Housing Satisfaction Urban Slums - Dhaka

Soc Indic Res (2013) 112:163–185
DOI 10.1007/s11205-012-0045-5
Housing Satisfaction Related to Health and Importance

of Services in Urban Slums: Evidence from Dhaka,
Bangladesh
Arina Zanuzdana • Mobarak Khan • Alexander Kraemer
Accepted: 16 April 2012 / Published online: 3 May 2012

Springer Science+Business Media B.V. 2012
Abstract Quality of housing plays one of the key roles in a public health research, since
inadequate housing may have direct or indirect negative impact on health. Higher satis-
faction with housing was shown to be associated with higher income, higher age, a smaller
family, higher education, being female and being an owner of a dwelling. The aim of our
study is to identify the multiple sources of the satisfaction with housing in population of
urban slums and rural areas in Dhaka, Bangladesh. We have used a combined variable
‘‘Housing Satisfaction’’, containing nine items related to satisfaction with different types of
housing facilities (water, electricity, toilet etc.). Ordinal as well as binary multiple logistic
regression models were applied to predict housing satisfaction. Rural residents (with 90 %
house ownership) were much more satisfied with their housing than urban slum dwellers.
Those respondents who perceived their area as ‘‘Very bad/Bad’’ to reach medical care
reported significantly higher levels of housing dissatisfaction. Low satisfaction with
available facilities (education, health services, etc.) as well as the adjacent neighbourhood
being perceived as negative for own health showed as well a strong predictive effect on
housing dissatisfaction. The major findings of our study showed a complex relationship
between housing satisfaction and the quality of basic facilities including the reachability of
medical care. Understanding the factors which lead to satisfaction with housing and res-
idential environment is crucial for planning successful and effective housing policies.
Keywords Housing satisfaction Facilities Distance to services Slums

South Megacity
A. Zanuzdana (&) M. Khan A. Kraemer

Department of Public Health Medicine, School of Public Health, University of Bielefeld,
Universitätstr. 25, 33604 Bielefeld, Germany
e-mail: azanuzdana@uni-bielefeld.de
A. Kraemer
e-mail: alexander.kraemer@uni-bielefeld.de
M. Khan
Department of Statistics, Jahangirnagar University, Savar, Bangladesh
e-mail: mobarak.khan@uni-bielefeld.de
123
164 A. Zanuzdana et al.
1 Background
The concept of housing satisfaction (other terms are residential satisfaction or household
satisfaction) has gained an enormous attention in an interdisciplinary research since several
decades (World Health Organization (WHO) 2008; Krieger and Higgins 2002; Baiden
et al. 2011; Parkes et al. 2002a, b; Nathan 1995; Herting and Guest 1985). An adequate1*
housing is a basic need together with food, clothing and sanitation. Previous research
showed that the ability to meet one’s basic needs can weigh more for an individual’s well-
being than the ability to have vacation or possess goods (Biswas-Diener and Diener 2001;
Maslow 1954). In the most recent report on environmental burden of disease in relation to
inadequate housing (2011) World Health Organization (WHO) defines housing through
four interrelated dimensions: the physical structure of the dwelling, the home including
psychosocial, economic and cultural attributes of the household, the neighbourhood
infrastructure and the community environment. In its initiative ‘Healthy housing’ WHO
outlines the negative health impact of certain housing conditions (e.g. injuries, indoor air
quality, pests etc.) and the particular vulnerability of different population groups (poor,
children, sick or disabled, housewives) spending most of the time in their home setting and
thus being exposed to negative impacts. An urgent need as well as a great potential for an
international guidelines for connecting housing and health is pronounced by WHO (WHO
2010). Such public health guidance can help preventing a wide range of diseases and
injuries and reduce health inequalities just through improved and adapted housing (WHO
2005, 2010). Disparities in housing quality are likely to be linked to disparities in health
(Krieger and Higgins 2002; Howden-Chapman 2004).
Housing satisfaction (self-perceived satisfaction of the person living in the house,
apartment etc.) can be seen as one of indicators of effectiveness of housing policies or
any other development of this urban domain (Jiboye 2010). Understanding the factors
which lead to satisfaction or dissatisfaction with housing and adjacent residential envi-
ronment is crucial for planning successful and effective housing policies as well as for
predicting housing mobility and migration (Lu 1999; Diaz-Serrano 2005). Increased
housing satisfaction following housing improvements has been strongly linked to
improvements in mental health as well as in physical health and general well-being
(Thomson et al. 2001). There are different determinants of personal housing satisfaction
known from a wealth of international evidence. The determinants of individual housing
satisfaction were profoundly analysed in the paper of Vera-Toscano and Ateca-Amestoy
(2007). According to their concept, housing satisfaction is ‘‘an elicit variable, expressing
the degree of content that a given housing situation provides to an individual (subjective
outcome)’’. They have examined the effects of individual and household characteristics
and emphasized particularly the positive effect of social interactions. Earlier Nathan
(1995) developed a research model trying to explain a complex relationship between
residential satisfaction and determinants from three domains like personal characteristics,
behaviours and socio-physical environment (Nathan 1995). Most of literature on housing
and residential satisfaction originated from the USA (Diaz-Serrano 2005). A series of
1
An adequate housing can be characterized through following factors: adequate privacy and space; physical
accessibility; adequate security; security of tenure; structural stability and durability; adequate lighting,
heating and ventilation; adequate basic infrastructure; suitable environmental quality and health-related
factors; adequate and accessible location with regard to work and affordable basic facilities (Global Housing
Foundation, online source).
123
Housing Satisfaction Related to Health and Importance 165
studies were conducted in Spain, India, UK, Thailand, Taiwan and other countries
(Vera-Toscano and Ateca-Amestoy 2007; Biswas-Diener and Diener 2001; Parkes et al.
2002a, b; Nathan 1995; Fuller et al. 1993; Chin-Chun 1985). Another specific feature of
the existing literature on housing satisfaction lies in the fact that most of the studies were
conducted among moderately poor population groups, but not among those living under
conditions of extreme poverty (e.g. urban slum dwellers in a developing country). There
is little knowledge about housing satisfaction in countries with developing economies
which differ from high-income countries in terms of socioeconomic and cultural char-
acteristics (Baiden et al. 2011). However, based on the small body of literature we can
suggest that despite poverty and adverse living conditions, some individuals and com-
munities in low-income countries experience surprisingly high levels of satisfaction,
whether with life as a whole, or with its particular domains (Diener and Diener 1995
cited in Biswas-Diener and Diener 2001; Peck and Stewart 1985). The study of Biswas-
Diener and Diener (2001) conducted in urban slums of Calcutta was designed ‘‘with
increased attention to cultural issues that have frequently plagued international studies’’.
Despite some common beliefs, Calcutta urban slum dwellers reported to be relatively
satisfied with many domains of their life, despite living in sub-standard conditions; social
relationship contributed greatly to their well-being (Biswas-Diener and Diener 2001).
Along with income, other determinants like higher age, living with a smaller family,
being higher educated, being female as well as being an owner of a dwelling were
associated with higher housing satisfaction in international studies (Rohe and Basolo
1997; Van Praag and Ferrer-i-Carbonell 2004; Vera-Toscano and Ateca-Amestoy 2007;
Howden-Chapman 2004).
Urban slum dwellers which are the subject of our research are especially heavily
affected by adverse living conditions and their health is threatened by a range of factors
related to their housing. It has been shown that poor quality housing may have a range of
negative impacts on human health, such as increased frequency of infectious diseases,
poor mental health, respiratory infections, chronic diseases, injuries etc. (Krieger and
Higgins 2002; WHO 2008, 2011; Howden-Chapman 2004). Available body of literature
provides a lot of evidence on healthy housing; however, this knowledge cannot be
transferred into praxis in many developing countries. To be able to develop or improve
an effective housing policy in such countries like Bangladesh there is a need for more
information on current housing quality, on housing differences and on housing satis-
faction. In this sense megacity Dhaka presents an informative research setting. According
to the results of the Census 2011 in Bangladesh Dhaka has the highest population density
throughout the country, with 8,111 inhabitants/km (Bangladesh Bureau of Statistics
2011). Higher density is only observed in Singapore and the smallest states, such as
Vatican. Due to high housing prices in Dhaka, an average household cannot afford
buying own property, resulting in the estimated figure of 97 % of urban poon in Dhaka
not owning any land (World Bank 2007).
This paper is an original research and presents the data from the health survey collected
from 3,207 households in urban slum and adjacent rural areas of the megacity Dhaka,
Bangladesh. To the best of authors’ knowledge there are no similar studies originating
from Dhaka, and exploring levels of housing satisfaction in relation to different individual
and socio-economic dimensions in such a highly urbanized settings. The aim of our study
is to investigate the associations of individual, family and neighbourhood factors with
individual satisfaction with housing.
123
2 Methods
2.1 Selection of Study Population and Sampling Strategy
The data used in this study was generated through baseline surveys (designed for one-year
cohort study) conducted between March and April in 2008 and 2009, respectively. A total
of 3,207 adult respondents were systematically selected from twelve marginal settlements
(slum areas) in Dhaka and three villages located nearby Dhaka (see also Gruebner et al.
2011).
First, in 2008, a sample of 1,269 adults (662 adults from three slum areas and 607 adults
from 3 villages) were selected for data collection. To increase the sample size and validity
of the study, a similar survey in nine further slums in Dhaka was conducted in 2009 which
collected information (using almost an identical questionnaire) from 1,938 adults (see
Fig. 3 in the ‘‘Appendix’’). Thus the total sample was 3,207 adults. For both baseline
surveys only one adult from each household was interviewed, resulting in the total sample
of 3,207 households/adults. Of them 49.7 % were female and 50.3 % were male. Infor-
mation about satisfaction with housing, facilities and personal characteristics was only
collected in the baseline study and only from the interviewed person.
We used a systematic sampling approach to select our households for interview. First,
we used slum information (e.g. name of slum, number of households, estimated population,
area of slum) provided by the Centre for Urban Studies (CUS) (CUS 2006). According to
CUS, there were approximately 4,900 slum settlements in 2005 in Dhaka. Next, in order to
select only large slums, we applied two inclusion criteria: a minimum of 500 households
in a slum and a minimum land size of six acres. To increase the representativeness of
the study area, we subsequently selected administrative units that were mostly not
neighbouring to each other. In the units with more than one slum we randomly selected one
of these slums. During our study we noticed that some slums (identified by CUS) were
evicted or turned into more affluent residential areas or open spaces. Third, after having
selected the study sites our research team prepared an individual household map for each
slum and marked all households in it (families). Each household was provided with one
unique identification number. Global positioning system (GPS) was also used to show and
record the location of each interviewed household. Afterwards we verified the estimated
number of families within each slum with the help of local residents and community
leaders. Each household sketch map with numbers was considered as the sampling frame
of the study.
Fourth, we estimated the representative sample of families for each slum using the
statistical formulae (not given here) proposed by Bartlett et al. (2001). A 95 % confi-
dence level (i.e., alpha = 0.05) and an acceptable error margin of d = 6 % were applied.
Since it was not possible to conduct a pilot study for estimating prevalences of outcomes
of interest (p), we choose the recommended value of p = 0.50, which can provide
maximum variance and maximum sample size. Our samples varied from slum to slum
depending on the number of households in slums. Slums with the highest and the lowest
number of households required the highest and the lowest number of samples, respec-
tively. Fifth, we calculated the sampling rate ‘‘r’’ by dividing the number of families in
the slum by the calculated sample size. We then interviewed an adult in every ‘‘rth’’
household. Our sample size was not adjusted for non-response rate as we achieved our
target by replacing the non-respondent household by the next available household at the
baseline survey.
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2.2 Ethical Considerations
Prior to the start of the survey we have contacted the local community leaders in urban
slum and rural areas of Dhaka and extensively discussed the aims and objectives of our
planned health survey with them. The leaders provided their consent and we invited the
residents of these areas to join our study.
The aims of the study were explained to each potential respondent and a verbal
informed consent was obtained. Therefore every respondent participated voluntarily and
provided his information to us with his own consent. Besides, any answers to our survey
questions could be rejected by respondents if not appropriate. All interviews took place in
the private dwellings of the respondents. Yet we could not always avoid the presence of
neighbours or family friends in the dwelling during the interviews.
No medical equipment and medicine placebo or drugs were used in the study. No blood
was collected from the respondents. All information (socio-demographic, economic, health
status, satisfaction etc.) were self-reported or self-assessed by the respondents. Data was
collected through a pre-tested questionnaire and face-to-face interviews were conducted by
trained university graduates. The study did not cause any risks or burdens to any of our
participants. Ethical considerations have been discussed beforehand with all project par-
ticipants in Germany involved in data collection in Dhaka, Bangladesh. In this case an
ethical approval for our study was not required.
In the present study only a selection of variables is used. Besides, items about satis-
faction were only collected at the baseline survey and thus only information from the first
interview was used for this research paper.
2.3 Outcome Variables
We have built our outcome variable ‘housing satisfaction’ by combining several items. We
have grouped them according to contents and controlled this grouping by conducting factor
analysis. The final variable contained following items:
• Are you satisfied by area of the house?
• Are you satisfied by electricity supply?
• Are you satisfied by water supply?
• Are you satisfied by water quality?
• Are you satisfied by water drainage?
• Are you satisfied by air quality?
• Are you satisfied by surrounding noise?
• Are you satisfied by garbage management?
• Are you satisfied by toilet?
The outcome variable was ordinal and included responses: ‘Highly unsatisfied’,
‘Unsatisfied’, ‘Moderately satisfied’ and ‘Satisfied’. Initial variables contained five cate-
gories, which we reduced to four groups by merging the categories ‘Satisfied’ and ‘Highly
satisfied’ (the former showed consistently low cell frequencies) into one group.
To subsequently conduct a binary multiple logistic regression we have dichotomised the
outcome variable into ‘‘Unsatisfied’’ and ‘‘Satisfied’’.
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2.4 Independent Variables
Quality of living and housing conditions of the respondents were assessed through the
questions about sufficiency of the house for the family, number of windows and sufficiency
of light, materials used for the floor, walls and roof. Further items concerned the quality of
water and sanitation facilities, garbage disposal, environmental pollutions and floods. In
this paper we evaluated only selected variables which showed the highest associations with
our target variable. Based on the exploratory analysis and available variables we have
selected the following sets of variables representing attributes of either an individual or a
household (Table 1).
The decision on which variables to include into the final model was based on the
exploratory analysis, data quality and data availability and evidence from the literature.
To predict ordinal responses for our outcome variable we have chosen ordinal regres-
sion model (with a link function logit) which showed to be more appropriate than common
regression techniques, e.g. logistic regression (Bender and Grouven 1997; Lu 1999;
Chau-Kuang and Hughes 2004). The advantage of this statistical approach is that the
ordinal nature of the dependent variable is taken into account and that the outcome variable
can have more than two (like in a logistic regression) or three (like in a multinomial
regression) categories. Furthermore, earlier findings in international studies showed that
common regression techniques may not accurately reflect the complex associations
between explanatory variables and housing satisfaction and thus their results should be
treated carefully.
Before running an ordinal regression and for careful examination of data we used plots
of cumulative observed percentages. In these plots we could see how large the differences
were for each category of the independent variable between the first reply (highly unsat-
isfied) and between every next added percentage (% ‘highly unsatisfied’ ? ‘unsatisfied’
etc. and 100 % which all must reach).
Finally, we have conducted a binary multiple logistic regression in order to examine the
strength of associations between single variables and housing satisfaction and adjust for
potential confounders.
Table 1 Sets of explanatory variables selected for statistical analysis

Set 1: Individual and family (household) characteristics
Sex, age, years of educations, family possessions (expressed as a wealth index (WI) and equivalent to
family income)
Set 2: Health perception
General health (self-perception)
Having any diseases in the last 3 months
Set 3: Housing and neighbourhood and locational factors
Tenure (house rented or owned), type of area (urban or rural), name of the area (only bivariate analysis),
toilet type, water source, materials of the walls (roof and floor), persons sharing one room (as a proxy
factor for private space), living area convenient to access medical care, sufficiency of the house for the
family, main way to access the house
Set 4: Perception of the living area
Whether environment of the surrounding neighbourhood negatively affects the health, satisfaction with
facilities (combining education, recreation, health services, work, leadership) in the living area
Set 5: Social relations/social capital
Membership in an non-governmental organization (NGO)
123
Predictor variables were tested for multicollinearity using Spearman correlation coef-
ficients. No pair of variables showed a correlation [0.4; the correlation coefficients of the
most pairs of variables were below 0.4.
All statistical procedures were performed using SPSS 17.0.
3 Results
3.1 Urban–Rural Differences
Figure 1 shows differences in the rating of overall housing satisfaction in urban slum areas
and rural districts of Dhaka. There were large urban–rural differences in the proportion of
the respondents being ‘highly unsatisfied’ and ‘unsatisfied’ with the aspects of their living.
Rural respondents seemed to be more satisfied with the housing in comparison to their
urban counterparts.
3.2 Differences Between Single Urban Slum and Rural Areas (by Name)
By taking a more detailed look at the data, we observed that level of dissatisfaction with
housing within nine urban slum areas ranged from 56.7 % (Baguntila bosti) up to 78.4 %
(Adabor no 10 bosti). The Fig. 1 shows further details of major socio-economic and
housing differences between single urban slum areas participating in our study. Addi-
tionally, we have provided each slum a Zone number (1–10) according to the classification
of the World Bank (World Bank 2007, Chapter, pp. 4–8).
Zones 2 and 10 have the lowest proportion of slum areas in Dhaka (\1 %), while Zone
1 has the highest proportion (11 %) (World Bank 2007). From our graph it is seen that the
proportion of very poor population was the highest in the slums of the Zone 10 and Zone 6.
Modern toilet was reported most often in the slum area Kullanpur pura bosti (Zone 6(7)).
The households from the slums in Zone 10 had a modern toilet only in 4.3 and 9.7 % of
Fig. 1 Selected socioeconomic and housing characteristics in study areas including urban slums only,
% within slums. Zone (Z) 1–10 are attributed according to the classification of the World Bank (World
Bank 2007, Chapter 1, pp. 4–8). p \ 0.0001 including three rural areas (data not shown in the graph)
123
cases. Zone 10 was also reported not to have any public toilets within on average 100
meters of slum settlements (World Bank 2007). The respondents from the largest slum in
our study Koral Bosti reported their areas to be very bad to reach medical care in 18.8 % of
cases. This is consistent with the above mentioned data showing that this slum did not have
a single public toilet or a health clinic (World Bank 2007, Chapter 1). Overall, we can
conclude that there were significant differences between single slum areas in terms of
major socio-economic and housing factors. Overall housing dissatisfaction was high (over
50 % in all cases), however, the reasons for it were likely to be different.
There was also an observable difference among three rural areas in our study: while two
of them reported housing dissatisfaction in 2.2 % (Khalia biad village, Monohordi) and
1 % (Gerua village, Savar) of cases, the third rural area (Purbochor paratola village,
Katiadi) was dissatisfactory for 55.5 % of the respondents. The main difference of the
former area from the two other was that 87 % of its residents were categorized as ‘very
poor’ and ‘poor’ according to the family possessions-based wealth index (WI). In terms of
health 99 % of the Purbochor paratola village, Katiadi, reported having had a diseases in
the last three months. Besides, more than one-third of the respondents from this rural area
reported that their living area was ‘‘bad to reach medical care’’. In two other areas this
proportion was 11.5 and 1 %, respectively.
Table 2 contains sample statistics, including standard errors of proportions.
3.3 Tenure in Urban Slum Areas and Rural Sites
Among our respondents 36.5 % reported owning their house, more than the half of the
respondents reported to rent their house (58.6 %) and the rest displayed other forms
of ownership or rent. By comparing rural and urban areas we identified that 99.2 % of
rural residents were owners of the houses, whereas in urban slum area only 21.9 % of
respondents reported an ownership (p \ 0.001). Notably, about 85 % of the survey
respondents had lived in rural areas before moving to the current place of living. Their
reported satisfaction with the current place of living was relatively high: only about 5 % of
the respondents in 2008 and 12 % in 2009 reported dissatisfaction (‘‘highly unsatisfied’’ or
‘‘unsatisfied’’).
Several questions in our survey were related to the materials of the roof, floor and walls of
the house where respondents were living. Possible categories were: tin, pucca (e.g. cement,
concrete), katcha (e.g. wood, hay, mud) and thatch (jhupri) for a roof; katcha, pucca and wood
for a floor, and tin, katcha, pucca and wood for a wall. Tin is the most common material used
for building houses in Bangladesh. Our data showed that similar materials were used for
houses in urban as well as in rural areas (with slight statistical differences, data not shown).
93.3 % of all roofs of the houses were reported to be built with tin.
3.4 Main Outcome Variables
Our outcome variable ‘Housing satisfaction’ contained four categories and was distributed
as shown in Fig. 2.
3.4.1 Results of Ordinal Regression
We examined the relation of each explanatory variable and housing satisfaction using plots
of cumulative percentage. We have built such plots for all explanatory variables (data not
123
Table 2 Sample statistics (n = 2,992)

Variables Proportions Standard errors of proportions
Housing satisfaction (dependent variable)

Highly unsatisfied 0.1688 0.0068
Unsatisfied 0.4756 0.0091
Moderately satisfied 0.2249 0.0076
Satisfied 0.1307 0.0062
Sex
Male 0.5043 0.0091
Female 0.4957 0.0091
Age
10–20 years 0.1146 0.0058
21–30 years 0.3767 0.0089
31–40 years 0.2574 0.0080
41–50 years 0.139 0.0063
51 and older 0.1123 0.0058
Years of education
10 years and more 0.0695 0.0046
6–9 years 0.13 0.0061
1–5 years 0.2216 0.0076
No education 0.5789 0.0090
Wealth index (based on household properties)
Very poor 0.2122 0.0075
Poor 0.1076 0.0057
Average 0.2039 0.0074
Rich 0.3038 0.0084
Very rich 0.1725 0.0069
Self-assessment of general health
Poor 0.0675 0.0046
Fair 0.131 0.0062
So so 0.5468 0.0091
Excellent/good 0.2547 0.0080
Recent diseases (3 months)
No 0.237 0.0078
Yes 0.763 0.0078
Type of area
Rural 0.1578 0.0067
Urban 0.8422 0.0067
Way to access the house
Car/lorry 0.1019 0.0055
Rickshaw 0.1156 0.0058
On foot 0.7824 0.0075
Living area convenient to reach medical care
Bad/very bad 0.1568 0.0066
Moderate 0.492 0.0091
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Table 2 continued
Variables Proportions Standard errors of proportions
Very good/good 0.3513 0.0087

Main source of drinking water
Surface/Other 0.0662 0.0045
Tubewell outside 0.1922 0.0072
Tubewell inside 0.2283 0.0077
Piped water inside 0.0371 0.0035
Piped water outside 0.4763 0.0091
Materials of the floor
Wood/Other 0.1751 0.0069
Pucca 0.2965 0.0083
Katcha 0.5284 0.0091
Number of persons living in respondent’s room
7 and more persons 0.1324 0.0062
4–5 persons 0.4178 0.0090
3 persons 0.2416 0.0078
1–2 persons 0.2082 0.0074
House sufficient for the family
Yes 0.2968 0.0084
No 0.7032 0.0084
Neighbourhood environment negatively affects health
DNK/Refuse 0.0267 0.0029
No 0.3934 0.0089
Yes 0.5799 0.0090
Membership in a community or NGO
Yes 0.124 0.0060
No 0.876 0.0060
Fig. 2 Rating of housing satisfaction in urban slum and rural areas, Dhaka, %, n = 3,045
123
shown) and made our decision on which of them to include based on the observable
differences. Major socio-demographic variables such as age and sex were included
regardless of their bivariate associations with the outcome variable.
In the following Table 3 we report the parameter estimates for the explanatory variables
for housing satisfaction obtained through ordinal regression.
We considered first individual and household factors at the top of the table. Neither sex
nor age of the respondents showed statistically significant associations with the level of
housing satisfaction. However, our respondents were more likely to be satisfied with their
housing conditions the more educated (more years of education) they were.
Further, we could observe a clear tendency in housing satisfaction in relation to the
family wealth status. There existed a highly significant correlation between being wealthy
and reporting higher satisfaction with housing.
The next set of variables included housing, neighbourhood and locational factors. The
initial model contained the variable ‘tenure’, which showed high statistical significance in
bivariate analysis. However, our exploratory analysis detected high correlation of this
variable with the type of the living area which led to the inclusion of only one of these two
variables into the final model. As we see from the table, rural residents reported much
higher satisfaction with their housing than urban residents (parameter estimate 1.923,
p \ 0.0001). From the descriptive analysis we know that 99.2 % of rural residents were
homeowners (in contrast to about 20 % of ownership in urban slums). From this we may
conclude that being the owner of a house was also likely to be a source of higher housing
satisfaction.
A good access or reachability of the house also played a role in defining housing
satisfaction. Though almost 80 % of the houses of study respondents could only be reached
on foot, those comparatively few respondents whose houses were better reachable (e.g. had
better roads which can be passed with a car or rickshaw) were more often satisfied with
their housing (parameter estimate 0.316 for rickshaw, p = 0.008).
Type of drinking water source showed a link with the housing satisfaction. An access
only to surface water (6.6 % of the sample) caused more dissatisfaction and access to piped
water inside dwelling (3.7 %) caused more satisfaction as compared to access to piped
water outside dwelling. Wooden floors in a house decreased levels of housing satisfaction
as opposed to katcha floor (p \ 0.0001).
Number of persons living in the respondent’s room seemed to have only a slight
predictive power over housing satisfaction. Those sharing their room and private space
with seven persons and more were less often satisfied with their housing conditions than
those living with one or two persons.
A strong and highly statistically significant association was detected for the locational
variable ‘Living area is located well to reach medical care’. Those respondents who
perceived their area as ‘‘Very bad or bad’’ or ‘‘Moderate’’ to reach medical care reported
much lower levels of housing satisfaction.
Respondents who perceived their neighbourhood environment as not harmful for their
health were much more frequently satisfied with their housing in general in our study
(parameter estimate 0.953, p \ 0.0001).
Finally, the last factor included into our model examined the relation between a social
participation, namely membership in a non-governmental organization (NGO), and
housing satisfaction. Indeed, a membership in NGO provided higher levels of housing
satisfaction (Table 3).
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Table 3 Ordinal regression model for the dependent variable ‘Housing satisfaction’, n = 2,992
N (%) Estimate b Significance level p value
Housing satisfaction (dependent variable)

Highly unsatisfied 505 (16.9)
Unsatisfied 1423 (47.6)
Moderately satisfied 673 (22.5)
Satisfied 391 (13.1)
Individual and family (household) characteristics
Sex
Male 1,509 (50.4) -0.069 0.356
Female 1,483 (49.6) 0
Age
10–20 years 343 (11.5) -0.372 0.021
21–30 years 1,127 (37.7) -0.061 0.634
31–40 years 770 (25.7) -0.045 0.731
41–50 years 416 (13.9) 0.036 0.804
51 and older 336 (11.2) 0
Years of education
10 years and more 208 (7.0) -0.021 0.894
6–9 years 389 (13.0) 0.348 0.004
1–5 years 663 (22.2) 0.301 0.001
No education 1,732 (57.9) 0
Wealth index (based on household properties)
Very poor 635 (21.2) -0.671 0.000
Poor 322 (10.8) -0.334 0.026
Average 610 (20.4) -0.247 0.050
Rich 909 (30.4) -0.142 0.213
Very rich 516 (17.2) 0
Health perception
Self-assessment of general health
Poor 202 (6.8) -0.028 0.865
Fair 392 (13.1) 0.022 0.865
So So 1,636 (54.7) -0.391 0.000
Excellent/good 762 (25.5) 0
Recent diseases (3 months)
No 709 (23.7) 0.300 0.001
Yes 2,283 (76.3) 0
Housing and neighbourhood and locational factors:
Type of area
Rural 472 (15.8) 1.923 0.000
Urban 2,520 (84.2) 0
Way to access the house
Car/lorry 305 (10.2) 0.306 0.019
Rickshaw 346 (11.6) 0.316 0.008
On foot 2,341 (78.2) 0
123
Table 3 continued
N (%) Estimate b Significance level p value
Living area convenient to reach medical care

Bad/very bad 469 (15.7) -1.203 0.000
Moderate 1,472 (49.2) -1.010 0.000
Very good/good 1,051 (35.1) 0
Main source of drinking water
Surface/Other 198 (6.6) -0.524 0.001
Tubewell outside 575 (19.2) 0.011 0.918
Tubewell inside 683 (22.8) -0.051 0.600
Piped water inside 111 (3.7) 0.451 0.020
Piped water outside 1,425 (47.6) 0
Materials of the floor
Wood/Other 524 (17.5) -0.393 0.000
Pucca 887 (29.6) 0.067 0.466
Katcha 1,581 (52.8) 0
Number of persons living in respondent’s room
7 and more persons 396 (13.2) -0.337 0.010
4–5 persons 1,250 (41.8) -0.050 0.625
3 persons 723 (24.2) 0.140 0.202
1–2 persons 623 (20.8) 0
House sufficient for the family
Yes 888 (29.7) 0.339 0.000
No 2,104 (70.3) 0
Perception of the living area in relation to health
Neighbourhood environment negatively affects health
DNK/Refuse 80 (2.7) 0.736 0.002
No 1,177 (39.3) 0.953 0.000
Yes 1,735 (58.0) 0
Social relations/social capital
Membership in a community or NGO
Yes 371 (12.4) 0.419 0.000
No 2,621 (87.6) 0
Valid 2,992 (100.0)
Missing 215
Total 3,207
-2 Log likelihood v2 df Sig.
Model fitting information

Intercept Only 7,418.236
Final 6,036.056 1,382.181 34 0.000
Goodness-of-fit (link function: logit)
Pearson 7,824.332 8,576 1.000
Deviance 5,958.791 8,576 1.000
123
Table 3 continued
-2 Log likelihood v2 df Sig.
Pseudo R2 (link function: logit)

Cox and Snell 0.370
Nagelkerke 0.403
McFadden 0.184
3.5 Logistic Regression Analysis
Our logistic regression model (Table 4) confirmed the associations identified by the ordinal
regression procedure to the most part and gave us a clue about strengths of association
between the outcome variable and selected predictors. The dichotomous outcome variable
was distributed as follows: ‘‘Satisfied’’ (1,046, 35.7 %) and ‘‘Unsatisfied’’ (1,882, 64.3 %).
Strong associations were observed between variables indicating different housing fea-
tures (water source (surface water), toilet type (unhygienic types), materials of the floor
(wood) and housing dissatisfaction. Living in rural areas displayed a strong protective
effect against being unsatisfied with own housing (OR = 0.12; 95 % CI 0.08–0.17).
A membership in a community or an NGO tended to cause higher housing satisfaction.
A very strong (though with a wide confidence interval) statistical association was observed
between self-reported satisfaction with available facilities (a combined variable of (edu-
cational, recreation, working facilities, leadership, health services and transportation) and
overall housing satisfaction. Respondents who reported being unsatisfied with different
types of facilities were also much more often dissatisfied with the overall housing
(OR = 15.52; 95 % CI 10.63–22.65).
We would like however make a particular emphasis on the link between health variables
and housing dissatisfaction. First, those respondents who reported not having any disease
within the last 3 months were less often dissatisfied with their housing (OR = 0.70; 95 %
CI 0.54–0.90). Further, a perception of own living area in regard to accessing of medical
care as ‘‘bad/very bad’’ or ‘‘moderate’’ showed to be a predictor of dissatisfaction with
housing. Finally, those respondents who did not perceive their neighbourhood as harmful
for their health were also more often satisfied with their housing (OR = 0.34; 95 % CI
0.27–0.42).
4 Discussion
We have explored the determinants of housing satisfaction among residents of urban slum
areas and adjacent rural areas of megacity of Dhaka, Bangladesh. Our data was collected
during 2008 and 2009 and included 3,207 households. Data on satisfaction with housing
was collected at the baseline surveys and from one respondent from each of the house-
holds. Based on the concepts described in the literature, we have applied an ordinal and
multiple logistic regression to analyse associations between housing satisfaction and its
determinants. Our findings contribute to the growing body of knowledge about the specific
of living environment in urban slums areas and help understanding the key factors
determining housing satisfaction among the most disadvantaged population groups which
should serve as a basis for improved housing policies.
123
Table 4 Results of binary multiple logistic regression (model adjusted for sex, years of education, house
sufficiency for the family (y/n), ways to access the house) (n = 2,928)
Name of variable Categories Sig. Exp (B) (OR) 95 % CI
for Exp (B)
Lower Upper
Individual and family (household) characteristics

Age 10–20 years 1
21–30 years 0.039 0.68 0.47 0.98
31–40 years 0.307 0.81 0.55 1.21
41–50 years 0.042 0.64 0.41 0.98
51 and older 0.051 0.63 0.40 1.00
Wealth index (based on household Very poor 0.000 2.40 1.64 3.50
properties) Poor 0.325 1.23 0.81 1.87
Average 0.540 1.11 0.79 1.57
Rich 0.269 1.20 0.87 1.64
Very rich 1
Health perception
Self-assessment of general health Poor 0.533 0.87 0.56 1.35
Fair 0.114 1.35 0.93 1.96
So So 0.001 1.53 1.18 1.98
Excellent/good 1
Recent diseases (3 months) No 0.006 0.70 0.54 0.90
Yes
Housing and neighbourhood and locational factors
Type of area Rural 0.000 0.12 0.08 0.17
Urban 1
Living area convenient to reach Bad/very bad 0.000 1.83 1.32 2.55
medical care Moderate 0.000 2.09 1.65 2.64
Very good/good 1
Main source of drinking water Surface/Other 0.001 2.18 1.36 3.48
Tubewell outside 0.893 0.98 0.73 1.31
Tubewell inside 0.196 1.20 0.91 1.59
Piped water inside 0.454 1.23 0.71 2.13
Piped water outside 1
Materials of the floor Wood/Other 0.000 1.80 1.30 2.49
Pucca 0.386 1.12 0.87 1.45
Katcha 1
Type of toilet Septic tank/modern toilet 1
Pit/slab latrine 0.000 1.86 1.41 2.45
Open latrine 0.000 2.20 1.44 3.36
Hanging latrine 0.010 1.63 1.12 2.36
Satisfaction with facilities in the living area
Satisfaction with facilities Unsatisfied 0.000 15.52 10.63 22.65
Moderately satisfied 0.000 3.71 2.60 5.29
Satisfied 1
123
Table 4 continued
Name of variable Categories Sig. Exp (B) (OR) 95 % CI

for Exp (B)
Lower Upper
Perception of the living area in relation to health

Neighbourhood environment DNK/Refuse 0.000 0.20 0.09 0.46
negatively affects health No 0.000 0.34 0.27 0.42
Yes 1
Social relations/social capital
Membership in a community Yes 0.013 0.68 0.51 0.92
or NGO No 1
Valid 2,928 100.0 %
Missing 279
Total 3,207
Model summary -2 Log likelihood Cox and Snell R2 Nagelkerke R2 Sig.
1 Step 2,402.293a 0.383 0.526
Hosmer and Lemeshow test v2 df Sig.
9.010 8 0.341
b c
Area Std. error Asymptotic sig. Asymptotic 95 % CI
Area under the curve

0.871 0.007 0.000 0.857–0.885
a
Estimation terminated at iteration number 5 because parameter estimates changed by \0.001
b
Under the nonparametric assumption
c
Null hypothesis: true area = 0.5
4.1 Specific of Situation about Housing in Bangladesh and Dhaka in Particular
As Dahlgren and Whitehead argue (2006), ‘‘the challenge in urban areas at any economic
level is to improve the health situation for the poorest or most disadvantaged by ‘‘levelling
up’’ their living conditions’’.
In Dhaka most of the city’s poor population live in provisional houses, only 5 per cent
are estimated to live in permanent houses. Rental prices are high and lead to overcrowding.
Dhaka’s unique topography combined with its rapid urban growth, large area and unstable
environmental conditions make a provision of permanent affordable housing and basic
amenities to a big challenge for political sector. World Bank prognoses that the size of
slum population in Dhaka grows up to eight million within next several years and
emphasizes the priority which housing improvement must get under these conditions
(World Bank 2007). Though the Government of Bangladesh supported by different
international and national organizations implemented several programmes aiming at
improvement of slums, none of them had a housing component as a main focus and was
123
able to make only a little impact on the massive problems which slum dwellers face (World
Bank 2007). Further urban planning development is urgently needed which can flexibly
and rapidly response to urbanization tempo in this megacity.
A draft of National Urban Sector Policy is being adapted and provides important policy
guidelines regarding urban housing. In context of the slum population guidelines concern
the resettlement of the slum dwellers, ensuring tenure security, creation of special zones for
urban poor, improvement of basic infrastructure services and supporting informal sector
activities. The document emphasizes the need for more urban research and reports
insufficiency of available reports in comparison with the rapid urbanization (Government
of the People’s Republic of Bangladesh et al. 2011).
4.2 Socio-Economic Predictors of Housing Satisfaction
As hypothesized, our research showed that income measured in goods possessions

(wealth index (WI)) had a direct effect on the level of housing satisfaction. This result is
consistent with findings from many other studies (Rohe and Basolo 1997; Biswas-Diener
and Diener 2001; Van Praag and Ferrer-i-Carbonell 2004; Vera-Toscano and Ateca-
Amestoy 2007) and indicates that better well-off households are more likely to afford
better housing and thus report higher housing satisfaction. This finding is not surprising
and can serve as a strong argument in the discussion on poverty reduction in low-income
countries.
Contrary to the evidence that higher education is associated with the lower levels of
housing satisfaction (e.g. due to higher chance of having unmet demands), our respon-
dents were more likely to be satisfied with their housing conditions i.e., the more
educated (more years of education) persons reported higher satisfaction. Yet this result
should be treated with caution, as more than 70 % of the sample reported zero or one to
5 years of education. Besides, taking into account the context of urban slums, literate
respondents are more likely to have better income and thus be able to afford better living
conditions.
4.3 Rural–Urban Differences, Tenure and Water Source
Further important finding of our research indicated that the rural residents were more
satisfied with their housing situation as compared to urban slum residents. We can offer
several interpretations of this finding. First, in our sample almost all of the respondents
from the rural areas of Dhaka reported being owner of their house which is common in
rural Bangladesh. Urban slum dwellers rarely own their dwellings and are more likely
to change their place of living, for example, to search for a new job. Ownership was
shown to be positively associated with housing satisfaction in many other studies, like,
for example, in Rohe and Basolo (1997), Ogu (2002) and Vera-Toscano and Ateca-
Amestoy (2007), Nathan (1995). Next, living conditions in urban slums in Dhaka are
characterized by extreme poverty, adverse sanitary conditions, low water quality and
high residential crowding due to rural–urban migration. Besides, such settlements are
often more flood-affected due growing urbanizations and increasing paving of the urban
areas. For example, the proportion of ‘windowless’ houses and houses with insufficient
light in urban slum areas was much higher as compared to rural areas. In general,
though rural areas in Dhaka may as well be characterized by relatively poor quality
123
living conditions their residents tend to have better mental well-being, low mobility
and have strong ties with family and neighbours, which predicts better overall housing
satisfaction (e.g. Khan et al. 2009). Moreover, houses in rural areas in our study were
more often surrounded by a piece of land and not only by other houses as this was
most often the case in urban slum areas. Dwelling satisfaction with the surrounding of
the house was higher when at least a small piece of land was adjoining the house in
the Indian study (Nathan 1995). Low levels of housing satisfaction in slums were
earlier reported in Hong Kong by Yeung and Drakakis-Smith (1982) (cited in Nathan
1995).
Satisfaction with housing in our study in relation to the water source displayed
significant associations, namely those respondents who had access to water inside their
dwelling were also more satisfied with their housing. Khan et al. (2010) reported as well
poor satisfaction levels among slum dwellers in terms of water supply, water quality and
water drainage. According to the data of Khan et al. (2010), most of the slums in Dhaka
(over 70 %) were affected by stagnant water. In general, accessing of drinking water in
Dhaka for slum dwellers can be very expensive, time consuming and physically demanding
(World Bank 2007, Chapter 1). Other results of our study showed positive associations
between having an unhygienic toilet and being dissatisfied with the housing. Therefore,
access to clean water and sanitation as well as waste disposal remains a traditional chal-
lenge for urban poor population significantly affecting the quality of their housing and life
(Kjellstrom et al. 2006). At the same time from the point of view of urban planners this
challenge can be addressed by targeted housing programmes and reach positive results
within assessable periods of time.
4.4 Reachability of Medical Care and Neighbourhood Perception in Regard to Health

and Facilities
Two of our findings concerned the locational characteristics of the living areas of our
respondents. Our statistical model showed that those respondents whose areas were not
convenient to reach/seek medical care were more often unsatisfied with their housing.
This result stresses the importance which study participants put on the reachability of a
health care provider. It is furthermore of interest considering the fact that most of the
dwellings of our respondents could only be reached by foot and were located in densely
built urban areas with poor access to roads and facilities. Consequently, the respondents
whose dwellings could be reached by transport (car, lorry, taxi) and not only by foot
had slightly higher levels of housing satisfaction. Similarly, in the study (though dated)
of low-income squatter settlements of Lima, Peru, a dissatisfaction index was higher
among residents who were concerned with the location of medical services, namely
with the distance and access to them. The quality of medical services was in turn less
important in this context (Andrews and Phillips 1970). In Mogapair, India, the roads,
access to the city from the dwelling and the overall mass transportation system were
severely criticized by the respondents and caused lower housing satisfaction (Nathan
1995).
One more essential finding was related to the perception of own living area in relation
to health. Those respondents whose perception of their neighbourhood was rather posi-
tive than negative for their health, reported much more often high satisfaction with
housing. This finding confirms that satisfactory quality of housing in relation to health is
123
also an important predictor of housing satisfaction. An adequate housing is as well an

important social determinant of health (Krieger and Higgins 2002). This demonstrates the
strong link existing between the neighbourhood adjacent to the own living house, its
influence on own health and well-being and satisfaction with housing as a whole
(Howden-Chapman 2004). Although the causality direction is not completely clear, a
neighbourhood satisfaction was shown to be most strongly influenced by satisfaction
with housing and private space (Parkes et al. 2002a; Fried 1982, 1984; Herting and Guest
1985) and was applied as a proxy determinant for overall life satisfaction (Fried 1984).
Evidence shows that associations between housing and health are complex and any
causal relationships can be masked or confounded by multiple variables and influenced
by effect modifiers (WHO 2010).
Finally, our respondents’ overall housing satisfaction was strongly linked to their sat-
isfaction with the facilities available in their living areas (educational, recreational, health
services etc.). By comparing level of satisfaction with single facilities and overall housing
satisfaction we have found no significant differences. This finding is consistent with the
results of a (spatial) slum survey reported by World Bank, according to which urban poor
have a limited access or long distances to such social services as schools and clinics, as
well as public toilets (World Bank 2007, Chapter 1). The results of our analysis point out at
the particular meaning which population living in poor urban areas of Dhaka pay to the
improvement of accessibility and usability of such basic facilities.
4.5 NGO Membership
At last our analysis revealed that respondents participating as a member in any NGO had
higher levels of housing satisfaction as compared to non-members. Though this was the
single factor analysed in terms of social capital it could give us a clue for further research.
We suggest that the positive influence of such social participations is based on respon-
dent’s feeling to have social control over certain actions taking place in the community,
having good relations to other community members and being able to make difference in
some important daily occurrences.
4.6 Limitations of the Study
Our study showed some limitations which are important to address in the further research
on housing satisfaction. First, though our whole study bore a longitudinal character, items
related to satisfaction were only collected at the baseline interviews. Therefore we could
not figure out whether housing satisfaction would change over time, or would display even
seasonal variations (Howden-Chapman 2004). Besides, only a single person from the
household which was at home during the interview could report his or her subjective
opinion about housing satisfaction. Next important limitation is that we have not used any
objective characteristics of the housing (e.g. measurement of water quality or assessment
of building materials or distance to doctor), but simply subjective reporting of different
housing features.
An expected method of regression for the hierarchical data would be a multilevel
regression modelling adjusting for clustering and distinguishing between individual and
neighbourhood and area-level variables (Howden-Chapman 2004). However, despite the
multistage sampling procedure used for this study, our data had limitations in the
number of groups at the level two. Only nine groups (nine units representing slum
areas, or PSU) would be available at the level two which would make it difficult to
123
estimate the contextual effects on the outcome variable (Maas and Hox 2004, 2005,
2005). Due to the lack of robustness of the data in terms of units per level we have
avoided performing a multilevel analysis and chose traditional single-level statistical
models. Finally, we could only include one variable as an indicator for social partic-
ipation (membership in NGO). According to the existing literature mentioned previ-
ously, family ties and neighbourhood or community support can be a source of higher
housing satisfaction and should be carefully addressed in the future research. Certainly,
it would be interesting to be able to predict whether housing satisfaction in urban slums
can influence decision of slum dwellers to move to another place or take community
action to improve their own living and housing conditions.
5 Conclusions
Our research is an important step in exploring the sources of housing satisfaction

among urban poor as well as rural dwellers in a megacity of global south. Despite the
limitations, the findings of our study clearly demonstrated the complexity of the con-
cept of housing satisfaction and its socioeconomic predictors and the importance of
including several sets of explanatory variables into analysis. The existing link between
health and housing satisfaction was made obvious and should be the focus of further
research in urban housing and urban planning policy. The study brings evidence for
urban planners and municipal governors about what multiple priorities which should be
addressed to provide urban residents with satisfactory and safe housing, taking into
account growing urbanisation and migration in the megacities like Dhaka. Beyond
efforts to reduce poverty, there are actions needed to improve substandard housing
conditions in long-term view.
Appendix
See Fig. 3.
123
Fig. 3 Map of the selected study areas in Dhaka
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Soc Indic Res (2013) 112:163–185

Housing Satisfaction Related to Health and Importance

Arina Zanuzdana • Mobarak Khan • Alexander Kraemer

Accepted: 16 April 2012 / Published online: 3 May 2012

Keywords Housing satisfaction Facilities Distance to services Slums

A. Zanuzdana (&) M. Khan A. Kraemer

2.1 Selection of Study Population and Sampling Strategy

2.2 Ethical Considerations

2.3 Outcome Variables

2.4 Independent Variables

Table 1 Sets of explanatory variables selected for statistical analysis

3.1 Urban–Rural Differences

3.3 Tenure in Urban Slum Areas and Rural Sites

3.4 Main Outcome Variables

3.4.1 Results of Ordinal Regression

Table 2 Sample statistics (n = 2,992)

Housing satisfaction (dependent variable)

Variables Proportions Standard errors of proportions

Very good/good 0.3513 0.0087

Housing satisfaction (dependent variable)

N (%) Estimate b Significance level p value

Living area convenient to reach medical care

-2 Log likelihood v2 df Sig.

Model fitting information

Pseudo R2 (link function: logit)

3.5 Logistic Regression Analysis

Individual and family (household) characteristics

Name of variable Categories Sig. Exp (B) (OR) 95 % CI

Perception of the living area in relation to health

Model summary -2 Log likelihood Cox and Snell R2 Nagelkerke R2 Sig.

1 Step 2,402.293a 0.383 0.526

Hosmer and Lemeshow test v2 df Sig.

Area under the curve

4.1 Specific of Situation about Housing in Bangladesh and Dhaka in Particular

4.2 Socio-Economic Predictors of Housing Satisfaction

As hypothesized, our research showed that income measured in goods possessions

4.3 Rural–Urban Differences, Tenure and Water Source

4.4 Reachability of Medical Care and Neighbourhood Perception in Regard to Health

also an important predictor of housing satisfaction. An adequate housing is as well an

4.5 NGO Membership

4.6 Limitations of the Study

Our research is an important step in exploring the sources of housing satisfaction

Fig. 3 Map of the selected study areas in Dhaka

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