Urban Health Updates
Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes. PLoS One, April 2014.
Authors: Marieke Heijnen, Oliver Cumming, Rachel Peletz, Gabrielle Ka-Seen Chan, Joe Brown, Kelly Baker, Thomas Clasen.
Background: More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines.
Methods and Findings: Shared sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared
sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76).
Conclusion: Evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.
Health in urban slums depends on better local data | Source/complete article: SciDevNet, March 2014 |
Excerpts: Speed read
- Local data for each slum would help to address their needs more effectively
- Scientists should work with local government and slum dwellers to gather data
- Aid agencies often lack the urban health statistics needed to measure progress
Scientists and aid agencies need to collect better data locally and tap into local people’s knowledge to improve basic services and healthcare for the one in seven of those around the world who live in urban slums, a major conference has heard.
Slum areas of fast-growing cities in developing countries are failing to benefit from the better and cheaper health services that are supposed to be derived from economies of scale, experts said at the International Conference on Urban Health held in Manchester, United Kingdom, earlier this month (5-7 March).
The main obstacle is a shortage of local data sets, which would reveal issues to prioritise in each slum, the conference heard.
“I’m stunned by how very little data there are on the causes of death in many African cities, for example Dar es Salaam,” says David Satterthwaite, senior fellow at UK-based research organisation the International Institute for Environment and Development.
His own research, presented at the meeting, he showed the main causes of mortality in 2012 in the slums of Tanzania’s largest city to be HIV, pneumonia, flu, malaria and diarrhoea. These are all preventable diseases, but they may only receive proper attention if studies identify them as key causes of death, he says.
Another problem is that local governments, the bodies that can act most directly to improve sanitation and healthcare, are unable to access much of the relevant data from national surveys carried out by public officials, often due to red tape, Satterthwaite says.
He urges scientists and doctors to ditch their “obsession” with working with national governments and start collaborating with local authorities and organisations representing those living in informal settlements or slums, since they are in the best position to provide information on what is most urgently needed at specific locations.
Currently, more than 30 developing countries, including Cambodia, India, Kenya, Namibia, the Philippines and South Africa, have federations of slums dwellers that campaign for better living conditions.
A greater focus on local collaboration would also help international aid agencies working to improve slum dwellers health. These too often lack the right information or fail to measure progress in an inadequate way, he says.
“Most international agencies have no urban policy and have ignored urban health statistics for 40 years, and then they use spurious statistics that suggest things are better than they really are,” Satterthwaite says.
“Many reports say that a long list of developing countries have access to ‘improved water’, but that also includes places where people have to queue for hours to have access to a public tap or standpipe. Those reports do not measure if the water is safe or if there is water in the pipe or even if it is affordable,” he says.
Urbanization and health in developing countries: a systematic review. World Health Popul. 2014;15(1):7-20.
Authors: Eckert S, Kohler S.
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.
Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting
Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana’s Community-based Health Planning and Services (CHPS). Health Research Policy and Systems 2014, 12:16.
P Adongo, et al.
Background: Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana.
Methods: This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones.
Results: The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs.
Conclusions: Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.
Reducing risks to urban health and building climate resilience, by David Dodman. Complete article/Source: IIED Blog, March 17, 2014.
Excerpts: Why are the health prospects for residents in informal urban settlements so poor, and what future issues will contribute to making these better or worse? These were among the questions discussed at the 11th International Conference on Urban Health held recently in Manchester.
As part of this event, a group of participants grappled with the ways in which climate change will affect urban health, based on experiences of both the threats and opportunities of managing health risks in countries including India, Tanzania and Vietnam.
Look at all the factors
Efforts to identify the health consequences of climate change have often adopted an ‘impacts-first’ perspective, identifying pathways through which particular changes in (for instance) temperature or rainfall patterns will affect individuals.
But this does not tell the full story. People exposed to high temperatures or disease pathogens will be affected in different ways, depending on their age, their pre-existing health, their work, the quality of their housing and many other factors.
Public health experts rightly identify both social and ecological factors as being important determinants of health. This awareness is central to understanding people’s vulnerability to climate change — which is shaped by exposure to particular shocks and stresses, their likelihood to be harmed as a result of these, and the extent of their capacity to adapt to reduce the harm they experience in future.
In this sense, approaches to improving urban health and to reducing harm from climate change in urban areas can be aligned effectively — through strengthening the underlying resilience of individuals and communities to health risks and other threats, and through addressing many of the underlying environmental health threats associated with poor sanitation and inadequate basic services.
City-wide sanitation project publishes situational analyses of its four focus cities | Source: SHARE, March 31, 2014.
SHARE partners Shack/Slum Dwellers (SDI), together with their affiliates and the International Institute for Environment and Development (IIED), have just published four situational analyses of the four focus cities in their SHARE-funded City-Wide Sanitation Project.
Rapidly growing urban populations and informal settlements coupled with inadequate sanitation provision create a concerning picture in the majority of major cities in developing countries. The Sanitation Project seeks to address this. One of the first steps was the analysis of the current situation in the four cities under study – Blantyre in Malawi, Chenhoyi in Zimbabwe and Dar es Salaam in Tanzania and Kitwe in Zambia. These reports seek to give an overview of the current situation in the four focus cities with regards water and sanitation provision.
A few issues across all four situational analyses, including the issue of affordability for communities (in Kitwe, for instance, around 39% of the monthly income of an average household goes towards water), lack of appropriate low cost sanitation technology, and insufficient human capital due to brain drain on the one hand and inadequate training and development on the other.
Access the full situational analyses here:
- Blantyre, Malawi, Situational Analysis
- Chinhoyi, Zimbabwe, Situational Analysis
- Dar es Salaam, Tanzania, Situational Analysis
- Kitwe, Zambia, Situational Analysis
Access a summary of each analysis here:
- Blantyre, Malawi, Policy Brief
- Chinhoyi, Zimbabwe, Policy Brief
- Dar es Salaam, Tanzania, Policy Brief
- Kitwe, Zambia, Policy Brief
Health in perspective: framing motivational factors for personal sanitation in urban slums in Nairobi, Kenya
Health in perspective: framing motivational factors for personal sanitation in urban slums in Nairobi, Kenya, using anchored best–worst scaling. Journal of Water, Sanitation and Hygiene for Development Vol 4 No 1 pp 108–119, 2014.
Authors: Carl Johan Lagerkvist, Suvi Kokko and Nancy Karanja
Department of Economics, Swedish University of Agricultural Sciences, PO Box 7013, 75007 Uppsala, Sweden E-mail: firstname.lastname@example.org
Department of Land Resource Management and Agricultural Technology, University of Nairobi, PO Box 30197, Nairobi 00100, Kenya
Severe health, safety and environmental hazards are being created by the growing population of urban poor in low-income countries due to lack of access to sanitation and to inadequate existing sanitation systems. We developed a multi-faceted motivational framework to examine the constituents that explain user motivation regarding a personalised sanitation system. In 2012 we interviewed slum dwellers in Nairobi, Kenya, to estimate individual motivational factor importance rankings from anchored best–worst scaling (ABWS) using hierarchical Bayesian methods.
We found that personal safety, avoidance of discomfort with shared toilets, cleanliness and convenience for children were ranked of highest importance. Motivational factors related to health were only relatively highly ranked. Thus factors contributing to overall individual wellbeing, beyond health benefits, drive adoption and use of the low-cost personal sanitation solution studied. This suggests that non-health benefits of low-cost sanitation solutions should be better acknowledged and communicated to raise awareness and encourage adoption of improved sanitation in urban slums. These findings may help develop policies to promote personal sanitation, improve public health and safety and reduce environmental risks.
Trends in access to water supply and sanitation in 31 major sub-Saharan African cities: an analysis of DHS data from 2000 to 2012. BMC Public Health 2014, 14:208.
Authors: Mike R Hopewell and Jay P Graham
Background – By 2050, sub-Saharan Africa’s (SSA) urban population is expected to grow from 414 million to over 1.2 billion. This growth will likely increase challenges to municipalities attempting to provide access to water supply and sanitation (WS&S). This study aims to characterize trends in access to WS&S in SSA cities and identify factors affecting those trends.
Methods – DHS data collected between 2000 and 2012 were used for this analysis of thirty-one cities in SSA. Four categories of household access to WS&S were studied using data from demographic and health surveys – these included: 1) household access to an improved water supply, 2) household’s time spent collecting water, 3) household access to improved sanitation, and 4) households reporting to engage in open defecation. An exploratory analysis of these measures was then conducted to assess the relationship of access to several independent variables.
Results – Among the 31 cities, there was wide variability in coverage levels and trends in coverage with respect to the four categories of access. The majority of cities were found to be increasing access in the categories of improved water supply and improved sanitation (65% and 83% of cities, respectively), while fewer were making progress in reducing the amount of time spent collecting water and reducing open defecation (50% and 38% of cities, respectively). Additionally, the prevalence of open defecation in study cities was found to be, on average, increasing.
Conclusions – Based on DHS data, cities appeared to be making the most progress in gaining access to WS&S along metrics which reflect specified targets of the Millennium Development Goals. Nearly half of the cities, however, did not make progress in reducing open defecation or the time spent collecting water. This may reflect that the MDGs have led to a focus on “improved” services while other measures, potentially more relevant to the extreme poor, are being neglected. This study highlights the need to better characterize access, beyond definitions of improved and unimproved, as well as the need to target resources to cities where changes in WS&S access have stalled, or in some cases regressed.
Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda
Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda. BMC Health Services Research 2014, 14:111.
Juliet N Babirye, et al.
Background – Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda.
Methods – Mixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Survey data underwent descriptive statistical analysis. Latent content analysis was used for qualitative data.
Results – Of the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years (95% CI 24–27). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents (24%, 95% CI 21–27). This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% (95% CI 30–37) of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% (95% CI 27–34) of the survey respondents utilised these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. Charges ranged from US$ 0.2 to US$4 and these were more commonly reported at private (70%, 95% CI 65–76) than at public (58%, 95% CI 54–63) facilities. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities.
Conclusions – Complex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, governments should strengthen health systems to cater for increasing urban populations.
Electronic waste – an emerging threat to the environment of urban India. J Environ Health Sci Eng. 2014; 12: 36.
Santhanam Needhidasan, et al.
Electronic waste or e-waste is one of the emerging problems in developed and developing countries worldwide. It comprises of a multitude of components with valuable materials, some containing toxic substances, that can have an adverse impact on human health and the environment. Previous studies show that India has generated 0.4 million tons of e-waste in 2010 which may increase to 0.5 to 0.6 million tons by 2013–2014. Coupled with lack of appropriate infrastructural facilities and procedures for its disposal and recycling have posed significant importance for e-waste management in India. In general, e-waste is generated through recycling of e-waste and also from dumping of these wastes from other countries.
More of these wastes are ending up in dumping yards and recycling centers, posing a new challenge to the environment and policy makers as well. In general electronic gadgets are meant to make our lives happier and simpler, but the toxicity it contains, their disposal and recycling becomes a health nightmare. Most of the users are unaware of the potential negative impact of rapidly increasing use of computers, monitors, and televisions. This review article provides a concise overview of India’s current e-waste scenario, namely magnitude of the problem, environmental and health hazards, current disposal, recycling operations and mechanisms to improve the condition for better environment.
An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities
An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Intl Health, Mar 2014.
Authors: Julie A. Nicholson, et al.
Objectives – To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children’s school absenteeism.
Methods – We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).
Results – Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (−25%, 95% confidence intervals [CI] = −37%, −2%), ARIs (−15%, 95% CI = −30%, −8%), school absences due to illnesses (−27%, 95% CI = −41%, −18%) and eye infections (−46%, 95% CI = −58%, −31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for ‘whole families’ (−31%, 95% CI = −37%, −5%; and −14%, 95% CI = −23%, −6%, respectively), 6- to 15-year-olds (−30%, 95% CI = −39%, −7%; and −15%, 95% CI = −24%, −6%) and under 5 s (−32%, 95% CI = −41%, −4%; and −20%, 95% CI = −29%, −8%).
Conclusions – Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public–private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.
Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru
Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru. Trop Med Intl Health, Jan 2014.
William E. Oswald, et al.
Objectives – To estimate the association between improved water and sanitation access and handwashing of mothers living in a peri-urban community of Lima, Peru.
Methods – We observed 27 mothers directly, before and after installation of private, piped water and sewerage connections in the street just outside their housing plots, and measured changes in the proportion of faecal-hand contamination and hand-to-mouth transmission events with handwashing.
Results – After provision of water and sewerage connections, mothers were approximately two times more likely to be observed washing their hands within a minute of defecation, compared with when they relied on shared, external water sources and non-piped excreta disposal (RR = 2.14, 95% CI = 0.99–4.62). With piped water and sewerage available at housing plots, handwashing with or without soap occurred within a minute after 48% (10/21) of defecation events and within 15 min prior to 8% (11/136) of handling food events.
Conclusions – Handwashing increased following installation of private, piped water and sewerage connections, but its practice remained infrequent, particularly before food-related events. Infrastructural interventions should be coupled with efforts to promote hygiene and ensure access to water and soap at multiple on-plot locations convenient to mothers.
Feb 11, 2014 – Promoting Urban Health and Launch of the Strengthening Ethiopia’s Urban Health Program (SEUHP) – Opening Remarks by Mission Director Dennis Weller
It is an honor to be here today on behalf of the United States Government and the American people to celebrate our partnership with the Government of Ethiopia to improve urban health services in this country.
The Ministry of Health has a strong reputation for its results-driven health program that empowers communities and demonstrates impressive successes. One such example is achieving Millennium Development Goal-4 of reducing child mortality well ahead of schedule.
We are pleased to witness the gains that health service delivery to homes has contributed toward improving health services in rural and urban areas. With an estimated 15.9 million people living in urban areas, Ethiopia is one of the least urbanized African nations. However, the population is growing and by 2050, Ethiopia’s urban population is projected to exceed 77 million.
The health challenges in urban areas are complex. For example:
- HIV prevalence is more than five times greater among women living in urban and peri-urban centers compared to women living in rural communities.
- More than 50 percent of pregnant women in urban centers still deliver at home, and
- Neonatal deaths in urban settings are almost as high as the rate in rural settings.
Adding to the complexity is that with the development of effective anti-retroviral therapies, life-long treatment of HIV is becoming similar to that of chronic illnesses, such as diabetes, cancer, and mental illness. As a result, there have been important changes to the public health response and many governments are now committing to mainstream, integrate, and decentralize HIV care.
We need to be prepared to address the health challenges related to rapid population growth and urbanization before it happens, and I am pleased to say that the Ministry of Health, USAID, and the development community are committed to making sure Ethiopia’s health system is ready to adapt to the ever-changing urban environment. In 2009, the Government of Ethiopia initiated the innovative Urban Health Extension Program.
The program’s aim is to improve access to and equity of public health information and services for urban populations by deploying thousands of nurses to serve as community health workers providing house-to-house health services. In support of the Government’s program, USAID implemented its Urban Health Extension Program from 2009 to 2012. The USAID program supported the training and deployment of more than 2,300 urban health extension professionals and provided HIV services for more than 110,000 most-at-risk persons.
Our partnership with the Ministry of Health is something that we deeply value and is a large part of the success of our joint efforts to address the prevailing health challenges in Ethiopia. Today, we are excited to continue that partnership as we launch USAID’s five-year Strengthening Ethiopia’s Urban Health Program, partially funding by the U.S. President’s Emergency Plan for AIDS Relief. This new program will build on the achievements of its predecessor by expanding access to essential health services.
The program will target vulnerable households in urban communities to reduce HIV- and TB-related illnesses and deaths and the incidence of communicable diseases in mothers, newborns and children. In cooperation with the Ministry of Health, the private sector, regional health bureaus, city administrations, and others, this new program will promote best practices to reach more than 1.6 million urban households with high-quality health services in the coming five years. As we celebrate the gains made over the last few years in combating HIV and TB and improving child health, we are committed to build on Ethiopia’s achievements in the health sector.
Ethiopia’s experience has shown that with commitment, clear policies, and innovative strategies, dramatic success in improving health care is well within our reach. In closing, I would like to thank the Government of Ethiopia for spearheading the Urban Health Extension Strategy that will contribute to strengthening Ethiopia’s health system. With a concerted multi-stakeholder collaboration under the leadership of the Ministry of Health, we will achieve the objectives of the Ethiopian Health Sector Development Plan IV. Today, we take a new step forward in that collaboration and in bringing vital health services to Ethiopia’s urban populations.
Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India
Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India, 2014.
Authors: Amanda Johnson, et al.
Between 2006 and 2009, Freedom from Hunger worked with Bandhan, one of the largest microfinance institutions (MFIs) in India, to pilot new health products and services for its clients as part of Freedom from Hunger’s global Microfinance and Health Protection (MAHP) initiative. Funded by the Bill & Melinda Gates Foundation, health innovations such as health education, financing, products, and linkages to health providers were developed and piloted with Bandhan and four other microfinance organizations around the world with the dual goal of improvement of client health and financial protection and the financial performance of the MFIs. Through MAHP, Bandhan identified pressing health needs and concerns of its clients and designed a responsive and cohesive health package: health education forums for clients and community members that deliver behavior change communication on breastfeeding, pre-, post- and neonatal care, infant and child feeding and diarrhea; health loans; health product distributors known as Swastha Sahayikas (SS) who reinforce health messages during home visits, sell health products, and support referrals to local healthcare services.
Evidence of positive changes in important maternal and child health knowledge and behaviors as well as high levels of client satisfaction sustained over a period of five years following the implementation of the program, is very promising. This study is an important contribution to a growing body of evidence for cross-sectoral interventions that address poverty and poor health. Bandhan and other organizations, including microfinance, self-help groups, and savings-led groups that convene women to access financial services, represent a large and mostly untapped resource for creating durable and sustainable channels to reach millions of poor families, and for making important contributions towards the achievement of national and global health improvement targets, especially in the area of maternal and child health and nutrition.
Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya
Olack B, Feikin DR, Cosmas LO, Odero KO, Okoth GO, et al. (2014) Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya, 2007–2010. PLoS ONE 9(1): e85913. doi:10.1371/journal.pone.0085913.
Background – We used population based infectious disease surveillance to characterize mortality rates in residents of an urban slum in Kenya.
Methods – We analyzed biweekly household visit data collected two weeks before death for 749 cases who died during January 1, 2007 to December 31, 2010. We also selected controls matched by age, gender and having a biweekly household visit within two weeks before death of the corresponding case and compared the symptoms reported.
Results – The overall mortality rate was 6.3 per 1,000 person years of observation (PYO) (females: 5.7; males: 6.8). Infant mortality rate was 50.2 per 1000 PYOs, and it was 15.1 per 1,000 PYOs for children <5 years old. Poisson regression indicates a significant decrease over time in overall mortality from (6.0 in 2007 to 4.0 in 2010 per 1000 PYOs; p<0.05) in persons ≥5 years old. This decrease was predominant in females (7.8 to 5.7 per 1000 PYOs; p<0.05). Two weeks before death, significantly higher prevalence for cough (OR = 4.7 [95% CI: 3.7–5.9]), fever (OR = 8.1 [95% CI: 6.1–10.7]), and diarrhea (OR = 9.1 [95% CI: 6.4–13.2]) were reported among participants who died (cases) when compared to participants who did not die (controls). Diarrhea followed by fever were independently associated with deaths (OR = 14.4 [95% CI: 7.1–29.2]), and (OR = 11.4 [95% CI: 6.7–19.4]) respectively.
Conclusions – Despite accessible health care, mortality rates are high among people living in this urban slum; infectious disease syndromes appear to be linked to a substantial proportion of deaths. Rapid urbanization poses an increasing challenge in national efforts to improve health outcomes, including reducing childhood mortality rates. Targeting impoverished people in urban slums with effective interventions such as water and sanitation interventions are needed to achieve national objectives for health.
Singh A, Singh MN. (2014) Diarrhoea and acute respiratory infections among under-five children in slums: Evidence from India. PeerJ PrePrints 2:e208v1 http://dx.doi.org/10.7287/peerj.preprints.208v1
Background: In the wake of burgeoning slum population, a substantial reduction in the prevalence of diarrhea and acute respiratory infections (ARI) is necessary for to achieve necessary reduction in child mortality in urban India. To achieve this, we need evidence based public health interventions and programs. However, a review of previous studies indicate that national level studies focused on slum population are very few. Therefore, the present study aims to study differentials and determinants of diarrhea and ARI in urban slums of India.
Methodology: Using data obtained from the third round of National Family Health Survey conducted in 2005-06, we analyzed information on 2687 under-5 children living in urban slums located in eight selected India cities. Apart from bivariate analysis, logistic regression analysis was performed to identify factor associated with diarrhea and ARI among slum children.
Results: The prevalence diarrhea and ARI is about 8% and 8.5%, respectively. Age, birth weight, access to safe water and improved toilet and region emerge as main factors affecting prevalence of diarrhea among slum children. Safe drinking water reduces the likelihood of getting diarrhea by about 19% compared to unsafe water [CI=0.563-1.151]. Children with normal birth are about 51% less likely to suffer from diarrhea compared to those with unknown birth weight [CI=0.368-0.814]. Older children are about 63% less likely to suffer from diarrhea [CI=0.274-0.502]. Children from Southern cities are about half as likely to have diarrhea as children from slums in Northern cities. ARI is associated with age, birth weight, religion, caste, education, family type, safe water, improved toilet, mass-media exposure, region and separate kitchen. Older children and children with normal birth weight are less likely to suffer from ARI. Children from ‘Other’ religions and OBC are 39% [CI=1.000-1.924] and 49% [CI=1.008-2.190], respectively, more likely to suffer from ARI. Parents’ education is strongly associated with prevalence of ARI. Exposure to mass media reduces the likelihood of ARI to 50% compared to the situation when mother of the child did not have any exposure to mass-media [CI=0.324-0.819]. Non-flush toilet and lack of separate kitchen increase the likelihood of ARI. Children from slums located in Southern region are less likely to suffer from ARI.
Conclusion: The findings call for dedicated programs and policies, in line with those already existing ones such as RAY, IHSDP, NUHM, ICDS and JNNURM, for the development of urban slums through provision of affordable housing, improved sanitation, safe water and clean fuel. Adequate nutrition to mothers and their children should be ensured and vulnerable groups identified in the analysis should be the focus of future public health intervention and strategies. The use of mass-media to change health behavior should also be considered.
Jan 2014 – USAID supports an Urban Gardens program in Ethiopia to provide vulnerable and HIV-infected women with the tools, land, and knowledge to plant vegetable gardens, feed their families, and sell the produce to increase household income. The program trains women in nutrition, composting, vegetable growing, irrigation, proper hygiene, and HIV/AIDS awareness, and workers with degrees in agriculture assist the women in planting and maintaining their gardens.
Measuring slum severity in Mumbai and Kolkata: A household-based approach. Habitat International 41 (2014) 300e306.
Authors: Amit Patel, Naoru Koizumi, Andrew Crooks.
E-mail addresses: email@example.com, firstname.lastname@example.org (A. Patel), email@example.com (N. Koizumi), firstname.lastname@example.org (A. Crooks)
Slums pose a signiﬁcant challenge for urban planning and policy as they provide shelter to a third of urban residents. UN-Habitat reports that, in 2001, approximately 924 million people lived in slums or informal settlements across the world (UN-Habitat, 2003). However, varying deﬁnitions of what constitutes a slum result in different slum population estimates. Most deﬁnitions treat a slum as a community of several households, rarely recognizing that housing conditions differ for each individual household within the area. Moreover, deﬁnitions of slums usually take a dichotomous approach whereby a place is either a slum or not. Little attempt is made to go beyond this slum/non-slum dichotomy.
This paper moves beyond the traditional ways of deﬁning a slum by proposing a new household level enumeration of slums and developing Slum Severity Index (SSI), which measures the level of deprivation on a continuous scale based on the UN-Habitat’s slum deﬁnition. We apply this new approach of analyzing slums to a household survey dataset to estimate the total number of slum households in Mumbai and Kolkata, two megacities in India. To contrast our approach, we compare these estimates with the Census of India’s. The comparison highlights stark differences in the two estimates and the slum/non-slum household classiﬁcations. The main objective of this study is to demonstrate the usefulness of the household level analysis of slums in drawing implications for designing and implementing slum policies.
State of Women in Cities 2012-2013, 2013. UN HABITAT.
Women need more equitable access to infrastructure, especially sanitation. Although over half (53 per cent) of the survey respondents thought that their cities were ‘committed’ in some form to promoting infrastructural development to fully engage women in urban development and productive work, only 22 per cent stated that they were ‘fully committed’ or ‘committed’, with a high of 39 per cent in Johannesburg. In turn, only 29.5 per cent of respondents felt that infrastructure was adequate, with lows of 15 per cent in Rio de Janeiro and 18.5 per cent in Kingston. The most problematic area was access to sanitation, especially in Bangalore and Rio de Janeiro. 50 per cent stated that sanitation and the burden of disease acted as barriers to the prosperity of women in cities.
Women residing in slums require special attention. Although women in slum and non-slum areas of cities experience a similar range of challenges in relation to gender inequalities, the greater concentration of poverty in slum settlements aggravated by overcrowding, insecurity, lack of access to security of tenure, water and sanitation, as well as lack of access to transport, and sexual and reproductive health services, often creates more difficult conditions for women in trying to achieve prosperity.
More attention to women in the informal economy needed. Only a little over one-third (35 per cent) of city dwellers thought that their cities had programmes that addressed the needs of women working in the informal economy. In cases where programmes existed, almost half (48 per cent) thought that these sought to legalise informal activities, while 44 percent aimed to move informal workers into the formal economy,with a further 42 per cent feeling that these programmes aimed to improve the quality of informal employment.
National Urban Health Mission (NUHM) for urban poor launched by Health Ministry – Source: The Health Site, Jan 21, 2014
Indian Health Minister Gulam Nabi Azad Monday launched the National Urban Health Mission (NUHM) here to provide health security to the urban poor, amounting to about 200 crore people.
‘The mission envisages setting up health check-up infrastructure and create manpower for the welfare of the poor dwelling in cities and towns on the lines of the National Rural Health Mission (NRHM),’ he said on the occasion.
The central government will bear 80 percent of the cost of implementing the programme in 779 urban areas with over 50,000 population across the country by 2015.
‘Primary health centres, sub-centres, referral units will be strengthened in urban areas and manned by auxiliary nurse midwifes (ANMs). Mobile health check-up vans will visit these centres with two doctors, two nurses and a pharmacist,’ Azad said. (Read: Bangalore’s urban poor to get healthcare facilities)
About 200 million people in urban areas will have access to free healthcare.
Lauding the central government’s initiative to provide healthcare to the needy, Karnataka Chief Minister Siddaramaiah said focus should be on creating awareness towards prevention than cure.
‘Urban rich have access to healthcare facilities but for the urban poor, medical expense is beyond their means, as 17 percent of them live in slums and majority of them are migrant labourers, rag pickers and marginalised sections of society,’ he noted.
State Health Minister U.T. Khader rolled out the ambulance service ‘Nagu Magu’ dedicated to shift pregnant women to the nearest hospital and take them back to home after delivery safely. About 10 ambulances will be operational across Bangalore from Tuesday for the service.
‘We have submitted to the central health ministry a project plan to implement the mission in Bangalore, Bagalkot, Mangalore, Mysore and Ullal in the coastal area at a cost of Rs.132 crore. About 50 health kiosks will be up across Bangalore under the mission,’ Khader said.