City-wide sanitation project publishes situational analyses of its four focus cities

March 31, 2014 · 0 comments

City-wide sanitation project publishes situational analyses of its four focus cities | Source: SHARE, March 31, 2014.

SHARE partners Shack/Slum Dwellers (SDI), together with their affiliates and the International Institute for Environment and Development (IIED), have just published four  situational analyses of the four focus cities in their SHARE-funded City-Wide Sanitation Project.

Rapidly growing urban populations and informal settlements coupled with inadequate sanitation provision create a concerning picture in the majority of major cities in developing countries. The Sanitation Project seeks to address this. One of the first steps was the analysis of the current situation in the four cities under study – Blantyre in Malawi, Chenhoyi in Zimbabwe and Dar es Salaam in Tanzania and Kitwe in Zambia. These reports seek to give an overview of the current situation in the four focus cities with regards water and sanitation provision.

A few issues across all four situational analyses, including the issue of affordability for communities (in Kitwe, for instance, around 39% of the monthly income of an average household goes towards water), lack of appropriate low cost sanitation technology, and insufficient human capital due to brain drain on the one hand and inadequate training and development on the other.

Access the full situational analyses here:

Access a summary of each analysis here:

 

 

Health in perspective: framing motivational factors for personal sanitation in urban slums in Nairobi, Kenya

March 13, 2014 · 0 comments

Health in perspective: framing motivational factors for personal sanitation in urban slums in Nairobi, Kenya, using anchored best–worst scaling. Journal of Water, Sanitation and Hygiene for Development Vol 4 No 1 pp 108–119, 2014.

Authors: Carl Johan Lagerkvist, Suvi Kokko and Nancy Karanja

Department of Economics, Swedish University of Agricultural Sciences, PO Box 7013, 75007 Uppsala, Sweden E-mail: carl-johan.lagerkvist@slu.se
Department of Land Resource Management and Agricultural Technology, University of Nairobi, PO Box 30197, Nairobi 00100, Kenya

ABSTRACT
Severe health, safety and environmental hazards are being created by the growing population of urban poor in low-income countries due to lack of access to sanitation and to inadequate existing sanitation systems. We developed a multi-faceted motivational framework to examine the constituents that explain user motivation regarding a personalised sanitation system. In 2012 we interviewed slum dwellers in Nairobi, Kenya, to estimate individual motivational factor importance rankings from anchored best–worst scaling (ABWS) using hierarchical Bayesian methods.

We found that personal safety, avoidance of discomfort with shared toilets, cleanliness and convenience for children were ranked of highest importance. Motivational factors related to health were only relatively highly ranked. Thus factors contributing to overall individual wellbeing, beyond health benefits, drive adoption and use of the low-cost personal sanitation solution studied. This suggests that non-health benefits of low-cost sanitation solutions should be better acknowledged and communicated to raise awareness and encourage adoption of improved sanitation in urban slums. These findings may help develop policies to promote personal sanitation, improve public health and safety and reduce environmental risks.

Trends in access to water supply and sanitation in 31 major sub-Saharan African cities

March 13, 2014 · 0 comments

Trends in access to water supply and sanitation in 31 major sub-Saharan African cities: an analysis of DHS data from 2000 to 2012. BMC Public Health 2014, 14:208.

Authors: Mike R Hopewell and Jay P Graham

Background – By 2050, sub-Saharan Africa’s (SSA) urban population is expected to grow from 414 million to over 1.2 billion. This growth will likely increase challenges to municipalities attempting to provide access to water supply and sanitation (WS&S). This study aims to characterize trends in access to WS&S in SSA cities and identify factors affecting those trends.

Methods – DHS data collected between 2000 and 2012 were used for this analysis of thirty-one cities in SSA. Four categories of household access to WS&S were studied using data from demographic and health surveys – these included: 1) household access to an improved water supply, 2) household’s time spent collecting water, 3) household access to improved sanitation, and 4) households reporting to engage in open defecation. An exploratory analysis of these measures was then conducted to assess the relationship of access to several independent variables.

Results – Among the 31 cities, there was wide variability in coverage levels and trends in coverage with respect to the four categories of access. The majority of cities were found to be increasing access in the categories of improved water supply and improved sanitation (65% and 83% of cities, respectively), while fewer were making progress in reducing the amount of time spent collecting water and reducing open defecation (50% and 38% of cities, respectively). Additionally, the prevalence of open defecation in study cities was found to be, on average, increasing.

Conclusions – Based on DHS data, cities appeared to be making the most progress in gaining access to WS&S along metrics which reflect specified targets of the Millennium Development Goals. Nearly half of the cities, however, did not make progress in reducing open defecation or the time spent collecting water. This may reflect that the MDGs have led to a focus on “improved” services while other measures, potentially more relevant to the extreme poor, are being neglected. This study highlights the need to better characterize access, beyond definitions of improved and unimproved, as well as the need to target resources to cities where changes in WS&S access have stalled, or in some cases regressed.

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda

March 13, 2014 · 0 comments

Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda. BMC Health Services Research 2014, 14:111.

Juliet N Babirye, et al.

Background – Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda.

Methods – Mixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Survey data underwent descriptive statistical analysis. Latent content analysis was used for qualitative data.

Results – Of the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years (95% CI 24–27). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents (24%, 95% CI 21–27). This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% (95% CI 30–37) of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% (95% CI 27–34) of the survey respondents utilised these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. Charges ranged from US$ 0.2 to US$4 and these were more commonly reported at private (70%, 95% CI 65–76) than at public (58%, 95% CI 54–63) facilities. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities.

Conclusions – Complex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, governments should strengthen health systems to cater for increasing urban populations.

Electronic waste – an emerging threat to the environment of urban India

March 13, 2014 · 0 comments

Electronic waste – an emerging threat to the environment of urban India. J Environ Health Sci Eng. 2014; 12: 36.

Santhanam Needhidasan, et al.

Electronic waste or e-waste is one of the emerging problems in developed and developing countries worldwide. It comprises of a multitude of components with valuable materials, some containing toxic substances, that can have an adverse impact on human health and the environment. Previous studies show that India has generated 0.4 million tons of e-waste in 2010 which may increase to 0.5 to 0.6 million tons by 2013–2014. Coupled with lack of appropriate infrastructural facilities and procedures for its disposal and recycling have posed significant importance for e-waste management in India. In general, e-waste is generated through recycling of e-waste and also from dumping of these wastes from other countries.

More of these wastes are ending up in dumping yards and recycling centers, posing a new challenge to the environment and policy makers as well. In general electronic gadgets are meant to make our lives happier and simpler, but the toxicity it contains, their disposal and recycling becomes a health nightmare. Most of the users are unaware of the potential negative impact of rapidly increasing use of computers, monitors, and televisions. This review article provides a concise overview of India’s current e-waste scenario, namely magnitude of the problem, environmental and health hazards, current disposal, recycling operations and mechanisms to improve the condition for better environment.

An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities

February 26, 2014 · 0 comments

An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Intl Health, Mar 2014.

Authors: Julie A. Nicholson, et al.

Objectives – To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children’s school absenteeism.

Methods – We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).

Results – Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (−25%, 95% confidence intervals [CI] = −37%, −2%), ARIs (−15%, 95% CI = −30%, −8%), school absences due to illnesses (−27%, 95% CI = −41%, −18%) and eye infections (−46%, 95% CI = −58%, −31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for ‘whole families’ (−31%, 95% CI = −37%, −5%; and −14%, 95% CI = −23%, −6%, respectively), 6- to 15-year-olds (−30%, 95% CI = −39%, −7%; and −15%, 95% CI = −24%, −6%) and under 5 s (−32%, 95% CI = −41%, −4%; and −20%, 95% CI = −29%, −8%).

Conclusions – Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public–private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.

Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru

February 26, 2014 · 0 comments

Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru. Trop Med Intl Health, Jan 2014.

William E. Oswald, et al.

Objectives – To estimate the association between improved water and sanitation access and handwashing of mothers living in a peri-urban community of Lima, Peru.

Methods – We observed 27 mothers directly, before and after installation of private, piped water and sewerage connections in the street just outside their housing plots, and measured changes in the proportion of faecal-hand contamination and hand-to-mouth transmission events with handwashing.

Results – After provision of water and sewerage connections, mothers were approximately two times more likely to be observed washing their hands within a minute of defecation, compared with when they relied on shared, external water sources and non-piped excreta disposal (RR = 2.14, 95% CI = 0.99–4.62). With piped water and sewerage available at housing plots, handwashing with or without soap occurred within a minute after 48% (10/21) of defecation events and within 15 min prior to 8% (11/136) of handling food events.

Conclusions – Handwashing increased following installation of private, piped water and sewerage connections, but its practice remained infrequent, particularly before food-related events. Infrastructural interventions should be coupled with efforts to promote hygiene and ensure access to water and soap at multiple on-plot locations convenient to mothers.

Feb 2014 – USAID/Ethiopia launches Urban Health Program

February 12, 2014 · 0 comments

Feb 11, 2014 – Promoting Urban Health and Launch of the Strengthening Ethiopia’s Urban Health Program (SEUHP) – Opening Remarks by Mission Director Dennis Weller

It is an honor to be here today on behalf of the United States Government and the American people to celebrate our partnership with the Government of Ethiopia to improve urban health services in this country.

The Ministry of Health has a strong reputation for its results-driven health program that empowers communities and demonstrates impressive successes. One such example is achieving Millennium Development Goal-4 of reducing child mortality well ahead of schedule.

We are pleased to witness the gains that health service delivery to homes has contributed toward improving health services in rural and urban areas. With an estimated 15.9 million people living in urban areas, Ethiopia is one of the least urbanized African nations. However, the population is growing and by 2050, Ethiopia’s urban population is projected to exceed 77 million.
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The health challenges in urban areas are complex. For example:

  • HIV prevalence is more than five times greater among women living in urban and peri-urban centers compared to women living in rural communities.
  • More than 50 percent of pregnant women in urban centers still deliver at home, and
  • Neonatal deaths in urban settings are almost as high as the rate in rural settings.

Adding to the complexity is that with the development of effective anti-retroviral therapies, life-long treatment of HIV is becoming similar to that of chronic illnesses, such as diabetes, cancer, and mental illness. As a result, there have been important changes to the public health response and many governments are now committing to mainstream, integrate, and decentralize HIV care.

We need to be prepared to address the health challenges related to rapid population growth and urbanization before it happens, and I am pleased to say that the Ministry of Health, USAID, and the development community are committed to making sure Ethiopia’s health system is ready to adapt to the ever-changing urban environment. In 2009, the Government of Ethiopia initiated the innovative Urban Health Extension Program.

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Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India

February 5, 2014 · 0 comments

Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India, 2014.

Authors: Amanda Johnson, et al.

Between 2006 and 2009, Freedom from Hunger worked with Bandhan, one of the largest microfinance institutions (MFIs) in India, to pilot new health products and services for its clients as part of Freedom from Hunger’s global Microfinance and Health Protection (MAHP) initiative. Funded by the Bill & Melinda Gates Foundation, health innovations such as health education, financing, products, and linkages to health providers were developed and piloted with Bandhan and four other microfinance organizations around the world with the dual goal of improvement of client health and financial protection and the financial performance of the MFIs. Through MAHP, Bandhan identified pressing health needs and concerns of its clients and designed a responsive and cohesive health package: health education forums for clients and community members that deliver behavior change communication on breastfeeding, pre-, post- and neonatal care, infant and child feeding and diarrhea; health loans; health product distributors known as Swastha Sahayikas (SS) who reinforce health messages during home visits, sell health products, and support referrals to local healthcare services.

Evidence of positive changes in important maternal and child health knowledge and behaviors as well as high levels of client satisfaction sustained over a period of five years following the implementation of the program, is very promising. This study is an important contribution to a growing body of evidence for cross-sectoral interventions that address poverty and poor health. Bandhan and other organizations, including microfinance, self-help groups, and savings-led groups that convene women to access financial services, represent a large and mostly untapped resource for creating durable and sustainable channels to reach millions of poor families, and for making important contributions towards the achievement of national and global health improvement targets, especially in the area of maternal and child health and nutrition.

 

 

 

Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya

February 5, 2014 · 0 comments

Olack B, Feikin DR, Cosmas LO, Odero KO, Okoth GO, et al. (2014) Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya, 2007–2010. PLoS ONE 9(1): e85913. doi:10.1371/journal.pone.0085913.

Background – We used population based infectious disease surveillance to characterize mortality rates in residents of an urban slum in Kenya.

Methods – We analyzed biweekly household visit data collected two weeks before death for 749 cases who died during January 1, 2007 to December 31, 2010. We also selected controls matched by age, gender and having a biweekly household visit within two weeks before death of the corresponding case and compared the symptoms reported.

Results – The overall mortality rate was 6.3 per 1,000 person years of observation (PYO) (females: 5.7; males: 6.8). Infant mortality rate was 50.2 per 1000 PYOs, and it was 15.1 per 1,000 PYOs for children <5 years old. Poisson regression indicates a significant decrease over time in overall mortality from (6.0 in 2007 to 4.0 in 2010 per 1000 PYOs; p<0.05) in persons ≥5 years old. This decrease was predominant in females (7.8 to 5.7 per 1000 PYOs; p<0.05). Two weeks before death, significantly higher prevalence for cough (OR = 4.7 [95% CI: 3.7–5.9]), fever (OR = 8.1 [95% CI: 6.1–10.7]), and diarrhea (OR = 9.1 [95% CI: 6.4–13.2]) were reported among participants who died (cases) when compared to participants who did not die (controls). Diarrhea followed by fever were independently associated with deaths (OR = 14.4 [95% CI: 7.1–29.2]), and (OR = 11.4 [95% CI: 6.7–19.4]) respectively.

Conclusions – Despite accessible health care, mortality rates are high among people living in this urban slum; infectious disease syndromes appear to be linked to a substantial proportion of deaths. Rapid urbanization poses an increasing challenge in national efforts to improve health outcomes, including reducing childhood mortality rates. Targeting impoverished people in urban slums with effective interventions such as water and sanitation interventions are needed to achieve national objectives for health.

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