Social, environmental and policy contexts affecting the feasibility and acceptability of improving household flooring for better health in rural Kenya

Publication Type

Journal Article

Journal Name

PLoS neglected tropical diseases

Name of Author

• Ulrike Fillinger, International Centre of Insect Physiology and Ecology, Nairobi, Kenya.
• Victoria A. Ochwal, International Centre of Insect Physiology and Ecology, Nairobi, Kenya.
• Hugo Legge, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
• Sharon Muli, International Centre of Insect Physiology and Ecology, Nairobi, Kenya.
• Karisa Kazungu, International Centre of Insect Physiology and Ecology, Nairobi, Kenya.
• Carlos Mcharo, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya.
• Jacinta Mwongeli, Department of Biomechanical and Environmental Engineering, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
• Charles Mwandawiro, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya.
• Katherine Halliday, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
• Doris Njomo, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya.
• Rachel Pullan, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
• Lynne Elson, Kenya Medical Research Institute- Wellcome Trust Research Programme, Kilifi, Kenya.
• Stella Kepha, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, Nairobi, Kenya.

Publication Date

2-4-2026

Abstract

BACKGROUND: Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens. METHODS: Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and Bungoma provided contextual insights. Transcribed data underwent thematic analysis. RESULTS: In the study areas, most homes were constructed by residents themselves using traditional techniques and locally sourced materials. Despite awareness of the health risks, unimproved floors remained widespread. In Bungoma and Kwale, financial constraints and competing household priorities were primary barriers to flooring improvements, while in Narok, cultural identity contributed strongly to the rejection of changes in traditional houses. Key enablers included perceived health benefits and social status, while feasibility depended on the affordability and availability of materials and skilled labour. Strengthening the role of local artisans and leveraging their social influence were seen as effective strategies to shift perceptions on cost and feasibility. Improved collaboration between health and built-environment sectors could enhance community trust and support environmental disease management. CONCLUSION: Communities in Kwale and Bungoma were more receptive to improved flooring, while cultural practices and preferences in Narok posed significant adoption challenges. For receptive communities, affordable flooring technologies are critical to overcoming financial barriers, while behaviour change initiatives should address cultural and perceptual concerns. However, clinical evidence on locally generated health benefits is needed to support policy decisions and budget allocations for flooring interventions.

Recommended Citation

Fillinger, U., Ochwal, V. A., Legge, H., Muli, S., Kazungu, K., Mcharo, C., Mwongeli, J., Mwandawiro, C., Halliday, K., Njomo, D., Pullan, R., Elson, L., & Kepha, S. (2026). Social, environmental and policy contexts affecting the feasibility and acceptability of improving household flooring for better health in rural Kenya. PLoS neglected tropical diseases, 20 (2), e0013943. https://doi.org/10.1371/journal.pntd.0013943

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.