such as toilets by multiple households. Slum dwellers are considered among high-risk individuals during pandemics and other disease outbreaks recording higher overall mortality and morbidity rates hence HSB of slum dwellers in Railways slums in Mombasa County was investigated. A descriptive cross-sectional study design was used to administer 133 structured questionnaires and 3 key informants’ interviews, to participants who were selected using simple random and purposive sampling, respectively. Data was analyzed and results presented using tables, charts, graphs and thematic narration. Ethical approval was obtained from Mount Kenya University, NACOSTI and local authorities in Mombasa County. The study found mean age was 37.5 years, 69.2% were married 46.6% had attained secondary level of education and 79.7% were Christians. Most slum dwellers are self-employed (51.9%) with an average monthly income of <Ksh 15,000. Housing included semi-permanent houses (56.4%) and most dwellers lived with their family members. Majority of slum dwellers preferred wearing face masks (93.2%), 59% of the respondents preferred seeking physician consultation, there was 76.7% COVID-19 testing rate and 76.7% COVID-19 vaccination rate. There was significant association between predisposing factors of marriage ((ꭓ2=15.471, df=3, p=0.001) and housing status (ꭓ2=12.235, df=5, p=0.032) with health seeking behavior. There was significant association between enabling factors of perceived health status (ꭓ2=32.105, df=4, p <0.001, access to insurance (ꭓ2=12.791, df=4, p=0.012) and self-efficacy (ꭓ2=11.252, df=4, p=0.024) with HSB choices. 63.2% of the participants were healthy with no pre-existing conditions, while among those with positive history of illnesses, hypertension was the leading condition (33.3%). Enabling factors of pre-existing conditions ((ꭓ2=11.559, df=3, p=0.009), self-reported health status (ꭓ2=13.105, df=4, p=0.011) and disease severity (ꭓ2=7.851, df=4, p=0.097) were significant in influencing HSB choices. The study also found that divorced slum dwellers were three times more likely to seek physician’s services than single slum dwellers (β=1.228, B/OR=3.415, p=0.447, 95%CI=0.144-80.177). Inadequate funds was the leading challenge in sustaining preventive and control measures of COVID-19. The study findings conclude that understanding slum dwellers health-seeking behaviors and their influencing factors during pandemic informs on development of effective preventive strategies for future SARS illnesses and recommends mass education and awareness to promote attitude change, mass testing and vaccination and promotion of adherence to control and preventive measures of SARs illnesses.