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

July 17, 2014 · 0 comments

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

July 17, 2014 · 0 comments

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

July 17, 2014 · 0 comments

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

July 2, 2014 · 0 comments

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

July 2, 2014 · 0 comments

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

July 2, 2014 · 0 comments

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

July 2, 2014 · 0 comments

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

June 20, 2014 · 0 comments

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.

Peri-Urban 2014: International conference on peri-urban landscapes: water, food and environmental security

June 20, 2014 · 0 comments

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 20, 2014 · 1 comment

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.

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