Health Place. 2011 Oct 4.
When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana.
Stoler J, Fink G, Weeks JR, Otoo RA, Ampofo JA, Hill AG. Department of Geography, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
Intraurban differentials in safe drinking water in developing cities have been exacerbated by rapid population growth that exceeds expansion of local water infrastructure. In Accra, Ghana, municipal water is rationed to meet demand, and the gap in water services is increasingly being filled by private water vendors selling packaged “sachet” water.
Sachets extend drinking water coverage deeper into low-income areas and alleviate the need for safe water storage, potentially introducing a health benefit over stored tap water. We explore correlates of using sachets as the primary drinking water source for 2093 women in 37 census areas classified as slums by UN-Habitat, and links between sachet water and reported diarrhea episodes in a subset of 810 children under five.
We find that neighborhood rationing exerts a strong effect on a household’s likelihood of buying sachet water, and that sachet customers tend to be the poorest of the poor. Sachet use is also associated with higher levels of self-reported overall health in women, and lower likelihood of diarrhea in children. We conclude with implications for sachet regulation in Accra and other sub-Saharan cities facing drinking water shortages.
BU Launches Urban Health Initiative: Global summit pools research from New York to New Delhi
The future of public health is urban health. That was the consensus among researchers at the Global Urban Health Summit hosted by Boston University’s Center for Global Health & Development (CGHD) October 28. Public health experts from universities in the United States and abroad explored strategies to meet the overwhelming health challenges of the urban poor, from New York City to the slums of New Delhi and Nairobi. The meeting, held at the Hotel Commonwealth, also marked the launch of BU’s Global Urban Health program, which will add new talent and an expanded research agenda to the center.
“This is not a typical academic meeting,” said Jonathon Simon, CGHD director and chair of the School of Public Health international health department. “We’re here to think out loud.” As Jean Morrison, University provost, put it, “We’ve established an incubator in this room” for many of the world’s leading thinkers on urban health. Simon said the seed for the summit was planted by University President Robert A. Brown, who believes that as a major urban research university, BU should make great contributions to global health.
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Luoto J, Najnin N, Mahmud M, Albert J, Islam MS, et al. (2011). What Point-of-Use Water Treatment Products Do Consumers Use? Evidence from a Randomized Controlled Trial among the Urban Poor in Bangladesh. PLoS ONE 6(10): e26132. doi:10.1371/journal.pone.0026132
Full-text: http://dx.plos.org/10.1371/journal.pone.0026132
Background: There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why.
Methods: We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water’s contamination with E. coli (compared to 200 control households).
Findings: Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls.
Conclusion: Traditional arguments for the low adoption of POU products focus on affordability, consumers’ lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household’s preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations.
Saqayti: For greater rationalization of tapstand water supplies, Field Actions Science Reports , Vol. 5 | 2011.
T. Hascoet, O. Gilbert and M. Yassine
In Morocco, considerable progress has been made in connecting users to water and sanitation. However, some households, particularly in urban and surrounding areas, currently cannot be given an individual connection to the drinking water network due to a lack of equipment and/or financial reasons. To ensure that they have access to this essential service, these households are generally supplied by means of communal tapstands (CTs) where water is made available to them free of charges by the local authorities. While these open access CTs provide a temporary connection solution, they do not enable the resource to be optimally managed nor equitably shared.
Free and open access to all has lead to over-consumption, wastage, and use of the resource by consumers outside the intended beneficiary group. This results in heavy costs for the municipalities concerned and jeopardizes the sustainability of the utility. In response to this situation, and in accordance with the recommendations of the international community and of civil society, a new type of tapstand “Saqayti” has been developed to distribute prepaid water to beneficiaries in Rabat, Tangier and Tetouan. Saqaytis allow for targeted distribution of the utility to the intended beneficiaries as they are accessible by means of a chip card distributed to users on a case-by-case basis by the municipal authority. These users benefit from free access to the tapstand up to a monthly limit equivalent to their basic needs.
This paper aims at demonstrating how Saqayti has shown itself to be an innovative addition to the provision of individual utility connections, providing the poorest with access to a water and sanitation service which meets international standards of quality, and fulfills a threefold goal of economic, social and environmental progress.
SWITCH in the City: putting urban water management to the test
The SWITCH project was a five year experiment focused on some of the key sustainability challenges in urban water management. In a number of cities around the globe, it set out to test what was needed for a transition to more sustainable urban water management through a combination of demand-led research, demonstration activities, multi-stakeholder learning and training and capacity building.
If it is possible to draw out a consensus from this diversity of people and specialisms, it is that modern cities can be made to work, that stormwater and sanitation issues can be tackled and that water can be a leading asset in creating cities of the future where people want to live.
In this book, you will read about some of the concerns that city planners, water sector specialists and researchers have for the future, but you will read rather more about their hopes. Each city learning alliance developed a vision for the future and those visions were generally optimistic rather than apocalyptic.
Evaluating the health impact of urban WASH programmes, 2011. Water and Sanitation for the Urban Poor (WSUP)
This paper argues for more widespread evaluation of the health impacts of WASH interventions: not with the aim of demonstrating that WASH can improve health (we know it can), but rather with the aim of assessing the impact of particular interventions. We suggest that more frequent evaluation could contribute to improved effectiveness, by encouraging investors and implementers to focus on impacts rather than outputs (such as number of toilets constructed).
More widespread health impact evaluation would also enable more objective comparative assessment of the value-for-money of different types of urban WASH intervention. Further, we argue that health
impact evaluation need not be as costly as is widely thought. We discuss available methods, and suggest that the most appropriate approach in urban WASH evaluation contexts will often be the before-after concurrent control (BAC) design.
Impacts of Household Credit on Education and Healthcare Spending by the Poor in Peri-urban Areas in Vietnam, 2011.
Tinh Doan, John Gibson and Mark Holm. UNIVERSITY OF WAIKATO
There is debate about whether microfinance has positive impacts on education and health for borrowing households in developing countries. To provide evidence for this debate we use a new survey designed to meet the conditions for propensity score matching (PSM) and examine the impact of household credit on education and healthcare spending by the poor in peri-urban areas of Ho Chi Minh City, Vietnam.
In addition to matching statistically identical non-borrowers with borrowers, our estimates also control for household pre-treatment income and assets, which may be associated with unobservable factors affecting both credit participation and the outcomes of interest. The PSM estimates of binary treatment effect show significant and positive impacts of borrowing on education and healthcare spending.
However, multiple ordered treatment effect estimates reveal that only formal credit has significant and positive impacts on education and healthcare spending, while informal credit has insignificant impacts on the spending.
Sanitation and water for poor urban communities: a manifesto, 2011. WaterAid.
Full-text (pdf)
WaterAid calls on governments and development agencies across the world to put the highest political priority on the provision of water and sanitation services to poor urban communities. These services
are fundamental to human health and development, nowhere more so than in densely populated urban areas.
With no indication that the pace of urbanisation, and subsequently the growth in poor urban areas, will slow, the international community must act collaboratively to ensure these basic human rights are afforded to poor urban communities – and it must act now. Here, WaterAid sets out the examples and objectives for successful delivery of sanitation and water to poor urban communities.
Journal of Water and Health In Press, 2011 | doi:10.2166/wh.2011.031
Water supply services for Africa’s urban poor: the role of resale
Valentina Zuin, Leonard Ortolano, Manuel Alvarinho, Kory Russel, Anne Thebo, Odete Muximpua and Jennifer Davis, E-mail: jennadavis@stanford.edu
In Sub-Saharan Africa only 35% of the urban population has access to a piped water connection on their premises. The majority of households obtain water from public standpipes or from neighbors who are connected to the municipal network. Water resale is often prohibited, however, because of concerns about affordability and risks to public health. Using data collected from 1,377 households in Maputo, Mozambique, we compare the microbiological quality, as well as the time and money costs of water supply from individual house connections, public standpipes, and water obtained from neighbors.
Households with their own water connections have better service across virtually all indicators measured, and express greater satisfaction with their service, as compared to those using other water sources. Households purchasing water from their neighbors pay lower time and money costs per liter of water, on average, as compared to those using standpipes. Resale competes favorably with standpipes along a number of service quality dimensions; however, after controlling for water supply characteristics, households purchasing water from neighbors are significantly less likely to be satisfied with their water service as compared to those using standpipes.
Soc Work Public Health. 2011 Sep 15
Cultural and Social Practices Regarding Menstruation among Adolescent Girls.
A Kumar, K Srivastava K. Department of Rural Management , Xavier Institute of Social Service , Ranchi , India.
The study attempts to find out the existing social and cultural practices regarding menstruation, awareness levels, and the behavioral changes that come about in adolescent girls during menstruation, their perception about menarche, how do they treat it, and the various taboos, norms, and cultural practices associated with menarche. The study was conducted on 117 adolescent girls (age 11-20 years) and 41 mothers from various communities and classes in Ranchi comprising residential colonies and urban slums.
The findings unfold many practices: cultural and social restrictions associated with menstruation, myth, and misconception; the adaptability of the adolescent girls toward it; their reaction, reaction of the family; realization of the importance of menstruation; and the changes that have come in their life after menarche and their resistance to such changes. The article also suggests the strategies to improve menstrual health and hygiene among adolescent girls. The study concludes that cultural and social practices regarding menstruation depend on girls’ education, attitude, family environment, culture, and belief.
