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

July 17, 2012 · 0 comments

Water Sci Technol. 2012;66(2):299-303.

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, (Indian Council of Medical Research), P- 33, Scheme-XM, CIT Road, Beliaghata, Kolkata 700 010, India

E-mail: palit_anup@rediffmail.com; palita@icmr.org.in

Abstract
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.

Use of Commercially Available Oral Rehydration Solutions in Lima, Peru

July 17, 2012 · 0 comments

Am J Trop Med Hyg. 2012 Jun;86(6):922-924.

Use of Commercially Available Oral Rehydration Solutions in Lima, Peru.

Pantenburg B, Ochoa TJ, Ecker L, Ruiz J.

Caregivers’ practices concerning oral rehydration of young children during diarrheal illness were investigated in a periurban community of low socioeconomic level in Lima, Peru. Data of 330 caregivers of children aged 6-36 months were analyzed; 72.7% of all caregivers would give commercially available oral rehydration solutions (ORSs). However, only 58.6% of those caregivers with children that had experienced diarrhea during the previous week stated that they had used commercially available ORSs, a significantly lower percentage.

The main reason for not using commercially available ORSs was that caregivers did not know about them. Of all recipes caregivers provided for homemade ORS, none contained the recommended concentrations of sugar and salt. Educating caregivers about availability, benefits, and use of commercially available ORSs as well as correct preparation of homemade ORS is urgently needed.

Increase in facility-based deliveries associated with a maternal health voucher programme

July 17, 2012 · 0 comments

Health Policy Plan. 2012 Mar 21.

Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya.

Bellows B, Kyobutungi C, Mutua MK, Warren C, Ezeh A. Population Council, Nairobi, Kenya and African Population and Health Research Center, Nairobi, Kenya.

OBJECTIVE – To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements.

Data sources – Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08.

METHODS – Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother’s place of delivery, NUHDSS-MCH recorded the use of the voucher.

Findings – There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme.

CONCLUSIONS A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations.

Slums and malnourishment: evidence from women in India

July 3, 2012 · 0 comments

Am J Public Health. 2012 July

Slums and malnourishment: evidence from women in India.

Swaminathan H, Mukherji A.

The authors are with the Indian Institute of Management Bangalore, Bangalore, Karnataka, India.

Objectives. We examined the association between slum residence and nutritional status in women in India by using competing classifications of slum type.

Methods. We used nationally representative data from the 2005-2006 National Family Health Survey (NFHS-3) to create our citywide analysis sample. The data provided us with individual, household, and community information. We used the body mass index data to identify nutritional status, whereas the residential status variable provided slum details. We used a multinomial regression framework to model the 3 nutrition states-undernutrition, normal, and overnutrition.

Results. After we controlled for a range of attributes, we found that living in a census slum did not affect nutritional status. By contrast, living in NFHS slums decreased the odds of being overweight by 14% (95% confidence interval [CI] = 0.79, 0.95) and increased the odds of being underweight by 10% (95% CI = 1.00, 1.22).

Conclusions. The association between slum residence and nutritional outcomes is nuanced and depends on how one defines a slum. This suggests that interventions targeted at slums should look beyond official definitions and include current living conditions to effectively reach the most vulnerable.

Effect of mother’s education on child’s nutritional status in the slums of Nairobi

July 3, 2012 · 0 comments

BMC Pediatr. 2012 Jun

Effect of mother’s education on child’s nutritional status in the slums of Nairobi.

Abuya BA, Ciera JM, Kimani-Murage E.

BACKGROUND: Malnutrition continues to be a critical public health problem in sub-Saharan Africa. For example, in East Africa, 48 % of children under-five are stunted while 36 % are underweight. Poor health and poor nutrition are now more a characteristic of children living in the urban areas than of children in the rural areas. This is because the protective mechanism offered by the urban advantage in the past; that is, the health benefits that historically accrued to residents of cities as compared to residents in rural settings is being eroded due to increasing proportion of urban residents living in slum settings. This study sought to determine effect of mother’s education on child nutritional status of children living in slum settings.

METHODS: Data are from a maternal and child health project nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The study involves 5156 children aged 0-42 months. Data on nutritional status used were collected between October 2009 and January 2010. We used binomial and multiple logistic regression to estimate the effect of education in the univariable and multivariable models respectively.

RESULTS: Results show that close to 40 % of children in the study are stunted. Maternal education is a strong predictor of child stunting with some minimal attenuation of the association by other factors at maternal, household and community level. Other factors including at child level: child birth weight and gender; maternal level: marital status, parity, pregnancy intentions, and health seeking behaviour; and household level: social economic status are also independently significantly associated with stunting.

CONCLUSION: Overall, mothers’ education persists as a strong predictor of child’s nutritional status in urban slum settings, even after controlling for other factors. Given that stunting is a strong predictor of human capital, emphasis on girl-child education may contribute to breaking the poverty cycle in urban poor settings.

The Disproportionate High Risk of HIV Infection Among the Urban Poor in Sub-Saharan Africa

June 21, 2012 · 0 comments

AIDS Behav. 2012 Jun 4.

The Disproportionate High Risk of HIV Infection Among the Urban Poor in Sub-Saharan Africa.

Magadi MA. Department of Sociology, School of Social Sciences, City University, Northampton Square, London, EC1V 0HB, UK, m.magadi@city.ac.uk.

The link between HIV infection and poverty in sub-Saharan Africa (SSA) is rather complex and findings from previous studies remain inconsistent. While some argue that poverty increases vulnerability, existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV. In this paper, we examine the association between HIV infection and urban poverty in SSA, paying particular attention to differences in risk factors of HIV infection between the urban poor and non-poor.

The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA, conducted during 2003-2008. We apply multilevel logistic regression models, allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region.

The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Furthermore, the gender disparity in HIV infection (i.e. the disproportionate higher risk among women) is amplified among the urban poor.

The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection. The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations reside.

Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare

June 21, 2012 · 0 comments

BMC Public Health. 2012 Jun 18;12(1):442.

Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009.

Luque Fernandez MA, Schomaker M, Mason PR, Fesselet JF, Baudot Y, Boulle A, Maes P.

BACKGROUND: In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009.

METHODS: We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighbouring suburbs.

RESULTS: This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30\% lower with a rate ratio of 0.70 (95\% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20\% and 40\%.

DISCUSSION: This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.

Lancet Commission – Shaping Cities for Health

June 6, 2012 · 0 comments

Lancet, 2 June 2012

Shaping cities for health: complexity and the planning of urban environments in the 21st century

Prof Yvonne Rydin, et al.

Summary

The Healthy Cities movement has been in process for almost 30 years, and the features needed to transform a city into a healthy one are becoming increasingly understood. What is less well understood, however, is how to deliver the potential health benefits and how to ensure that they reach all citizens in urban areas across the world. This task is becoming increasingly important because most of the world’s population already live in cities, and, with high rates of urbanisation, many millions more will soon do so in the coming decades.

The Commission met during November, 2009, to June, 2011, to provide an analysis of how health outcomes can be improved through modification of the physical fabric of towns and cities and to discuss the role that urban planning can have in the delivering of health improvements. The Commission began from the premise that cities are complex systems, with urban health outcomes dependent on many interactions and feedback loops, so that prediction within the planning process is fraught with difficulties and unintended consequences are common.

Although health outcomes are, on average, better in higher-income than in lower-income countries, urban health outcomes in specific cities cannot be assumed to improve with economic growth and demographic change. The so-called urban advantage—a term that encapsulates the health benefits of living in urban as opposed to rural areas—has to be actively created and maintained through policy interventions. Furthermore, average levels of health hide the effect of socioeconomic inequality within urban areas. Rich and poor people live in very different epidemiological worlds, even within the same city. And such disparity occurs in both high-income and low-income countries.

Through case studies of sanitation and wastewater management, urban mobility, building standards and indoor air quality, the urban heat island effect (the difference in average temperatures between city centres and the surrounding countryside), and urban agriculture, we draw attention to the complexities involved in the achievement of urban health improvement through urban planning policies. Complexity thinking stresses that the development of a plan that anticipates all future change for these issues will not be possible. Instead, incremental attempts to reach a goal need to be tried and tested. Such thinking suggests a new approach to planning for urban health—one with three main components.

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Hitting Hotspots: Spatial Targeting of Malaria for Control and Elimination

June 5, 2012 · 0 comments

Hitting Hotspots: Spatial Targeting of Malaria for Control and Elimination, PLoS Medicine, Jan 2012.

Bousema T, et al

Heterogeneity is a common facet of infectious diseases, whereby infection and disease are concentrated in a small proportion of individuals. In malaria, heterogeneity is manifested as small groups of households, or hotspots, that are at a substantially increased risk of malaria transmission. These hotspots exist in all transmission settings but are less easily detected at high transmission intensity. Hotspots maintain transmission in low transmission seasons and fuel transmission in the high transmission seasons. Targeting hotspots is a highly efficient way to reduce malaria transmission at all levels of transmission intensity.

Urban malaria: myth and reality

June 5, 2012 · 0 comments

Urban malaria: myth and reality, Africa Health, July 2011.

William Brieger.

The basic factor involved in urban malaria is availability of breeding sites for anopheline species of mosquitoes. In general one could say that the malaria-carrying mosquitoes prefer to lay their eggs in still, clean, and sun-exposed water, ranging from ponds to small puddles, even as small as those made by hoof prints of cattle. In Africa only 20 of an estimated 140 anopheline species are responsible for malaria transmission and of these five are responsible for 95% of malaria transmission.

Although anopheline species can adapt to other aquatic environments, the main limitation of their survival in cities is the lack of clean water collections. In contrast, other mosquito species that carry viral febrile diseases abound in the gutters, water storage pots, and discarded tyres and cans commonly found in and around domestic premises in urban areas.

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