1    INTRODUCTION

The paper intends to find significant conclusions and make recommendations based on scientific information and ethically accepted data. The paper focuses on women, hygiene and sanitation in Kibera slums which is one of the largest slums in Africa with a population of almost 2 million people; and where 10-25% of the population are infected with HIV/AIDS. (UNDP, 2005.)

Kibera is not the only slum dealing with sanitation and hygiene problems, many developing cities are also facing the challenge. Widespread of sanitation and hygiene problems are a result of poor political leadership, mismanagement of resources and poverty. Many first world or underdeveloped countries face the same challenges, although with good political leadership it is possible to overcome the problems. Poor political leadership and corruption has led to poverty, widespread diseases and war. African leaders should be encouraged to meet the needs of citizens instead of being self -centred about wealth and power. By doing this, the poor population will be able to access basic needs such as food, education, water, shelter and medical care with less difficulties.

According to the Ministries of Health and Water, in 1983 national sanitation reached 49% of the population. Research carried out by the United Nations Children’s Education fund (UNICEF) estimated that sanitation in Kenya covered 45%and 46% in 1996.

Dickens in 1883 quoted that Charity begins at home. This means good hygiene and sanitation must start at the grass roots level. Thus the study focuses on women because woman’s health is reflects on the well being of the family. It is important for nurse’ to bear in mind women’s concerns in poor urban areas in order to be able to implement effective care given to women when they visit hospitals.

The purpose of this study is to review relevant literature on sanitation and hygiene of women in poor urban centres and to describe how nurses can help women by giving them suggestions on how to improve sanitation and hygiene. Finally, we will design a poster for community health care nurses working with women living in under privileged environments.

2                     HEALTH CARE AND CONCERNS IN KIBERA SLUMS

2. 1Description and statistics

Kibera lies at an altitude of 1,670 meters above sea level, latitude 36 degrees, 50 degrees east and longitude 1 degree, 17 degrees south about 140 km south of equator. The emergence of Kibera as an informal settlement is connected with the phenomenal growth of the city of Nairobi. Kibera slums, the largest informal settlement in Africa, is situated 5 kilometres south of Nairobi City centre which is the capital city of Kenya. It houses more than a quarter of Nairobi’s population. The name `Kibera´ originated from a Nubian word which means `forest.´ (Karanja et al., 2002)

Kibera is divided into nine official villages, with each village having its own elder. They are Kianda, Soweto, Kisumu Ndogo, Lindi, Laini saba, Silanga, Makini and Mashimoni. There are no residences greater or bigger than a single storey. The average home is nine square meters which has five inhabitants per dwelling. Urban services such as water and sanitation are scarce. There is one pit latrine for every fifty to five hundred people hence leading to `flying toilets.´ Kenya has a great water shortage residents rely on piped water, boreholes and the polluted Nairobi river. Drinking water is pumped through plastic pipes alongside sewage trenches. (Karanja et al., 2002)

2.2Health care delivery systems

The Ministry of Health (MOH) in Kenya is responsible for providing health care to the Kibera population. Kenyatta National Hospital, the biggest referral hospital in East and Central Africa, is close to the Kibera slums. Other health care facilities in the slum include: health clinics, dispensaries, maternity homes, nursing homes, medical centres, laboratories and radiological services, dental clinics which are owned by non-governmental organisations and private individuals.

Attempts have been made to improve the healthcare system in Kibera by the Kenyan government, non-governmental institutions and the private sector. Health care facilities are licensed by the Ministry of Health if they meet the requirements of the National Hospital Insurance Fund (NHIF). However, most of the private facilities operate illegally, thus leading to malpractice and poor quality of health.