Urban Health Updates
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
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. 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
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.
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 email@example.com.
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.
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. Sci Total Environ. 2014 Jul
Wright J1, Liu J2, Bain R3, Perez A4, Crocker J5, Bartram J6, Gundry S7.
1Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: firstname.lastname@example.org.
2Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: email@example.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: firstname.lastname@example.org.
4Facultad de Ciencias e Ingeniería, Universidad de Boyacá, Campus Universitario Cra 2a este #64-169 Tunja, Boyacá, Colombia. Electronic address: email@example.com.
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: firstname.lastname@example.org.
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: email@example.com.
7Water & Health Research Centre, Department of Civil Engineering, Queens Building, University Walk, Bristol BS8 1TR, UK. Electronic address: firstname.lastname@example.org.
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: 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.
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. Sci Total Environ. 2014 Aug 15
Bain RE1, Wright JA2, Christenson E1, Bartram JK3.
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: email@example.com.
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. 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 (firstname.lastname@example.org) is with the Population Foundation of India, Odisha as Water and Sanitation Specialist in USAID’s Health of the Urban Poor Programme.
Peri-Urban 2014: International conference on peri-urban landscapes: water, food and environmental security
Peri-Urban 2014: International conference on peri-urban landscapes: water, food and environmental security, July 8-10, 2014, Australia
There are growing concerns about water and food security to meet increases in population in urban areas. For cities to be liveable and sustainable into the future there is a need to maintain the natural resource base and the ecosystem services in the peri-urban areas surrounding cities. Development of peri-urban areas involves the conversion of rural lands to residential use, closer subdivision, fragmentation and a changing mix of urban and rural activities and functions. Changes within these areas can have significant impacts upon agricultural uses and productivity, environmental amenity and natural habitat, supply and quality of water and water and energy consumption. These changes affect the peri-urban areas themselves and the associated urban and rural environments.
In the past, cities and towns have been established in areas that had secure water and energy supplies and fertile lands for food production. The burgeoning population growth and expansion of urban centres worldwide has placed increasing pressure on potable water supplies, energy and food supplies and the ecosystems services on which the community and the liveability of the community depend. The themes of the conference are selected to focus on critical natural resource, socio-economic, legal, policy and institutional issues that are impacted by the inevitable drift of cities into peri-urban areas.
Peri-urban’14 is the first of its kind; an international, transdisciplinary conference which provides a valuable opportunity to explore these issues.
New USAID-DFID partnership to expand healthcare services for the urban poor in Bangladesh, June 2014 | Source: USAID Website
The United States Agency for International Development (USAID) and the United Kingdom’s Department for International Development (DFID) have joined together to make quality healthcare more widely available for poor families through the Smiling Sun network of health clinics. Under the new partnership, DFID will provide an additional US $29 million to the $54 million USAID NGO Health Service Delivery Project. As a result, Smiling Sun clinics will be able to reach several million additional people with basic health services that focus on improving women’s and children’s health in urban areas.
Secretary of the Ministry of Health and Family Welfare M.M. Niazuddin Miah, USAID Mission Director Janina Jaruzelski, and the Country Representative of DFID Bangladesh Sarah Cooke announced the collaboration at a launch event in Dhaka. Joya Ahsan, a renowned Bangladeshi actress and former brand ambassador for Smiling Sun clinics, was also in attendance to advocate for better healthcare for the poor.
In her remarks, Jaruzelski applauded the new partnership. “By joining forces, USAID and DFID, working hand-in-hand with the Government of Bangladesh, will enable the long-running and exceedingly popular Smiling Sun health clinic program to reach new heights and ultimately benefit millions more women and children who urgently need healthcare,” said Jaruzelski.
“Improving the health of poor mothers and their babies is a priority for the UK government. Through our urban health program, UK aid will continue supporting the poorest women to give birth safely, under skilled care, giving mothers and babies the best opportunity to thrive and helping to prevent such tragic and unnecessary deaths,” added Sarah Cooke.
Smiling Sun clinics provide essential healthcare services at the door step for the poorest people in Bangladesh through a network of 26 NGOs, 350 clinic locations and more than 6,000 community health workers. The program also complements Government of Bangladesh efforts to reach the poor with high-quality healthcare at low or no cost. This collaboration is also part of DFID’s broader urban health program in which the UK government will be supporting new partnerships to increase access to quality primary care, especially maternal and newborn health and nutrition services for the urban poor. The partnership will include USAID and Marie Stopes Clinic Society Bangladesh, and will collaborate closely with BRAC urban health services.
India – Urbanization is creating a decline in immunization levels by Alan Mwendwa, Urban Gateway, June 2014
If you thought the decline in immunization levels must be in India’s rural areas, you would be surprised to learn that the decline seen in high performing states seems to have happened largely among the urban poor in peri-urban and newly urbanized areas due to rapid urbanization leaving these areas neither rural nor fully urban.
According to an article in the latest issue of the Indian Journal of Paediatrics by experts collaborating across three leading national institutes, districts with high level of urbanization showed a higher probability of recording a decline in immunization coverage. The experts found that there was a negative relationship between immunization coverage levels and proximity to towns. “As the proportion of villages in the district which were located at a distance of more than 10 km from the nearest town increased, the probability of decline in immunization coverage decreased,” stated the article.
The authors of the article, Rajib Dasgupta of the Centre of Social Medicine and Community Health in JNU, Purnamita Dasgupta of the Institute of Economic Growth of Delhi University and Ankush Agrawal of the Indian Institute of Technology, studied the steep decline in immunization coverage at the district level between the District Level Health Survey of 2002-04 and the 2007-08 round. Since then, there have been no surveys at the district level.
The authors chose nine states known for good governance in terms of performance in several socio-economic factors such as infrastructure availability, law and order, educational achievements and so on, but which had several districts reporting a decline. The states chosen were Punjab, Haryana, Andhra Pradesh, Tamil Nadu, Kerala, Gujarat, Karnataka, Maharashtra and Himachal Pradesh.
“We were puzzled by the very high percentage of districts in high performing states showing a decline. The EAG states (earlier BIMARU states) actually showed an increase in immunization coverage; few districts registering any decline. On closer examination we found that these were districts with many newly classified ‘urban areas’. The decline is likely to be greater in the peripheral and newly urbanising areas rather than the core, fully urbanized areas,” explained Rajib Dasgupta.
The authors found that the probability of decline reduced as the proportion of villages with a primary health centre increased. They also found that with an increase in the proportion of SC/ST population, the probability of decline reduced. They attributed this to special efforts made to reach these groups. Their study revealed that fast-paced urbanization was emerging as a ‘risk factor’; peri-urban areas and small towns with relatively poor health access offered a rational explanation to the phenomenon of decline in immunization coverage.
Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums. BMC Public Health 2014, 14:624 doi:10.1186/1471-2458-14-624
Authors: Japheth Kwiringira (email@example.com), Peter Atekyereza (firstname.lastname@example.org), Charles Niwagaba (email@example.com) Isabel Günther (firstname.lastname@example.org)
Background – While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities.
Methods – A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the
Results – Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the
ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection.
Conclusion – Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.
Metabolized-water breeding diseases in urban India: Socio-spatiality of water problems and health burden in Ahmedabad, 2014.
V. S. Saravanan, et al. Center for Development Research, University of Bonn.
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 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.
Why women choose to give birth at home: a situational analysis from urban slums of Delhi. BMJ Open, May 2014.
Niveditha – Devasenapathy, et al.
Objectives Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events.
Design – Cross-sectional survey using quantitative and qualitative methods.
Setting – Urban poor settlements in Delhi, India.
Participants – A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities.
Results – Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births.
Conclusions – Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births.
Integrating the environment in urban planning and management: key principles in and approaches for cities in the 21st century, 2014.
Authors: David Dodman, Gordon McGranahan and Barry Dalal-Clayton. International Institute for Environment and Development (IIED).
Cities can use a range of principles and approaches to integrate the environment in urban planning and management. This report is intended to encourage and support urban decision makers in this process. It starts with recognizing that action taken in towns and cities is essential for addressing global environmental problems. It accepts that, with an increasing proportion of the world’s population living in urban areas in low- and middle-income countries, these are important sites for engaging with the environment. The report describes the social and economic benefits that can be generated by addressing environmental challenges, and provides convincing evidence to support engagement with these issues.
Strengthening climate resilience in African cities A framework for working with informality, 2014.
By Anna Taylor and Camaren Peter, African Centre for Cities.
The idea of ‘climate compatible development’ is gaining ground in international policy circles. It is aimed at fusing the climate change adaptation and mitigation agendas with the mainstream development agenda. This raises a key set of questions, especially where African cities – and other developing world cities – are concerned. What opportunities and challenges does this present in the context of rapidly growing cities across the African continent, where two key features are widespread: informality and deeply entrenched inequality? Informality comes in many forms, including settlement on unplanned land without public services and bulk infrastructure; unregistered housing construction and transfer; informal and insecure jobs; and unregulated trade and service provision.
In the light of the threats posed by changing climatic conditions and the prevailing realities of economic and political disempowerment, how might we go about grounding and working with the idea of climate compatible development so that we can envision and build new urban futures in cities across Africa that are vibrant, inclusive and sustainable? This document is intended mainly for use by city practitioners operating in local government agencies and civic organisations. It distils a set of eight principles for engaging in such development work, and suggests an eight-step process as a guide for undertaking climate compatible development in African cities that factors in climate dynamics alongside the socioeconomic, spatial and political dimensions of development.
Prospective Study of Leptospirosis Transmission in an Urban Slum Community: Role of Poor Environment Repeated Exposures to the Leptospira Agent. PLoS NTDs, May 2014.
Ridalva D. M, et al.
Leptospirosis is a disease that is transmitted by human contact with an environment contaminated with urine from animals, such as rodents, infected by the Leptospira bacteria. Human illness due to these bacteria can be mild, or can have very severe complications. Residents of urban slum settlements are at high risk for this disease, but the specific risk factors for transmission in these settlements are not understood because of the lack of prospective studies in this epidemiological setting.
We performed a prospective study in a Brazilian slum community to measure the risk of infection, identify the environmental and social factors that place slum residents at risk for infection, and determine whether some individuals are at risk of repeated infections. We identified a burden of infection with leptospirosis among slum residents, and found that male gender and low income both increase the risk for infection.
In addition, a significant proportion of slum residents had a second exposure to leptospirosis and re-infection occurred most frequently among young adults and the poorest members of the slum community who reside in proximity of open sewers. These risk factors are amenable to interventions aimed to reduce the burden that leptospirosis imparts in this high-risk setting.
Urban health: it’s time to get moving! Global Health: Science and Practice, May 2014.
Victor Barbiero, George Washington University.
The global health community should mainstream urban health and implement urban health programs to address the triple health burden of communicable diseases, noncommunicable diseases, and injuries in low- and middle-income countries.
THE URBAN OPPORTUNITY
Urbanization also presents new opportunities (Box 2). Population density and closer proximities of health infrastructure could facilitate service delivery by public and private institutions and nongovernmental organizations (NGOs). Mass media through print, radio, and even television have wide audience reach in urban centers. Decentralized authority in urban municipalities could foster pro-poor policies that maximize affordable preventive and curative care for underserved populations.
Resources, both public and private, are often greater in the urban environment, and urban centers often enjoy political recognition and support. Furthermore, the commercial sector has providers and products that can be better deployed. The Internet and the ubiquity of mobile phones enhance communication and the potential support for health promotion, disease prevention, and treatment. Perhaps most importantly, urban environs have a middle class and formal sector that support commerce, promote stability, and anticipate change for the better. These groups and cohorts may be early adopters to change.
Nairobi – Myths and cultural beliefs regarding maternal and child nutrition, 2014.
M Najeri, African Population and Health Reseach Center.
Recent statistics indicate that poor maternal and child nutrition are the underlying causes of 3.5 million deaths every year and 35 percent of disease burden for children under five years globally (Bryce et al. 2008). In Kenya, neonatal and infant mortality rates are relatively high at 31 and 52 in 1000 live births respectively (KDHS 2008/09).
Effect of maternal nutrition on infant and child mortality has been the subject of concern with an increase in the pool of scientific knowledge showing that poorly nourished mothers are at a higher risk of giving birth to low birth-weight babies, while facing multiple threats to their own health. Their babies in turn face greater risk of neonatal deaths and, if they survive, will have to reckon with poor growth, ill health, and slow cognitive development in childhood.
As a result, numerous programmes have been initiated to improve maternal and newborn health including the Baby-Friendly Hospital Initiative (BFHI), a global programme that aims at enhancing optimal levels of maternal and infant feeding and care in healthcare facilities. The envisaged results of these programmes, however, have not been satisfactorily achieved due to several challenges that constantly cripple their efforts.
Some of these challenges include retrogressive myths and cultural beliefs, which contribute to reluctance to adopt good practices through behavior change in relation to maternal and child nutrition. With the high levels of literacy reported in Kenya, it may seem inconceivable that such beliefs still exist but in reality, they are very present and are a major hurdle that must be addressed and overcome if the Millennium Development Goals 4 and 5 of reducing child mortality and improving maternal health respectively, are to be realized.
A study done by the African Population and Health Research Center (APHRC) among residents of two informal settlements in Nairobi indicate that pregnant women avoid some foods as dictated by myths and their cultural beliefs. Of importance are eggs which are avoided in some communities during pregnancy and infancy for fear that they cause delayed or slurred speech in children. A fruit a day keeps the doctor away’ does not work in some of these communities as pregnant women are discouraged from eating various fruits including avocados and bananas as they are alleged to have a lot of ‘energy’ and may cause the fetus to grow ‘too big’ resulting in mothers having complications while giving birth and forcing them to undergo caesarean section during delivery (something they’d rather avoid).
Others often refrain from eating some animal protein like fish, chicken and beef also in the fear that the unborn baby will ‘overgrow’ in the womb and cause birth complications as above. Having heavy meals a few days before delivery is also not recommended in some communities as the mother may have a ‘poop’ during delivery which is deemed as very embarrassing for the mother.
However, no scientific evidence has linked moderate intake of any of these foods to any birth complications and the truth is that these foods are excellent and affordable sources of the much needed nutrients during pregnancy. Avoiding them thus may mean missing out on essential nutrients and limited food diversity which eventually results in poor maternal nutrition and consequently, increased risks of infant and child morbidity and mortality. Unfortunately, the same cultural beliefs also prohibit pregnant women from seeking professional advice from health care facilities from where they could receive the right information, further complicating the situation.
APHRC is in the process of implementing a community based intervention programme in these two informal settlements in Nairobi where the study dubbed Maternal Infant and Young Child Nutrition (MIYCN) project is being conducted. The three- year intervention is funded by the Wellcome Trust and aims at actualizing the BFH initiative at the community level through the already existing community health strategy. This will involve personalized home-based counselling of pregnant women and mothers of infants in both Korogocho and Viwandani, on optimal maternal, infant and young child nutrition by community health workers. It is envisaged that this study will be beneficial in, among other things, demystifying all these harmful cultural beliefs and myths existing in these communities, thus improving maternal and child nutrition and consequently preventing any complications that may arise in the critical first 1,000 days of a child’s life as a result of poor nutrition. This will ensure a healthy, productive and intellectual future generation.
It is hoped that if the project is proven to be effective and worthwhile, it will be adopted by the Kenyan government for scaling up countrywide.
Tackling climate change in cities: The role of best practices, 2014.
Sabrina Dekker, ICCG
This paper aims to present what cities are currently doing in the area of climate change policy, specifically the best practices that have impacts on human health. In addition to this, the paper will highlight practices that are innovative and demonstrate efforts that go beyond, what ‘common’ best practices set to achieve.
Finally the paper will examine the policies holistically to identify how cities can further develop policies related to climate change and health. Analysis of municipal plans from 51 cities across the globe, has highlighted commonalities in the efforts of cities to mitigate the adverse effects of climate change on human health.