Urbanization, emerging slums and increasing health problems: a challenge before the nation

December 20, 2012 · 0 comments

E3 Journal of Environmental Research and Management Vol. 3(9). pp. 0146-0152, December, 2012

Urbanization, emerging slums and increasing health problems: a challenge before the nation: an empirical study with reference to state of uttar pradesh in India

Ghuncha Firdaus

Urbanization in developing world is unprecedented, and in coming few years the number of urban dwellers is expected to exceed rural dwellers. In India, due to unprecedented and unplanned urbanization the slum areas in urban society are rapidly increasing posing serious threat to sustainable development of the country. The objective of the present study is to map out major slum areas of an urban centre, the environmental conditions in and around of those slum areas and the impact of environmental condition on health profile of the dwellers.

The analysis is based on primary data collected at two points of time i.e. November-December 2001; May-June 2009 with the help of a questionnaire through a comprehensive survey of ten major slum areas of Aligarh city, India. The analysis reveals that these areas are characterized by complete absence of basic amenities and facilities like drinking water, toilets and bathroom, drainage system and garbage disposal facilities, and no improvement has been observed over the period of seven years.

Various infectious non-communicable and communicable diseases especially respiratory infections (60.22%), tuberculosis (31.26%) and diarhoea/dysentery (54.23%) were observed to be very common health problems that showed positive relationship with the use of traditional fuels (p<0.01), poor personal hygiene (p<0.01) and contaminated drinking water (p<0.01) respectively. The paper concludes with policy-oriented discussion of the relationship between urbanization, increasing number of slums and health challenges before the developing nations.

In-house contamination of potable water in urban slum of Kolkata, India

December 11, 2012 · 0 comments

Water Sci Technol. 2012;66(2):299-303. doi: 10.2166/wst.2012.177.

In-house contamination of potable water in urban slum of Kolkata, India: a possible transmission route of diarrhea.

Palit A, Batabyal P, Kanungo S, Sur D. Division of Microbiology, National Institute of Cholera & Enteric Diseases, Beliaghata, Kolkata, India. palit_anup@rediffmail.com

We have investigated and determined the potentiality of different water sources, both for drinking and domestic purposes, in diarrheal disease transmission in diarrhea endemic foci of urban slums in Kolkata, India in a one and half year prospective study. Out of 517 water samples, collected from different sources, stored water (washing) showed higher prevalence of fecal coliforms (58%) (p < 0.0001) in comparison with stored (drinking) samples (28%) and tap/tubewell water (8%) respectively.

Among different sources, stored water (washing) samples had the highest non-permissible range of physico-chemical parameters. Fecal coliform levels in household water containers (washing) were comparatively high and almost 2/3 of these samples failed to reach the satisfactory level of residual chlorine. Interestingly, 7% stored water (washing) samples were found to be harboring Vibrio cholerae.

Improper usage of stored water and unsafe/poor sanitation practices such as hand washing etc. are highlighted as contributory factors for sustained diarrheal episodes. Vulnerability of stored water for domestic usage, a hitherto unexplored source, at domiciliary level in an urban slum where enteric infections are endemic, is reported for the first time. This attempt highlights the impact of quality of stored water at domiciliary level for fecal-oral contamination vis-à-vis disease transmission.

Urban cholera transmission hotspots and their implications for reactive vaccination

December 11, 2012 · 0 comments

PLoS Negl Trop Dis. 2012 Nov

Urban cholera transmission hotspots and their implications for reactive vaccination: evidence from bissau city, Guinea bissau.

Azman AS, Luquero FJ, Rodrigues A, Palma PP, Grais RF, Banga CN, Grenfell BT, Lessler J.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

BACKGROUND: Use of cholera vaccines in response to epidemics (reactive vaccination) may provide an effective supplement to traditional control measures. In Haiti, reactive vaccination was considered but, until recently, rejected in part due to limited global supply of vaccine. Using Bissau City, Guinea-Bissau as a case study, we explore neighborhood-level transmission dynamics to understand if, with limited vaccine and likely delays, reactive vaccination can significantly change the course of a cholera epidemic.

METHODS AND FINDINGS: We fit a spatially explicit meta-population model of cholera transmission within Bissau City to data from 7,551 suspected cholera cases from a 2008 epidemic. We estimated the effect reactive vaccination campaigns would have had on the epidemic under different levels of vaccine coverage and campaign start dates. We compared highly focused and diffuse strategies for distributing vaccine throughout the city. We found wide variation in the efficiency of cholera transmission both within and between areas of the city. “Hotspots”, where transmission was most efficient, appear to drive the epidemic. In particular one area, Bandim, was a necessary driver of the 2008 epidemic in Bissau City. If vaccine supply were limited but could have been distributed within the first 80 days of the epidemic, targeting vaccination at Bandim would have averted the most cases both within this area and throughout the city. Regardless of the distribution strategy used, timely distribution of vaccine in response to an ongoing cholera epidemic can prevent cases and save lives.

CONCLUSIONS: Reactive vaccination can be a useful tool for controlling cholera epidemics, especially in urban areas like Bissau City. Particular neighborhoods may be responsible for driving a city’s cholera epidemic; timely and targeted reactive vaccination at such neighborhoods may be the most effective way to prevent cholera cases both within that neighborhood and throughout the city.

A spatial analysis of pit latrine density and groundwater source contamination.

December 6, 2012 · 0 comments

Environ Monit Assess. 2012 Sep 14.

A spatial analysis of pit latrine density and groundwater source contamination.

Wright JA, Cronin A, Okotto-Okotto J, Yang H, Pedley S, Gundry SW. Geography and Environment, University of Southampton, University Road, Southampton, SO17 1BJ, UK, j.a.wright@soton.ac.uk.

This study aims to assess the relationship between chemical and microbial contamination of groundwater sources and a range of potential hazards in two peri-urban areas of Kisumu, Kenya where shallow wells and pit latrines are widely used. From 1998 to 2004, 263 samples were taken from 61 groundwater sources and tested for thermotolerant coliforms. Eighteen of these sources were also tested for chemical contaminants, including nitrate, chloride and fluoride. The locations of all water sources, buildings and pit latrines in the study area were surveyed. Local pit latrine densities were calculated using a geographic information system.

Ten out 18 samples were above the World Health Organization guideline values for nitrate, 236 out of 263 were positive for thermotolerant coliforms, and all were above the guideline values for fluoride. There was neither a relationship between thermotolerant coliform levels and daily rainfall patterns nor with sanitary risk inspection scores for samples from shallow wells (r = 0.01, p = 0.91, n = 191). The density of pit latrines within a 100-m radius was significantly correlated with nitrate and chloride levels (r = 0.64, p = 0.004 and r = 0.46, p = 0.05, respectively) but not with thermotolerant coliforms (r = 0.22, p = 0.11).

These results illustrate both the public health risks associated with shallow groundwater sources, on-site sanitation and high population density. These findings have implications for current policies that promote latrine construction, especially in peri-urban areas of high population density. More comprehensive studies of larger communities should be commissioned to extend this analysis of the links between latrine density and groundwater contamination and so identify the contingent policy risks.

Comprehensive family hygiene promotion in peri-urban Cape Town

December 5, 2012 · 0 comments

S Afr J CH 2012;6(4):109-117. DOI:10.7196/SAJCH.459

Comprehensive family hygiene promotion in peri-urban Cape Town: Gastrointestinal and respiratory illness and skin infection reduction in children aged under 5

E C Cole, et al.

Background. Hygiene promotion has become increasingly important to public health policy makers as an illness reduction strategy. The primary aim of this study was to assess the differential effects of hygiene education alone compared with hygiene education plus hygiene products on the reduction of target illnesses/infections.

Aims and methods. We hypothesised that a participatory learning and action (PLA) family hygiene education approach plus the regular use of hygiene products could result in marked reduction of morbidity in children aged under 5 years. Population groups in two separate geographical areas were utilised (685 households). Each group consisted of a government (Reconstruction and Development Programme, RDP) housing community (indoor tap/flush toilet) and an informal (INF) housing community (communal tap/latrines). Illness data were gathered in both groups before hygiene education was introduced in June – November 2006 (study baseline) and for the same period in 2007 (study follow-up) after one group had received hygiene education only (control) and the other group hygiene education plus hygiene products (intervention). Facilitators from the communities monitored symptoms weekly and reinforced disease prevention behaviours, focusing on handwashing and bathing with soap, cleaning toilet/food surfaces, and treating skin problems with antiseptic.

Results. Children aged under 5 years in all communities had significant reductions in gastrointestinal and respiratory illnesses and skin infections over time. At study follow-up the control RDP community with hygiene education only was 2.46 times more likely to experience gastrointestinal illnesses (hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.17 – 4.91) and 4.56 times more likely to experience respiratory illnesses (HR 4.56, CI 1.97 – 10.54) at study follow-up than the intervention group. There was no statistical difference in the incidence of skin infections for children living in RDP housing. The INF community with hygiene education only was 1.64 times more likely to experience gastrointestinal illnesses (HR 1.64, CI 1.32 – 2.03), 4.62 times more likely to experience respiratory illnesses (HR 4.62, CI 4.19 – 5.09) and 1.29 times more likely to experience skin infections (HR 1.29, CI 1.26 – 1.32) than the intervention group.

Conclusion. While hygiene education alone resulted in meaningful reductions in gastrointestinal and respiratory illness and skin infections in children aged under 5 years across all communities, families with hygiene education plus consistent use of provided hygiene products had greater reductions.

Factors Contributing to Urban Malaria Transmission in Sub-Saharan Africa

November 29, 2012 · 0 comments

J Trop Med. 2012 Oct.

Factors Contributing to Urban Malaria Transmission in Sub-Saharan Africa: A Systematic Review

Prathiba M. De Silva and John M. Marshall

Sub-Saharan Africa suffers by far the greatest malaria burden worldwide and is currently undergoing a profound demographic change, with a growing proportion of its population moving to urban areas. Urbanisation is generally expected to reduce malaria transmission; however the disease still persists in African cities, in some cases at higher levels than in nearby rural areas.

Objective. This paper aims to collate and analyse risk factors for urban malaria transmission throughout sub-Saharan Africa and to discuss their implications for control.

Methods. A systematic search on malaria and urbanisation was carried out focusing on sub-Saharan Africa. Particular interest was taken in vector breeding sites in urban and periurban areas.

Results. A variety of urban vector breeding sites were catalogued, the majority of which were artificial, including urban agriculture, tyre tracks, and ditches. Natural breeding sites varied according to location. Low socioeconomic status was a significant risk factor for malaria, often present in peri-urban areas. A worrying trend was seen in the adaptation of malaria vector species to the urban environment. Urban malaria is highly focused and control programs should reflect this.

Conclusion. As urbanisation continues and vector species adapt, continued monitoring and control of urban malaria in sub-Saharan Africa is essential.

Sanitary Pad Interventions for Girls’ Education in Ghana: A Pilot Study

November 29, 2012 · 0 comments

PLoS One. Oct 2012; 7(10): e48274.

Sanitary Pad Interventions for Girls’ Education in Ghana: A Pilot Study

Paul Montgomery, et al.

Background – Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls’ transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of sanitary pads in girls’ education.

Methods – A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a non-randomized trial of sanitary pad provision with education. The trial had three levels of treatment: provision of pads with puberty education; puberty education alone; or control (no pads or education). The primary outcome was school attendance.

Results – After 3 months, providing pads with education significantly improved attendance among participants, (lambda 0.824, F=3.760, p<.001). After 5 months, puberty education alone improved attendance to a similar level (M=91.26, SD=7.82) as sites where pads were provided with puberty education (Rural M=89.74, SD=9.34; Periurban M=90.54, SD=17.37), all of which were higher than control (M=84.48, SD=12.39). The total improvement through pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level.

Conclusion – This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls’ education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.

A research agenda for helminth diseases of humans

November 29, 2012

PLoS Negl Trop Dis. 2012; 2012 Apr 24.

A research agenda for helminth diseases of humans: the problem of helminthiases.

Lustigman S, et al.

A disproportionate burden of helminthiases in human populations occurs in marginalised, low-income, and resource-constrained regions of the world, with over 1 billion people in developing areas of sub-Saharan Africa, Asia, and the Americas infected with one or more helminth species. The morbidity caused by such infections imposes a substantial burden of disease, contributing to a vicious circle of infection, poverty, decreased productivity, and inadequate socioeconomic development. Furthermore, helminth infection accentuates the morbidity of malaria and HIV/AIDS, and impairs vaccine efficacy.

Polyparasitism is the norm in these populations, and infections tend to be persistent. Hence, there is a great need to reduce morbidity caused by helminth infections. However, major deficiencies exist in diagnostics and interventions, including vector control, drugs, and vaccines. Overcoming these deficiencies is hampered by major gaps in knowledge of helminth biology and transmission dynamics, platforms from which to help develop such tools. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps.

In this review, we provide an overview of the forces driving the persistence of helminthiases as a public health problem despite the many control initiatives that have been put in place; identify the main obstacles that impede progress towards their control and elimination; and discuss recent advances, opportunities, and challenges for the understanding of the biology, epidemiology, and control of these infections. The helminth infections that will be discussed include: onchocerciasis, lymphatic filariasis, soil-transmitted helminthiases, schistosomiasis, food-borne trematodiases, and taeniasis/cysticercosis.

Improving Health of Children in Urban Slums Through an Integrated Model Based Approach

November 8, 2012 · 0 comments

India Pediatrics, June 2012.

Improving Health of Children in Urban Slums Through an Integrated Model Based Approach – A Case Study from Chennai, 2012.

S BALASUBRAMANIAM, et al.

This work was started with objective to improve health status of children in an urban slum by an integrated model based approach. An urban slum was selected based on fixed criteria and health needs were assessed. The environmental conditions were improved. Health care needs were taken care and self-help groups were started to make them financially independent. This model was evaluated in 204 families with 350 under-five children.

Survey revealed that 88% of them used safe garbage disposal and 95% of them had household latrines. Only 24% of under-five children had water borne morbidity in past one year and there were no vector borne diseases. 71% of them followed some contraception.

Mean duration of exclusive breast feeding was 7 months and average total duration of breast feeding
was 15 months. Integrated model based approach based on principles of primary health care works in
urban slums with effective community participation.

Off the map: the health and social implications of being a non-notified slum in India

November 8, 2012 · 0 comments

Env & Urban, Oct 2012

Off the map: the health and social implications of being a non-notified slum in India

Ramnath Subbaraman, et al. PUKAR, Shivaji Nagar, BMC Colony, Mumbai, India, e-mail: ramnath.sub@gmail.com

Approximately half of all slums in India are not recognized by the government. Lack of government recognition, also referred to as “non-notified status” in the Indian context, may create entrenched barriers to legal rights and basic services such as water, sanitation and security of tenure. In this paper, we explore the relationship between non-notified status and health outcomes in Kaula Bandar, a slum in Mumbai, India.

We illustrate this relationship using the findings of a four-year long series of studies in the community. By comparing Kaula Bandar’s statistics with those from other Mumbai slums captured by India’s National Family Health Survey–3, we show that Kaula Bandar has relative deficiencies in several health and social outcomes, including educational status, child health and adult nutrition. We then provide an explanatory framework for the role that Kaula Bandar’s non-notified status may play in generating poor health outcomes, by discussing the health consequences of the absence of basic services.

We also highlight the criminalization by the government of activities necessary for fulfilling access to fundamental needs such as water, toilets and shelter. We argue that the policy vacuum surrounding non-notified slums such as Kaula Bandar results in governance failures that lead to poor health outcomes. Our findings highlight the need for cities in India and other developing countries to establish and fulfill minimum humanitarian standards in non-notified slums for the provision of basic services such as water, sanitation, solid waste removal, electricity and education.

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