University of Florida Thesis Or Dissertation Formatting

THE SOCIOECOLOGY OF DIARRHEAL DISEASE EXPOSURE IN PERI-URBAN COMMUNITIES OF KISUMU, KENYA By JOHN DAVID ANDERSON IV A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2016 © 2016 John David Anderson IV To my Grandma, Betty Lou Hetzel and Dr. Hugh Popenoe ACKNOWLEDGMENTS First and foremost, erokamano ahinya and asante sana to all of the participants and people in the peri-urban communities of Kisumu who generously gave their time, opened their compounds, walked us through their neighborhoods and told us about their difficulties. Erokamano ahinya and asante sana to all the hard-working Community Health Volunteers (CHVs) of Nyalenda, Nyawita and Obunga, this research was not possible without them! A special thanks to Zadock Tako, Winnie Alando and Steve Biko for helping us organize research activities, navigate communities and providing the support of their wonderful teams of CHVs. I thank all the faculty, staff and students at Great Lakes University of Kisumu, for being gracious hosts that welcomed me from the moment I arrived in Kisumu. I thank Dr. Jane Mumma for not only organizing an amazing team of dedicated and competent researchers but for timely, constant support, laughs and friendship. I thank the leaders of our talented team of researchers, Kevin Achola, Lily Lukorito, Leah Marende, and Damaris Nalima not only for dedicating long hours and positive spirit to a complex research project but also making me feel at home in Kisumu. A special thanks to all of the research crew, from Jane Agola, Jackson Otieno Anangwe, and Martin Ouma Oyoo of the lab group, to Veronica Odeny, Philip Okello, Lilian Alouch Opiyo, George Otieno, Kephers Njoga, Carolyne Musula of the household enumeration team to Daisy Kurui, Josephine Atieno Odhiambo, Ritah Owino, and Anne Sila of the nutrition team, to the environmental team, with whom I worked daily with – Enos Ochieng Migun, Felix Odhiambo Oketch, Mildred Khaemba, Titus Owour, and Miriam Wanzala. Also and importantly, I thank James and Moses for patiently driving all of us around Kisumu, safely. I thank Dr. Zahid Mahmud and Eteshamul Islam for their help coordinating the 4 GLUK lab team and bringing their expertise and experience on diarrheal disease lab research. At the Kenya Medical Research Institute and Center for Disease Control Research Station, I thank Cathrine and Fred Ade for their commitment to their careers and work and to Clayton Onyango for supporting this project. I especially thank Oliver Cumming for teaching me about coordinating global health research and how to relieve stress by underwater laps. Thanks to KUAP for including me in their CLTS initiatives and partnerships with the health system in peri-urban Kisumu. I thank the SHARE Consortium for their financial support for this project. I thank Dunga and Nanga, for days by the lake, at Hill Camp, Abraham’s roof, Red Gate, and Hippo Point. Many thanks to Carey Francis, Nanshu Tuba, Samora Ogutu, and Silas “Selassie” Ochieng for controlling scene, solid friendship, and showing me life by Nam Lolwe. Map it! I thank Sir Charles Odongo for his mostly-reliable transportation services and for volunteering your wisdom on a host of worldly matters. I thank my coach, Moses “Jaja” Oduor, for inviting me to play on the Nanga football team and for many safe trips to Kisian. I thank my surrogate parents in Kisumu, Mr. and Mrs. Pabari and their staff, who, always made me feel at home in their beautiful garden compound and for pleasant Sunday lunches and stimulating discussions. I thank Charles Ojiambo, Nicodemus Mukabana, Claud Kolongo, Mutua, and Everley for making coming home from long work days and late nights joyful and safe. I thank all the folks around Impala Junction: Dolrose, Douglas Otieno, Bonche, Seth and many others for making the neighborhood a friendly place and for many insightful discussions on the state of Kisumu, Kenya and the world. 5 At the University of Florida in Gainesville, I would like to especially thank my colleagues, Amber Barnes, Poulomy Chakraborty, Karoun Bagamian and Lindsey Laytner who worked tirelessly alongside our team to complete the WASH Disparities Study and are pillars of this dissertation. I thank Jacob Atem and Mirna Amaya for their dedication and support for all of the lab’s projects. Over nearly 10 years in Gainesville, there have been many philosophical discussions that have contributed to this work, but the Ethnoeocology Garden was often the setting for these and many other thoughtful idea exchanges. A special thanks to the late Dr. Hugh Popenoe, who mentored and inspired generations of ethnoecologists and a loose confederation of enthusiastic, intellectual gardeners who made the Ethnoecology Garden a beautiful hub of hands-on education. A special thanks to all the past and present members of the Ethnoecology Society, especially Jay “Mr. President” Bost, Too Blue, Mushu, Nora Rodli, Alvaro Valle, Matt Palumbo, Wendy Lin Bartels, Erica Van Etten, Nick Kawa, Damion “DEEEEE” Graves, Jeff Hubbard, Julia Showalter, Asha Bertsch, Dominique Ardura, Brian Tyler, Sanjiv Jagtap, Dan Stirling, Ethan Kelly and many others. It was at the Ethnoecology Garden that I met Dr. Richard Rheingans, to whom I am eternally grateful for being a generous and patient mentor who supported me as a research coordinator, student and friend. A second thanks to Nick Kawa, Jeff Hubbard, and later Chris Kawa and the many other denizens of the Estate, especially Rafa “Krishels” Mendoza and Nikolay Kazakov for providing and maintaining a creative home, with many days and nights of heated and respectful intellectual debate as well as eight years of four lokos, backyard art, settling Catan, and planting an inspiring garden, essential to my final days of dissertation writing. There are so many other friends who 6 have influenced my life during my dissertation. I thank Jessica Jean Casler for providing constant support during my academic pursuits as well as taking time out for the important things in life, such as impromptu afternoon cocktails. I thank Pepe Clavijo for keeping me health and fit with futsal and workouts, hours of advice and good debate over beers and Venezuelan rums, and along with Bryan Tarbox, good excuses to go birding. I thank Joe Feldman and Eric Holgate for high-level intellectual conversations about our research and also boozy conversations about our social circles. I also thank Drs. Alyson Young and Song Liang for their commitment to my Ph.D. work and for valuable guidance through the final stretch of dissertation writing. I am blessed to be surrounded by a loving and supportive family who raised me and helped guarantee opportunities to pursue my life goals and interests through higher education. I thank my Mom, Dad, Matthew, Sarah and Emmet for being there for me through my most important life events and for being an endless source of love and support. Finally, I thank my fiancée, Katie Knoll, for always being a loving, patient, steady and supportive friend and partner, who has never wavered, even as we spent over a year an ocean apart and nearly 3 years 1,000 miles apart. I am truly blessed to have her in my life along with many wonderful, supportive friends across the world. 7 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES .......................................................................................................... 10 LIST OF FIGURES ........................................................................................................ 12 LIST OF ABBREVIATIONS ........................................................................................... 15 ABSTRACT ................................................................................................................... 16 CHAPTER 1 GLOBAL HEALTH AND DISPARITIES IN PERI-URBAN KISUMU ........................ 18 Introduction ............................................................................................................. 18 Poverty ............................................................................................................. 19 Peri-urban Ecosystems .................................................................................... 21 Informal Settlements ........................................................................................ 24 Research Objectives ........................................................................................ 25 Methods .................................................................................................................. 28 Sampling Design .............................................................................................. 30 Sampling Weights ............................................................................................ 32 Spatial Analysis ................................................................................................ 33 Population Density Estimates ........................................................................... 34 Poverty Index ................................................................................................... 35 Results .................................................................................................................... 39 Social Factors and Poverty ............................................................................... 39

Load more