Public Health Risks in Urban Slums: Findings of the Qualitative 'Healthy Kitchens Healthy Cities' Study in Kathmandu, Nepal.
BACKGROUND
Communities in urban slums face multiple risks to their health. These are shaped by intermediary and structural determinants. Gaining a clear understanding of these determinants is a prerequisite for developing interventions to reduce the health consequences of urban poverty. With 828 million people living in slum conditions, the need to find ways to reduce risks to health has never been greater. In many low income settings, the kitchen is the epicentre of activities and behaviours which either undermine or enhance health.


METHODS
We used qualitative methods of semi-structured interviews, observation and participatory workshops in two slum areas in Kathmandu, Nepal to gain women's perspectives on the health risks they faced in and around their kitchens. Twenty one women were interviewed and four participatory workshops with a total of 69 women were held. The women took photographs of their kitchens to trigger discussions.


RESULTS
The main health conditions identified by the women were respiratory disease, gastrointestinal disease and burn injuries. Women clearly understood intermediary (psychosocial, material and behavioural) determinants to these health conditions such as poor ventilation, cooking on open fires, over-crowding, lack of adequate child supervision. Women articulated the stress they experienced and clearly linked this to health conditions such as heart disease and uptake of smoking. They were also able to identify protective factors, particularly social capital. Subsequent analysis highlighted how female headed-households and those with disabilities had to contend with greater risks to health.


CONCLUSIONS
Women living in slums are very aware of the intermediary determinants-material, behavioural and psycho-social, that increase their vulnerability to ill health. They are also able to identify protective factors, particularly social capital. It is only by understanding the determinants at all levels, not just the behavioural, that we will be able to identify appropriate interventions.
Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
Helen
http://orcid.org/0000-0003-4724-0581
H
Elsey
Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
Shraddha
S
Manandah
Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
Dilip
D
Sah
Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
Sudeepa
S
Khanal
Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
Frances
F
MacGuire
Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
Rebecca
R
King
Burn Injury Research Unit, The University of Western Australia, Perth, Australia.
Hilary
H
Wallace
Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
Sushil Chandra
SC
Baral
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