Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: an application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Kibuchi, E. , Chumo, I., Kabaria, C., Elsey, H., Phillips-Howard, P., Teixeira de Siqueira-Filha, N., Whittaker, L., Leyland, A. , Mberu, B. and Gray, L. (2024) Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: an application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLoS Global Public Health, 4(2), e0002931. (doi: 10.1371/journal.pgph.0002931) (PMID:38422055) (PMCID:PMC10903897)

Abstract

In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as “not applicable”. The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need.

• Item Type: Articles
• Additional Information: Funding: The GCRF Accountability for Informal Urban Equity Hub (‘ARISE’) is a UKRI Collective Fund award with award reference ES/S00811X/1. The MRC/CSO Social and Public Health Sciences Unit is funded by the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gray, Dr Linsay and Leyland, Professor Alastair and Kibuchi, Dr Eliud

Creator Roles

Kibuchi, E.: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review and editing
Leyland, A.: Conceptualization, Data curation, Writing – review and editing
Gray, L.: Conceptualization, Data curation, Methodology, Writing – review and editing

• Authors: Kibuchi, E., Chumo, I., Kabaria, C., Elsey, H., Phillips-Howard, P., Teixeira de Siqueira-Filha, N., Whittaker, L., Leyland, A., Mberu, B., and Gray, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: PLoS Global Public Health
• Publisher: Public Library of Science
• ISSN: 2767-3375
• ISSN (Online): 2767-3375
• Copyright Holders: Copyright: © 2024 Kibuchi et al.
• First Published: First published in PLoS Global Public Health 4(2): e0002931
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
304823002	1	Inequalities in health	Alastair Leyland	Medical Research Council (MRC)	MC_UU_00022/2	HW - MRC/CSO Social and Public Health Sciences Unit
304823007	1	Inequalities in health	Alastair Leyland	Office of the Chief Scientific Adviser (CSO)	SPHSU17	HW - MRC/CSO Social and Public Health Sciences Unit