Transitional Infrastructures Extending Access to Safe Water in Informal Settlements: A Cross-Sectional Study in Nairobi, Kenya.

There is a pressing need for transitional water infrastructures in rapidly growing cities where conventional infrastructures lag behind human settlement expansion. In Kenya, sectoral innovations have addressed local socioeconomic challenges, but empirical evidence on their efficacy (combining quantitative indicators of safety and continuity) is lacking. We addressed this gap by comparing different water infrastructures in their ability to provide constant access to safe water in informal settlements in Nairobi, Kenya. We conducted a cross-sectional survey including 1,147 households in two informal settlements. Water infrastructures were categorized based on their distribution system: 1) piped to premises; 2) piped to a neighboring compound; 3) public tap/dispenser; and 4) street vendor. We tested associations between these systems with two outcomes: constant water availability and diarrhea (stratified by age group). We used adjusted odds ratios (AORs) to test associations between distribution systems and the selected outcomes, while accounting for confounders. Obtaining water from public taps/dispensers or street vendors was associated with service continuity (AOR = 1.45, 95% confidence interval [CI]: 1.06-1.99; AOR = 11.16, 95% CI: 2.45-50.82). Piped sources were associated with service disruption, especially when obtained from a neighboring compound (AOR = 0.45, 95% CI: 0.28-0.70). Public taps/dispensers were the only system consistently associated with lower odds of diarrhea, notably in children under the age of 5 years (AOR = 0.47, 95% CI: 0.29-0.79). Hence, in cities with a high prevalence of informal settlements and limited financial resources, public taps and dispensers hold promise as transitional water infrastructures.