Caregiver Dynamics and Factors Affecting Health-Seeking Behaviors for Childhood Diarrhoea in Mukuru Informal Settlements in Nairobi, Kenya

Rahma Osman^1*Eric Ndombi²Mary Gitahi²Amos Njuguna¹Mackwellings Phiri³Amha Mekasha⁴Nigel Cunliffe⁵Chisomo Msefula⁶Khuzwayo Jere⁵Daniel Asrat⁴Schola Kamwethya¹Morgan Wasilwa¹Jessicah Jepchirchir⁷Deborah Nyirenda³Beatrice Ongadi¹Phelgona Otieno¹Chikondi Mwendera⁵Kelvin Kering¹Cecilia Mbae¹Samuel Kariuki¹

• ¹Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
• ²Kenyatta University School of Public Health and Applied Human Sciences, Nairobi, Kenya
• ³Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
• ⁴Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
• ⁵Liverpool School of Tropical Medicine, Liverpool, United Kingdom
• ⁶Kamuzu University of Health Sciences, Blantyre, Malawi
• ⁷Kenya Medical Research Institute, Nairobi, Kenya

Background: Diarrhoeal disease is the third leading cause of morbidity and mortality in children under five globally, with approximately 1.7 billion cases reported annually, resulting in over 400,000 deaths. Sub-Saharan Africa has the highest mortality rates for diarrhoea, accounting for about 60% of all deaths in this age group. In Kenya, diarrhoea contributes significantly to child mortality, causing around 16,000 deaths annually among children under five, particularly in urban informal settlements where access to clean water and sanitation is limited. This study aimed to investigate the determinants of healthcare-seeking practices among caregivers of children under five with diarrhoea in Mukuru informal settlement, Nairobi County. Methods: A cross-sectional design was employed to examine healthcare-seeking behaviors among caregivers. From September 2023 to January 2025, we conducted focus group discussions with 90 caregivers identified through purposive sampling. Additionally, we interviewed 374 caregivers using a structured questionnaire at Mother and Child Health (MCH) clinics, targeting those bringing healthy children for immunization. Qualitative data were analyzed thematically using NVivo, while bivariate and multivariate analyses were performed on the quantitative data. Results: Caregivers with secondary education had lower odds of seeking care compared to those with only primary education (AOR = 0.171, 95% CI: [0.060 - 0.488], p = 0.001). Caregivers who believed that poor human fecal disposal causes diarrhoea had significantly higher odds of seeking healthcare (AOR = 3.259, 95% CI: [1.185 - 8.965], p = 0.022). Trust in clinicians also influenced care-seeking behavior, with those who strongly agreed on the importance of clinicians in treating diarrhoea having higher odds of seeking care (AOR = 0.259, 95% CI: [0.028 - 2.374], p = 0.050). Conclusion: This study shows that socio-demographic factors, particularly education level and perceptions of disease causation, significantly influence health-seeking behaviors among caregivers in Mukuru. Caregivers with secondary education were less likely to seek care, while those aware of the sanitation-diarrhoea link showed increased healthcare-seeking behavior. Trust in healthcare providers was also crucial in care-seeking decisions.