2.2. Selection of Study Site

The study was conducted in Kenya between January and April 2017. Kenya is a LMIC located in on the eastern side of sub-Saharan Africa (Figure 2). Kenya is governed by a federal government system with 47 counties (Figure 2). The population of Kenya is young, with approximately two in every ten (19%) Kenyans aged 15 to 24 years [40,41]. Many Kenyans (40%) live below $1.25 a day, and as a result, many experience social and health inequalities in relation to accessing basic amenities such as water, sanitation facilities, food, and decent housing [14]. While the urban residents, especially those in the formal settlements report better wealth index and health outcomes, populations in arid to semi-arid areas and poor rural settings are worse off in terms of their wealth quintile and overall wellbeing.

The map of Kenya showing provincial and county boundaries. Note: Red rings show specific counties where the research was conducted.

To capture these diversities, our research was undertaken in four counties: Kisumu, Nairobi, Nyandarua, and Makueni. The counties were purposively selected based on a constraint of urban areas, with a diversity of socioeconomic status, and arid and semi-arid conditions. Kisumu County in Nyanza Province is mainly inhabited by the Luo; it is a relatively poor region that has consistently been in opposition government since Kenya’s independence. The region has a low housing quality index (7.9%), low access to improved water and sanitation services (38%), and electricity and household asset ownership below the national level. Nyandarua County, on the other hand, is in Central Province and is a relatively wealthy region with a housing quality index (38%) second only to Nairobi County [42]. Nyandarua County also has access to piped water and improved sanitation services, access to electricity, and household asset ownership above the national level. To represent the arid to semi-arid regions, we selected Makueni County in Eastern province. Because of the climatic conditions, Makueni county is relatively poor with at least four in every ten households reporting a lack of food (or money to buy food) and clean drinking water [42]. Nairobi County in Nairobi Province was selected to represent an urban area with both formal (i.e., Langata gated community) and informal (i.e., Kibera slums) settlements.