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State of the Health of the Urban Poor in Nairobi

28 August 2014 12:00 (America/New_York)

Population and Health Dynamics in Nairobi’s Informal Settlements, 2014. African Population and Health Research Center (APHRC).

This report documents the living conditions and health risks of slum-dwellers across Nairobi’s informal settlements a decade after the Nairobi Cross-sectional Slums Survey of 2000 (NCSS 2000). It aims to not only highlight the needs of slum-dwellers but also inform policymakers on the changes that have occurred in the living conditions of Nairobi’s urban poor since 2000, considering development interventions by the Government of Kenya (GoK) and its development partners. The primary objective of the NCSS 2000 report was to document population and health problems among the residents of Nairobi’s informal settlements and to compare these with indicators from national surveys for other sub-groups of the Kenyan population. The survey report, Population and Health Dynamics in Nairobi‘s Informal Settlements, for the first time brought to light the plight of slum residents in Kenya.

Hitherto, this plight had remained hidden in national data systems and urban averages. In particular, the survey brought to focus the excess mortality and disease burden among the urban poor compared to any other subgroup in the country; their limited access to health care and family planning services; and the debilitating environment that characterizes their physical living conditions, including inadequate access to water and sanitation, poor housing conditions, poor livelihood opportunities and the near-absence of public sector services. A decade after the NCSS 2000, it became critical to revisit the slums of Nairobi to take stock of the changes that had taken place since 2000. The current report is guided by these key questions:

  • Are the needs of the slum-dwellers still the same?
  • What has really changed since the last report?
  • What are the new areas of focus to improve the well-being of the slum-dwellers?

Urbanization and health in developing countries: a systematic review.

28 August 2014 11:51 (America/New_York)

Urbanization and health in developing countries: a systematic review. World Health Popul. 2014;15(1):7-20.

Authors: Eckert S, Kohler S. Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany.

BACKGROUND: Future population growth will take place predominantly in cities of the developing world. The impact of urbanization on health is discussed controversially. We review recent research on urban-rural and intra-urban health differences in developing countries and investigate whether a health advantage was found for urban areas.

METHODS: We systematically searched the databases JSTOR, PubMed, ScienceDirect and SSRN for studies that compare health status in urban and rural areas. The studies had to examine selected World Health Organization health indicators.

RESULTS: Eleven studies of the association between urbanization and the selected health indicators in developing countries met our selection criteria. Urbanization was associated with a lower risk of undernutrition but a higher risk of overweight in children. A lower total fertility rate and lower odds of giving birth were found for urban areas. The association between urbanization and life expectancy was positive but insignificant. Common risk factors for chronic diseases were more prevalent in urban areas. Urban-rural differences in mortality from communicable diseases depended on the disease studied.

CONCLUSION: Several health outcomes were correlated with urbanization in developing countries. Urbanization may improve some health problems developing countries face and worsen others. Therefore, urbanization itself should not be embraced as a solution to health problems but should be accompanied by an informed and reactive health policy.

Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority

28 August 2014 11:32 (America/New_York)

Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority. Burns, Volume 40, Issue 6, September 2014, Pages 1194–1200.

Authors: Joshua M. Wonga, et al.

Introduction – Ninety-five percent of burn deaths occur in low- and middle-income countries (LMICs); however, longitudinal household-level studies have not been done in urban slum settings, where overcrowding and unsafe cook stoves may increase likelihood of injury.

Methods- Using a prospective, population-based disease surveillance system in the urban slum of Kibera in Kenya, we examined the incidence of household-level burns of all severities from 2006–2011.

Results – Of approximately 28,500 enrolled individuals (6000 households), we identified 3072 burns. The overall incidence was 27.9/1000 person-years-of-observation. Children <5 years old sustained burns at 3.8-fold greater rate compared to (p < 0.001) those ≥5 years old. Females ≥5 years old sustained burns at a rate that was 1.35-fold (p < 0.001) greater than males within the same age distribution. Hospitalizations were uncommon (0.65% of all burns).

Conclusions – The incidence of burns, 10-fold greater than in most published reports from Africa and Asia, suggests that such injuries may contribute more significantly than previously thought to morbidity in LMICs, and may be increased by urbanization. As migration from rural areas into urban slums rapidly increases in many African countries, characterizing and addressing the rising burden of burns is likely to become a public health priority.

WSUP – The urban water supply guide: service delivery options for low-income communities

14 August 2014 10:49 (America/New_York)

The urban water supply guide: service delivery options for low-income communities, 2014.

Water and Sanitation for the Urban Poor.

Providing improved water supply to low-income urban communities is a difficult challenge faced by water utilities throughout Africa and Asia. This guide provides an introduction to available options for serving these communities. The guide draws on sector experience in general, and more particularly on WSUP’s extensive experience of implementing urban WASH programmes in sub-Saharan Africa and elsewhere.

This guide is aimed primarily at executive and technical staff in water utilities and related organisations, such as asset-holders and regulators. It will also be useful for WASH professionals working in governments, development agencies, funding agencies or civil society organisations.

Metabolized-water breeding diseases in urban India: Socio-spatiality of water problems and health burden in Ahmedabad

14 August 2014 10:46 (America/New_York)

Metabolized-water breeding diseases in urban India: Socio-spatiality of water problems and health burden in Ahmedabad, 2014.

Subramanian, Saravanan V., et al. Center for Development Research, University of Bonn.

The paper brings together urban metabolism, political ecology and anthropological studies to examine how the material flow of water is socially constructed and reconstructed through everyday water problems and its health burden in Ahmedabad city, India. The article geo-references the water problems and occurrence of diseases and through interviews documents the socio-spatial characteristics of water problems and health burden in two case study wards. The paper provides a situated understanding of the everyday practices that exposes the water infrastructure through leakages, reveals the citizens desire for better water quality and struggle to gain access to water using diverse ‚pressure‘ tactics.

It is this social-material construct of infrastructure that gives structure and coherence to urban space, which spatially coincides with the occurrence of diseases. The analysis reveals the socio-political drivers of the water problems, spatial inequity in water access, and identify potential hypothesis of the hotspots of disease emergences. Attempts to bring about a desired change have to be collective and incremental that takes into consideration the diffuse interplay of power by diverse actors in managing the flow of water. The methodology offers a way forward for researchers and development agencies to improve the surveillance and monitoring of water infrastructure and public health. By bringing ‚place-based‘ and ‚people-based‘ approach, the analysis charts out avenues for incorporating the socio-spatiality of the everyday problems within the field of urban metabolism for improving resource use efficiencies in cities of rapidly growing economies.

 

Unintended Pregnancies among Young Women Living in Urban Slums: Evidence from a Prospective Study in Nairobi City, Kenya

14 August 2014 10:40 (America/New_York)

Unintended Pregnancies among Young Women Living in Urban Slums: Evidence from a Prospective Study in Nairobi City, Kenya. PLoS One, July 2014.

Donatien Beguy, et al.

Background: Despite the significant proportion of young people residing in slum communities, little attention has beenpaid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harshenvironment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes,especially during this key developmental period. This paper aims to fill this research gap by examining the levels of andfactors associated with unintended pregnancies among young women aged 15–22 in two informal settlements in Nairobi,Kenya.

Methods: We use data from two waves of a 3-year prospective survey that collected information from adolescents living inthe two slums in 2007–2010. In total, 849 young women aged 15–22 were considered for analysis. We employed Cox andlogistic regression models to investigate factors associated with timing of pregnancy experience and unintended pregnancyamong adolescents who were sexually active by Wave 1 or Wave 2.

Findings: About two thirds of sexually experienced young women (69%) have ever been pregnant by Wave 2. For 41% of adolescents, the pregnancies were unintended, with 26% being mistimed and 15% unwanted. Multivariate analysis shows asignificant association between a set of factors including age at first sex, schooling status, living arrangements and timing ofpregnancy experience. In addition, marital status, schooling status, age at first sex and living arrangements are the only factors that are significantly associated with unintended pregnancy among the young women.

Conclusions: Overall, this study underscores the importance of looking at reproductive outcomes of early sexual initiation, the serious health risks early fertility entail, especially among out-of school girls, and sexual activity in general among young women living in slum settlements. This provides greater impetus for addressing reproductive behaviors among youngwomen living in resource-poor settings such as slums

Shelter from the Storm: Upgrading Housing Infrastructure in Latin American Slums

14 August 2014 10:35 (America/New_York)

Shelter from the Storm: Upgrading Housing Infrastructure in Latin American Slums, 2014.

Sebastián Galiani, Paul Gertler, Ryan Cooper, Sebastián Martínez, Adam Ross, Raimundo Undurraga. InterAmerican Development Bank.

This paper provides empirical evidence on the causal effects that upgrading slum dwellings has on the living conditions of the extremely poor. In particular, we study the impact of providing better houses in situ to slum dwellers in El Salvador, Mexico and Uruguay. We experimentally evaluate the impact of a housing project run by the NGO TECHO which provides basic pre-fabricated houses to members of extremely poor population groups in Latin America. The main objective of the program is to improve household well-being. Our findings show that better houses have a positive effect on overall housing conditions and general well-being: treated households are happier with their quality of life. In two countries, we also document improvements in children’s health; in El Salvador, slum dwellers also feel that they are safer. We do not find this result, however, in the other two experimental samples. There are no other noticeable robust effects on the possession of durable goods or in terms of labor outcomes. Our results are robust in terms of both internal and external validity because they are derived from similar experiments in three different Latin American countries.

IIED – Urbanisation Concepts and Trends

14 August 2014 10:29 (America/New_York)

Urbanisation Concepts and Trends, 2014.

Authors: Gordon McGranahan, David Satterthwaite. International Institute for Environment and Development.

There is an emerging consensus that urbanisation is critically important to international development, but considerable confusion over what urbanisation actually is, whether it is accelerating or slowing, whether it should be encouraged or discouraged, and more generally what the responses should be. This Working Paper reviews some key conceptual issues and summarises urbanisation trends. It ends with a brief review of urbanisation and sustainable development, concluding that while urbanisation brings serious challenges, attempts to inhibit urbanization through exclusionary policies are likely to be economically, socially and environmentally damaging. Moreover, with the right support urbanisation can become an important element of sustainable development.

 

WSUP – Fecal Sludge Management Services in Lusaka: Moving Up the Excreta Management Services,

14 August 2014 10:24 (America/New_York)

Fecal Sludge Management Services in Lusaka: Moving Up the Excreta Management Services, 2014. Water and Sanitation for the Urban Poor.

Despite most residents of African and Asian cities depending on non-sewered sanitation, only a handful of sanitation authorities have addressed the management of faecal sludge from these systems. This Practice Note describes the launch of a faecal sludge management  (FSM) service in the peri-urban area of Kanyama.

2015 International Conference on Urban Health, Dhaka, Bangladesh

31 July 2014 10:48 (America/New_York)

March 9-12, 2015 – International Conference on Urban Health, Dhaka, Bangladesh – Urban Health for a Sustainable Future: Post 2015 Agenda

ICUH 2015 will be unique. Why? Because this will be the first ICUH in South Asia, and Bangladesh is very important to the region’s development.

The hosting of the conference in Bangladesh is meaningful at a time in the country’s development with the realization of importance of urban health for sustainable development. The conference will also have significant relevance globally.ICUH 2015 will promote the idea that we need to think of urbanization with its impact on environment, economy and social factors which will benefit all segments of the population. It will aim to address to sustain urbanization in such a way that promotes equality, development and health.

The major objective of the ICUH is to gather scientists, practitioners, policy makers and community organizations across disciplines and geographic boundaries (high and low-income settings), to exchange ideas and advance research and practice that promote the health of individuals who are in urban regions, including those individuals who belong to disadvantaged groups. The conference aims to promote trans disciplinary and collaborative research, policy, and interventions, to foster international discussion of urban health issues, to build networks among individuals engaged in urban health, and to promote the understanding of the impact of urban areas on health and behavior. ICUH 2015 aims to focus on post 2015 development agenda on urban health.

 

Urban Development in Sub-Saharan Africa: Bearer of Goods and Risks

31 July 2014 10:39 (America/New_York)

Urban Development in Sub-Saharan Africa: Bearer of Goods and Risks. PLoS Medicine, July 2014.

Authors: Fahad Raza, et al.

Sub-Saharan Africa remains the least urbanized region of the world and more than 60% of the population, 570 million people, still live in rural areas [1]. Over the next few decades Africa will be one of the most rapidly urbanizing regions [2], and with this transition is an expected rise in cardiovascular risk factors and disease (CVD) [3]. Across sub-Saharan Africa, many adults migrate back and forth from rural home communities to more urban areas for work and education; others have moved to urban areas; and in still other cases, rural communities themselves have urbanized.

In this issue of PLOS Medicine, a study by Riha and colleagues is directly concerned with the latter scenario within the context of urbanizing rural Uganda [4]. As the authors aptly note, the crude dichotomy of urban-rural difference obscures the changes occurring within rural regions themselves, as characteristics of urban environments, defined as urbanicity [5], become more prominent. Urbanization is a complex worldwide phenomenon and challenges global populations to re-calibrate a set of far reaching behaviors as the meaning of communities change, networks widen, and globalization influences attitudes and access to new resources. Some of these phenomena are likely to be health promoting, while others expose formerly rural populations to new risks.

Diarrhoea in slum children: observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh.

31 July 2014 10:25 (America/New_York)

Diarrhoea in slum children: observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh. Trop Med Int Health, 2014 Jul 18. doi: 10.1111/tmi.12357. |Order information|

Authors: Ferdous F1, Das SK, Ahmed S, Farzana FD, Malek MA, Das J, Latham JR, Faruque AS, Chisti MJ.

1International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh; Department of Clinical Trial and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.

OBJECTIVES: To determine and compare socio-demographic, nutritional and clinical characteristics of children under five with diarrhoea living in slums with those of children who do not live in slums of Dhaka, Bangladesh.

METHODS: From 1993 to 2012, a total of 28 948 under fives children with diarrhoea attended the Dhaka Hospital of icddr,b. Data were extracted from the hospital-based Diarrhoea Disease Surveillance System, which comprised 17 548 under fives children from slum and non-slum areas of the city.

RESULTS: Maternal illiteracy [aOR = 1.57; 95% confidence interval (1.36, 1.81), P-value <0.001], paternal illiteracy [1.37 (1.21, 1.56) <0.001], mother’s employment [1.59 (1.37, 1.85) <0.001], consumption of untreated water [2.73 (2.26, 3.30) <0.001], use of non-sanitary toilets [3.48 (3.09, 3.93) <0.001], 1st wealth quintile background [3.32 (2.88, 3.84) <0.001], presence of fever [1.14 (1.00, 1.29) 0.047], some or severe dehydration [1.21 (1.06, 1.40) 0.007], stunting [1.14 (1.01, 1.29) 0.030] and infection with Vibrio cholerae [1.21 (1.01, 1.45) 0.039] were significantly associated with slum-dwelling children after controlling for co-variates. Measles immunisation [0.52 (0.47, 0.59) P < 0.001] and vitamin A supplementation rates [0.36 (0.31, 0.41) P < 0.001] amongst children 12-59 months were lower for slum dwellers than other children in univarate analysis only.

CONCLUSIONS: Slum-dwelling children are more malnourished, have lower immunisation rates (measles vaccination and vitamin A supplementation) and higher rates of measles, are more susceptible to diarrhoeal illness due to V. cholerae and suffer from severe dehydration more often than children from non-slum areas. Improved health and nutrition strategies should give priority to children living in urban slums.

Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out

17 July 2014 12:22 (America/New_York)

Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out. Health & Place, Sept 2014.

Authors: E.W. Kimani-Muragea, et al.

Background – We describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials.

Methods - We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results - Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions - The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums

 

Peri-Urban Sanitation and Water Service Provision: Challenges and opportunities for developing countries

17 July 2014 12:12 (America/New_York)

Peri-Urban Sanitation and Water Service Provision: Challenges and opportunities for developing countries, 2014.

Jennifer McConville and Hans Bertil Wittgren (eds). Stockholm Environment Institute.

The challenges facing peri-urban areas may seem daunting, especially because many of them are interlinked and subject to frequent change, which brings greater complexity. However, when problems are interconnected, there can also be opportunities for synergetic and cross-cutting solutions, and rapid change creates space for effective innovation.Thus, despite the challenges, peri-urban areas can also offer rich opportunities. Decentralization of institutional arrangements has had the effect of slowly increasing the mandates and capacity of local government in PUAs, and there is growing recognition of the role that informal and community-based sectors play in urban economics and development. The lack of services in PUAs can present market opportunities for new actors, while weak regulations and competition Anna Norströmfor resources can stimulate innovation.

PUAs can provide openings to change existing, often ineffective, approaches to service delivery. There is room to develop new regulatory procedures, approaches to planning, financing schemes and innovative governance. Many peri-urban residents are already resorting to alternative approaches to service provision, which can be improved and up-scaled to meet demands. There are also opportunities to make the most of the urban-rural divide.

 

Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS

17 July 2014 12:03 (America/New_York)

Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS. Global Health Action, July 2014.

Authors: Clementine Rossier, et al.

Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi(Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences.

Objective: By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play.

Design: We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n3,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatalcare (ANC) use and deliveries at health facilities, controlling for demographic variables.

Results: ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou,there are few differentials in having at least one ANC visit and in delivering at a health facility; however,differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyuwomen, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility.

Conclusions: These results suggest that women are more aware of the importance of ANC utilization inNairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums inNairobi may also help women have all four ANC visits, although the services received may be of substandardquality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.

 

Microbiological Evaluation of the Efficacy of Soapy Water to Clean Hands: A Randomized, Non-Inferiority Field Trial

2 July 2014 10:31 (America/New_York)

Microbiological Evaluation of the Efficacy of Soapy Water to Clean Hands: A Randomized, Non-Inferiority Field Trial. Am J Trop Med Hyg. 2014 Jun 9.

Amin N1, Pickering AJ2, Ram PK2, Unicomb L2, Najnin N2, Homaira N2, Ashraf S2, Abedin J2, Islam MS2, Luby SP2.
Author information
1International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia nuhu.amin@icddrb.org.
2International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract
We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds.

Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P > 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbiologically effective cleansing agent to improve handwashing among households with vulnerable children.

Water quality laboratories in Colombia: a GIS-based study of urban and rural accessibility

2 July 2014 10:27 (America/New_York)

Water quality laboratories in Colombia: a GIS-based study of urban and rural accessibility. Sci Total Environ. 2014 Jul

Wright J1, Liu J2, Bain R3, Perez A4, Crocker J5, Bartram J6, Gundry S7.
Author information
1Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: j.a.wright@soton.ac.uk.
2Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: jenny19880813@gmail.com.
3The Water Institute at UNC, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA. Electronic address: rbain@email.unc.edu.
4Facultad de Ciencias e Ingeniería, Universidad de Boyacá, Campus Universitario Cra 2a este #64-169 Tunja, Boyacá, Colombia. Electronic address: aperezv@uniboyaca.edu.co.
5The Water Institute at UNC, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA. Electronic address: crockerj@live.unc.edu.
6The Water Institute at UNC, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA. Electronic address: jbartram@email.unc.edu.
7Water & Health Research Centre, Department of Civil Engineering, Queens Building, University Walk, Bristol BS8 1TR, UK. Electronic address: stephen.gundry@bristol.ac.uk.

The objective of this study was to quantify sample transportation times associated with mandated microbiological monitoring of drinking-water in Colombia. World Health Organization Guidelines for Drinking-Water Quality recommend that samples spend no more than 6h between collection and analysis in a laboratory. Census data were used to estimate the minimum number of operational and surveillance samples required from piped water supplies under national regulations. Drive-times were then computed from each supply system to the nearest accredited laboratory and translated into sample holding times based on likely daily monitoring patterns.

Of 62,502 surveillance samples required annually, 5694 (9.1%) were found to be more than 6 h from the nearest of 278 accredited laboratories. 612 samples (1.0%) were more than 24 hours’ drive from the nearest accredited laboratory, the maximum sample holding time recommended by the World Health Organization. An estimated 30% of required rural samples would have to be stored for more than 6 h before reaching a laboratory. The analysis demonstrates the difficulty of undertaking microbiological monitoring in rural areas and small towns from a fixed laboratory network. Our GIS-based approach could be adapted to optimise monitoring strategies and support planning of testing and transportation infra-structure development. It could also be used to estimate sample transport and holding times in other countries.

Risk factors for cholera transmission in Haiti during inter-peak periods

2 July 2014 10:23 (America/New_York)

Risk factors for cholera transmission in Haiti during inter-peak periods: insights to improve current control strategies from two case-control studies. Epidemiol Infect. 2014 Aug.

Grandesso F1, Allan M1, Jean-Simon PS2, Boncy J3, Blake A1, Pierre R4, Alberti KP1, Munger A2, Elder G5, Olson D5, Porten K1, Luquero FJ1.
Author information
1Epicentre, Paris,France.
2Médecins sans Frontières, Paris,France.
3Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince,Haiti.
4Direction Sanitaire de l’Artibonite, Gonaives,Haiti.
5Médecins sans Frontières, New York,USA.

SUMMARY Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level.

These findings suggest that, in addition to contaminated water, factors related to direct and indirect inter-human contact play an important role in cholera transmission during inter-peak periods. In order to reduce cholera transmission in Haiti intensive preventive measures such as hygiene promotion and awareness campaigns should be implemented during inter-peak lulls, when prevention activities are typically scaled back.

Rural:urban inequalities in post 2015 targets and indicators for drinking-water

2 July 2014 10:18 (America/New_York)

Rural:urban inequalities in post 2015 targets and indicators for drinking-water. Sci Total Environ. 2014 Aug 15

Bain RE1, Wright JA2, Christenson E1, Bartram JK3.

Author information
1The Water Institute at UNC, University of North Carolina at Chapel Hill, NC, USA.
2Geography and Environment, University of Southampton, Southampton, UK.
3The Water Institute at UNC, University of North Carolina at Chapel Hill, NC, USA. Electronic address: jbartram@unc.edu.

Disparities in access to drinking water between rural and urban areas are pronounced. Although use of improved sources has increased more rapidly in rural areas, rising from 62% in 1990 to 81% in 2011, the proportion of the rural population using an improved water source remains substantially lower than in urban areas. Inequalities in coverage are compounded by disparities in other aspects of water service. Not all improved sources are safe and evidence from a systematic review demonstrates that water is more likely to contain detectable fecal indicator bacteria in rural areas.

Piped water on premises is a service enjoyed primarily by those living in urban areas so differentiating amongst improved sources would exacerbate rural:urban disparities yet further. We argue that an urban bias may have resulted due to apparent stagnation in urban coverage and the inequity observed between urban and peri-urban areas. The apparent stagnation at around 95% coverage in urban areas stems in part from relative population growth – over the last two decades more people gained access to improved water in urban areas. There are calls for setting higher standards in urban areas which would exacerbate the already extreme rural disadvantage.

Instead of setting different targets, health, economic, and human rights perspectives, We suggest that the focus should be kept on achieving universal access to safe water (primarily in rural areas) while monitoring progress towards higher service levels, including greater water safety (both in rural and urban areas and among different economic strata).

India – Safe Drinking Water in Slums From Water Coverage to Water Quality

20 June 2014 12:08 (America/New_York)

India – Safe Drinking Water in Slums From Water Coverage to Water Quality. Economic and Political Weekly, June 2014.

Author: Biraja Kabi Satapathy

This article analyses the water, sanitation and hygiene situation in slum households and compares it with the non-slum urban households using data from the 2011 Census. It argues for a shift from the mere water supply coverage to an emphasis on quality water distribution. Intermittent water supply coupled with poor sanitation contributes to higher health risks. Promoting point-of-use water treatment and basic hygiene practices on safe handling and storage of water are important preventive health interventions. This article advocates for a shift from availability of infrastructure to delivery of service-level outcomes.

This article was made possible by the generous support of the United States Agency for International Development. The views expressed herein are those of the author and do not necessarily refl ect the views of the Health of the Urban Poor Programme implemented by the Population Foundation of India or of USAID.Biraja Kabi Satapathy (birajakabi@gmail.com) is with the Population Foundation of India, Odisha as Water and Sanitation Specialist in USAID’s Health of the Urban Poor Programme.

 

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