Includes Appendix and Reference

Globally, approximately 1.7 billion people lack basic sanitation, with 494 million practicing open defecation, and a dire situation in slums. However, despite national sanitation policies and global efforts, over two million tons of sewage are released into water sources annually, particularly in slum areas like Mukuru, Nairobi, Kenya. This study assessed societal norms, health effects, and coping strategies influencing raw sewage disposal in water sources of Mukuru slums, Nairobi, Kenya. Specifically, the study examined societal norms influencing behaviour, the perceived health risks from exposure to sewage-contaminated water, and coping strategies employed by residents. The study employed a descriptive cross-sectional design, integrating both quantitative and qualitative methodologies. Stratified random sampling was used to select 246 household heads for quantitative data collection via a structured questionnaire. For qualitative data, purposive sampling guided the selection of participants for Focus Group Discussions and interviews. Quantitative data were analysed using SPSS version 25, with both descriptive statistics and Chi-square tests applied. Qualitative findings were thematically analyzed and summarized in narrative form. Descriptive findings revealed that 96.1% of respondents reported raw sewage disposal into water sources, and 87.7% had observed such actions within their community. Societal norms played a significant role, with 85.1% indicating belief in proper sewage disposal, 43.8% highlighting the importance of communication and coordination, and 46.4% acknowledging social network influence. Regarding health impacts, 93.4% of households reported diarrheal cases, 92.3% experienced respiratory symptoms, 85.1% noted anxiety, and 83.8% identified skin infections among residents. In terms of coping strategies, 49.4% used pour-flush toilets, while 76.2% lacked knowledge of proper disposal systems. Relocation (43.5%), passive waiting (42.9%), and negligence (79.1%) were common coping mechanisms in the face of persistent sanitation challenges. Chi-square tests revealed statistically significant associations (χ², p < .05) between societal norms—such as beliefs, household initiative, community communication—and raw sewage disposal behavior. Similarly, significant relationships were found between raw sewage exposure and skin-related conditions. Furthermore, coping strategies such as household relocation, inaction, and lack of sanitation investment were strongly associated with unsafe disposal practices. The study concludes that raw sewage disposal in Mukuru is not only a matter of infrastructural inadequacy but also deeply influenced by entrenched societal norms, perceived health vulnerabilities, and adaptive coping behaviors. Addressing this issue requires holistic, community-centered interventions that integrate bahaviour change, health education, and locally sustainable sanitation technologies. The findings offer a foundation for targeted policy making and further research in similar urban informal settlements.