Comparing the effects of unregulated open dumpsite pollution on child growth and maternal health in Nairobi slums, Kenya: A cross-sectional study

Abstract

Background:Research on the impact of environmental pollution on the growth of children in Africa has been relatively limited. Globally, pollution is associated with one out of every six deaths, totaling 9 million deaths. Sub-Saharan African countries contribute to the third-highest pollution-related deaths, with 980,000 deaths. Well-established negative health effects from pollution include an increased likelihood of cancer, impaired repro-duction, and heightened susceptibility to diseases. In Kenya, the compromised immune system due to mal-nutrition and lack of safe water may exacerbate these effects. Korogocho slum has one of the largest dumping sites in Dandora estate which has been present for 40 years. No study has investigated the potential impact of this dump site on the health of children and the reproductive health of mothers in its vicinity. This study aimed to assess the effects of prolonged exposure to toxic pollutants from the dumpsite. Objectives: 1. Determine the growth status of children aged between 6 years to 12 years exposed to the effects of unregulated open dumpsite pollutants for more than 5 consecutive years with non-exposed children. 2. Compare the clinical symptoms of children between exposed and unexposed populations 3. Compare the birth outcomes of women in the last 5 years between the exposed and non-exposed groups Method: This was a cross-sectional comparative study that randomly recruited 140 children (70 exposed and 70 unexposed) aged between 6 years -12 years and a sufficient sample size of 70 mothers/caregivers (35ex-posed and 35unexposed) from Korogocho A (exposed) and Kibera Slums (unexposed). Anthropometric measurements were taken from the children: mean weight, height, HAZ, WAZ and BAZ scores calculated. A structured questionnaire was used to obtain recall information of the clinical symptoms and birth outcome from the 70 randomly selected mothers/caregivers. Descriptive statistics was used to analyze categorical as well as continuous data using measures of central tendency. Chi -square test was performed for all co-variates to check statistical significance between exposed and non-exposed group and independent t-test carried out to detect differences in the anthropometric mean with the significance level set at 0.05. Results: The mean age and parity of women in Korogocho were 32.6 (sd 2.8) and 3 (sd 1.4), respectively, while in Kibera, the mean age and parity were 39.6 (sd 4.2) and 2 (sd 0.7), respectively. The pregnancy and birth outcomes varied between the two populations. The exposed population had a significantly higher pro-portion of birth-related complications, with 7 (19%) cases, including Convulsions 3 (42%), Postpartum hem-orrhage 2 (29%), and Infection 2 (29%), compared to the unexposed population, which had 2 (5.9%) cases, including Convulsion 1 (50%) and Infection 1 (50%) (p=0.024). A higher proportion of miscarriages was recorded in the exposed group, with 7 (19%) cases compared to 1 (2.9%) in the unexposed group (p = 0.053). However, no significant differences were noted in the birthweight outcomes (p = 0.651) and the occurrence of fetal congenital anomalies (p = 0.583) between the two populations. The mean age of children was; Korogocho 9.2 (sd2.07) and Kibera 8 (sd0.08). The mean difference in the height and weight between the exposed and unexposed children was 0.2cm and 1.2kgs respectively. The difference in the mean HAZ, WAZ and BAZ scores (Male and Female) for the children from the exposed and unexposed population was not statistically significant (p= 0.586), (p = 0.483), (p = 0.07) and (p = 0.474) respectively. However, Clinical symptoms varied significantly between the two groups; coughing (p=0.001), eye irritation (p= 0.001) and stomach-ache (p=0.001), with unexposed population experiencing less than 50% of the 10 clinical symptoms reported. Conclusion: Overall, the study notes an increased proportion of maternal and fetal-related complications in pregnancy among women residing near an unregulated waste dumpsite (exposed). The maternal birth-related complications included convulsions/eclampsia, postpartum hemorrhage and infection. Miscarriage was noted as a significant fetal complication. In children, the proportion of children suffering from various morbidities was significantly higher in the exposed group, with these children (exposed) also noted to be shorter and of lesser body weight. Recommendations: The Nairobi County government should urgently take steps and enact environmental protection policies, addressing household and industrial waste management as well as act on relocating the Dandora dumpsite. Future research studies in this area should consider prospective cohort study design, which will ideally ex-plore mobility of children from the exposed area and also account for acute morbidity experienced in the follow-up period.