IIED presents SHARE-funded City-Wide Sanitation Project findings at the 11th International Conference on Urban Health

May 7, 2014 · 0 comments

May 6, 2014 – IIED presents SHARE-funded City-Wide Sanitation Project findings at the 11th International Conference on Urban Health at the University of Manchester | Source: SHARE website

SHARE partner IIED presented its findings on the challenges and opportunities of different models for improving sanitation in deprived communities at the 11th International Conference on Urban Health at the University of Manchester.

The work presented was published last year in a paper entitled ”Overcoming obstacles to community-driven sanitary improvement in deprived urban neighbourhoods: lessons from practice”. Sanitary improvement has historically been central to urban health improvement efforts. Low cost sanitation systems almost inevitably require some level of community management, and in deprived urban settlements there are good reasons for favouring community-led sanitary improvement.

It has been argued that community-led sanitary improvement also faces serious challenges, including those of getting local residents to act collectively, getting the appropriate public agencies to co-produce the improvements, finding improvements that are acceptable and affordable at scale, and preventing institutional problems outside of the water and sanitation sector (such as tenure or landlord-tenant problems) from undermining improvement efforts. This paper examines these sanitary challenges in selected cities where organizations of the urban poor are actively trying to step up their work on sanitary issues, and considers they can best be addressed.

This work is part of the three-year SHARE-funded City-Wide Sanitation Project. This project, delivered by IIED and SDI, exists to develop inclusive, sustainable sanitation strategies. In practice this involves creating a scalable, bottom-up model for the development and realisation of pro-poor citywide sanitation, in which the residents of informal settlements engage with their local authority to identify new ways forward.

 

 

 

Infant feeding practices among HIV exposed infants using summary index in Sidama Zone, Southern Ethiopia

April 30, 2014 · 0 comments

Infant feeding practices among HIV exposed infants using summary index in Sidama Zone, Southern Ethiopia: a cross sectional study. BMC Pediatr. 2014; 14: 49.

Demewoz Haile,

Background – Combining various aspects of child feeding into an age-specific summary index provides a first answer to the question of how best to deal with recommended feeding practices in the context of HIV pandemic. The objective of this study is to assess feeding practices of HIV exposed infants using summary index and its association with nutritional status in Southern Ethiopia.

Methods – Facility based cross-sectional study design with cluster random sampling technique was conducted in Sidama Zone, Southern Ethiopia. Bivariate and multivariable linear regression analyses were performed to assess the association between summary index (infant and child feeding index) (CS-ICFI) and nutritional status.

Results – The mean (±standard deviation (SD)) cross-sectional infant and child feeding index (CS-ICFI) score of infants was 9.09 (±2.59), [95% CI: 8.69-9.49]). Thirty seven percent (36.6%) of HIV exposed infants fell in the high CS-ICFI category while 31.4% of them were found in poor feeding index tertile. About forty two percent (41.6%) of urban infants were found in the high index tertile but only 24% of the rural infants were found in high index tertile. Forty six percent (46%) of the rural infants were found in low (poor) feeding index category. The CS-ICFI has a statistically significant association with weight for age z score (WAZ) (ß = 0.168, p = 0.027) and length for age z score (LAZ) (ß = 0.183 p = 0.036). However CS-ICFI was not significantly associated with weight for height z score (WLZ) (p = 0.386).

Conclusion – Majority of HIV exposed infants had no optimum complementary feeding practices according to cross-sectional infant and child feeding index. CS-ICFI was statistically associated especially with chronic indicators of nutritional status (LAZ and WAZ). More rural infants were found in poor index tertile than urban infants. This may suggest that rural infants need more attention than urban infants while designing and implementing complementary feeding interventions.

USAID – Universal Health Coverage Measurement in a Low-Income Context: An Ethiopian Case Study

April 30, 2014 · 0 comments

Universal Health Coverage Measurement in a Low–Income Context: An Ethiopian Case Study, 2014. Bethesda, MD: Health Finance & Governance Project, Abt Associates Inc.

Authors: Alebachew, Abebe, Laurel Hatt, Matt Kukla, Sharon Nakhimovsky.

Universal health coverage (UHC) as a goal of health policy has gained wide acceptance at country and global levels since the publication of the World Health Report 2010 and is seen as a critical component of sustainable development. UHC has also been listed as one of the possible goals of the post-2015 development agenda. To achieve these goals, however, policymakers must first be able to define, measure, and monitor UHC.

The objective of this case study was to analyze Ethiopia’s approach to monitoring progress towards UHC and consider the implications of Ethiopia’s experience with UHC measurement for other low-income countries and the international community. The study achieved this objective by (i) exploring indicators that Ethiopia is already using to measure progress towards UHC; (ii) evaluating Ethiopia’s institutional capacity to collect data for and generate a set of proposed UHC indicators; and (iii) providing recommendations based on findings.

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo

April 30, 2014 · 0 comments

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey. BMC Health Services Research 2014, 14:173.

Mukalenge F Chenge

Background – Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.

Methods – A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey.

Conclusions -This study points to the importance of self-medication as the first therapeutic option for the
majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients’ itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

Noncommunicable diseases among urban refugees and asylum-seekers in developing countries

April 30, 2014 · 0 comments

Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Globalization and Health 2014, 10:24.

Authors: Ahmed Hassan Amara, et al.

With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic noncommunicable diseases (NCDs). However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees.

Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries.

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes

April 21, 2014 · 0 comments

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

April 17, 2014 · 0 comments

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

April 17, 2014 · 0 comments

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

April 17, 2014 · 0 comments

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.

David Dodman/IIED – Reducing risks to urban health and building climate resilience

March 31, 2014 · 0 comments

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.

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