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.
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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 (nkjapheth@yahoo.co.uk), Peter Atekyereza (atekyereza@chuss.mak.ac.ug), Charles Niwagaba (cniwagaba@cedat.mak.ac.ug) Isabel Günther (isabel.guenther@nadel.ethz.ch)
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.
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).
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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.
