Living and health conditions of selected cities in India

September 30, 2011 · 0 comments

Cities, Volume 28, Issue 5, October 2011, Pages 461-469

Living and health conditions of selected cities in India: Setting priorities for the National Urban Health Mission

Srinivas Goli, et. al.

The concept of “healthy city” promotes the physical, mental, social, and environmental well-being of people who live and work in urban areas. Fostering sustainably healthy cities is the prime objective of the National Urban Health Mission (NUHM) in India. However, attaining this goal requires establishing priorities, key concerns, strategies and guidelines for action.

This paper aims to assist policymakers by providing critical insights into the health and living conditions in selected major cities in India, with special emphasis on slums. This paper presents evidence that many of India’s major cities face significant deficits in the provision of basic amenities, including shelter, safe drinking water, improved sanitation and electricity. Demographic and health conditions in these cities lag far behind the goals set forth in national policies almost a decade ago. Despite the apparent proximity of city dwellers to urban health facilities, less than one third of the urbanites in India utilize government health facilities.

Highlights

  • This study provides critical insights on the living and health situation of eight cities of India with special emphasis on slums.
  • The demographic and health conditions of selected cities are way behind the goals set in population policy 2000 and health policy 2002.
  • Despite the supposed proximity of the urban people to government health facilities, their utilization is limited.
  • This study suggests that population stabilization, controlling communicable and non-communicable diseases are necessary for creation of healthy cities.

Household and community poverty, biomass use, and air pollution in Accra, Ghana

September 30, 2011 · 0 comments

PNAS July 5, 2011 vol. 108 no. 27 11028-11033

Household and community poverty, biomass use, and air pollution in Accra, Ghana

Zheng Zhoua, et al.

Many urban households in developing countries use biomass fuels for cooking. The proportion of household biomass use varies among neighborhoods, and is generally higher in low socioeconomic status (SES) communities. Little is known of how household air pollution varies by SES and how it is affected by biomass fuels and traffic sources in developing country cities. In four neighborhoods in Accra, Ghana, we collected and analyzed geo-referenced data on household and community particulate matter (PM) pollution, SES, fuel use for domestic and small-commercial cooking, housing characteristics, and distance to major roads.

Cooking area PM was lowest in the high-SES neighborhood, with geometric means of 25 (95% confidence interval, 21–29) and 28 (23–33) μg/m3 for fine and coarse PM (PM2.5 and PM2.5–10), respectively; it was highest in two low-SES slums, with geometric means reaching 71 (62–80) and 131 (114–150) μg/m3 for fine and coarse PM.

After adjustment for other factors, living in a community where all households use biomass fuels would be associated with 1.5- to 2.7-times PM levels in models with and without adjustment for ambient PM. Community biomass use had a stronger association with household PM than household’s own fuel choice in crude and adjusted estimates. Lack of regular physical access to clean fuels is an obstacle to fuel switching in low-income neighborhoods and should be addressed through equitable energy infrastructure.

Neighborhood Urban Environmental Quality Conditions Are Likely to Drive Malaria and Diarrhea Mortality

September 28, 2011 · 0 comments

Journal of Environmental and Public Health, Volume 2011

Neighborhood Urban Environmental Quality Conditions Are Likely to Drive Malaria and Diarrhea Mortality in Accra, Ghana

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Julius N. et al.

Background. Urbanization is a process which alters the structure and function of urban environments. The alteration in the quality of urban environmental conditions has significant implications for health. This applies both to the ecology of insect vectors that may transmit diseases and the burden of disease. Study

Objectives. To investigate the relationship between malaria and infectious diarrhea mortality and spatially varied neighborhood environmental quality conditions in a low-income economy.

Design. A one time point spatial analysis of cluster-level environmental conditions and mortality data using principal component analysis (PCA), one-way analysis of variance (ANOVA) and generalized linear models (GLMs). Methods. Environmental variables were extracted from the Ghana Census 2000 database while mortality data were obtained from the Ghana Births and Deaths Registry in Accra over the period 1998–2002.

Results. Whereas there was a strong evidence of a difference in relative mortality of malaria across urban environmental zones of differing neighborhood environmental conditions, no such evidence of mortality
differentials was observed for diarrhea. In addition, whereas bivariate analyses showed a weak to strong evidence of association between the environmental variables and malaria mortality, no evidence of association was found between diarrhea mortality and environmental variables.

Conclusion.We conclude that environmental management initiatives intended for infectious disease control might substantially reduce the risk of urban malaria mortality and to a less extent that for urban diarrhea mortality in rapidly urbanizing areas in a low-income setting.

Clean Team – urban sanitation in Kumasi, Ghana

September 21, 2011 · 0 comments

Nutritional Status of Under-five Children Living in an Informal Urban Settlement in Nairobi, Kenya

September 20, 2011 · 0 comments

Jnl Health Pop Nut August 2011

Nutritional Status of Under-five Children Living in an Informal Urban Settlement in Nairobi, Kenya

Full-text: http://www.jhpn.net/index.php/jhpn/article/view/795/769

Beatrice Olack, Heather Burke, Leonard Cosmas, Sapna Bamrah, Kathleen Dooling, Daniel R. Feikin, Leisel E. Talley, Robert F. Breiman

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007–March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes.

During 25 March–4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months.

Boys were more stunted than girls (p<0.01), and older children were significantly (p<0.0001) stunted compared to younger children. In the third year of life, girls were more likely than boys to be wasted (p<0.01). The high prevalence of chronic malnutrition suggests that stunting is a sustained problem within this urban informal settlement, not specifically resulting from the relatively brief political crisis. The predominance of stunting in older children indicates failure in growth and development during the first two years of life. Food programmes in Kenya have traditionally focused on rural areas and refugee camps. The findings of the study suggest that tackling childhood stunting is a high priority, and there should be fostered efforts to ensure that malnutrition-prevention strategies include the urban poor.

WWF – Water in an urbanizing world

September 7, 2011 · 0 comments

Water in an urbanizing world, 2011. Katalina Engel, et al. World Wildllife Fund.

The following recommendations can be made for future urban planning with regard to water sustainability:

  • Cities must protect and restore ecosystems that are important water sources for surface waters and aquifers. The adoption of a multi-sectoral approach to water and wastewater management at the national level is a matter of urgency.
  • Successful and sustainable wastewater management that supports peri-urban agriculture is crucial for reducing water consumption.
  • In order to better understand their vulnerabilities, prepare for climate change impacts, and make informed political and financial decisions, cities must conduct vulnerability and water risk assessments covering the core urban and peri-urban areas.
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India – Public Toilets in Chennai

September 7, 2011 · 0 comments

PUBLIC TOILETS IN CHENNAI, 2011. IFMR Research.

Link to full-text:  http://www.transparentchennai.com/wp-content/uploads/2011/05/Public-Toilets-Transparent-Chennai-Issue-Brief.pdf

Summary:  Sanitation is often called the “orphan MDG,” and India ranks among the worst countries in the world in  terms of access to sanitation. In the city of Chennai, sanitation for the poor has not been articulated as a  priority  by city managers. Transparent Chennai  – a project that  collects and creates maps, data, and research about the city to empower citizens and  increase government accountability  – conducted extensive research on one aspect of sanitation for the poor i.e. public toilets, and our work revealed  alarming findings. There are only 714 public toilets in the city of Chennai, for a population of 46.81  lakhs.

Of these 714, Transparent Chennai mapped and surveyed the 49 toilets in Zone 4. Despite evident  need, we found that many toilets were not being used very much by women or children. This is because  toilets are often poorly maintained, locked at night, charge user fees through a process of what appears to be informal privatization, and are located away from areas of greatest need, such as market areas, bus stops, areas with heavy  pedestrian traffic,  informal workplaces,  and undeveloped slums. Budget allocations for public toilets are meagre, yet sometimes remain unspent. Data on public toilets are poorly maintained in the city, suggesting a poor knowledge base for adequate planning and monitoring of toilets.

Transparent Chennai recommends that the government improve data about sanitation needs and government resources, use this data to spend more on toilets in a targeted manner, and to create lines of accountability on both public toilets and access to sanitation for the poor at all levels of government. The remainder of this issue brief summarizes the process, findings, and recommendations of the study on public toilets.

Livestock related zoonotic diseases in Kampala, Uganda

September 2, 2011 · 0 comments

J Vet Med Sci. 2011 Aug 30;73(8):991-1000.

Evidence-based identification of the most important livestock related zoonotic diseases in kampala, Uganda.

Makita K, Fèvre EM, Waiswa C, Kaboyo W, Eisler MC, Welburn SC. Centre for Infectious Diseases, Division of Pathway Medicine, School of Biomedical Science, College of Medicine and Veterinary Medicine, University of Edinburgh.

Urban and peri-urban livestock farming in developing countries plays an important role in food security in cities; however it brings with it zoonotic risks. The present study was conducted to identify the most important livestock farming-related zoonotic diseases among the human population in urban and peri-urban areas of Kampala, Uganda and to assess the risks from such farming.

A framework for identifying livestock farming-related significant zoonoses was developed. The process consisted of screening of medical record summaries for zoonotic diagnoses, selection of the zoonoses which are related to livestock farming, case estimation of the identified zoonoses and evidence-based reassurance of the importance of diseases. Medical records in the Mulago National Referral Hospital were used for the analysis. Leaders and residents of 75 Local Councils (LC1s: villages; 48 urban, 11 peri-urban and 16 rural) randomly selected in Kampala were interviewed for information regarding livestock farming systems, value chains and use of medical service units.

Twelve zoonoses were identified in the screening and four out of them were related to livestock farming: animal sourced food-borne gastroenteritis, brucellosis, Taenia solium neuro-cysticercosis and Mycobacterium bovis tuberculosis. Livestock farming, value chain and severity of the diseases confirmed that all four diseases were important. Poor geographical correlation between animals in peri-urban and rural areas and patients in urban areas suggested that the majority of these zoonoses were caused by informally-marketed foods.

Hand-washing, subclinical infections, and growth: evaluation of an intervention in Nepali slums

September 2, 2011 · 0 comments

Am J Hum Biol. 2011 Sep;23(5):621-9. doi: 10.1002/ajhb.21189.

Hand-washing, subclinical infections, and growth: A longitudinal evaluation of an intervention in Nepali slums.

Langford R, Lunn P, Brick CP. School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, BS8 2PS, United Kingdom. beki.langford@bristol.ac.uk.

OBJECTIVE: We conducted a longitudinal study to assess the impact of a hand-washing intervention on growth and biomarkers of child health in Nepali slums. This is the first study to evaluate the impact of hand-washing on markers of subclinical, asymptomatic infections associated with childhood growth faltering.

METHODS: We recruited a total sample of infants in the target age-range (3-12 months) living in the eight largest Kathmandu slums, allocating them to intervention (n = 45) and control (n = 43) groups. In intervention areas, a small-scale community-based hand-washing program was implemented for six months; in control areas, mothers continued their normal practices. Time series linear regression was used to assess the impact of the intervention on levels of morbidity, mucosal damage, immune stimulation and growth.

RESULTS: As expected, children with higher levels of mucosal damage exhibited worse growth over the period of the intervention (P = 0.01, <0.001 and 0.03 for height-for-age, weight-for-age, and weight-for-height z-scores, respectively). We observed a 41% reduction in diarrheal morbidity (P = 0.023) for the intervention group relative to control. However, the hand-washing intervention did not lower levels of mucosal damage or immune stimulation, nor slow growth faltering.

CONCLUSIONS: Reducing exposure to pathogens is an important global health priority. This study confirms the importance of hand-washing campaigns for reducing childhood morbidity. Yet our data suggest that promoting hand-washing is necessary but not sufficient to address chronic, subclinical infections. From a human biology standpoint, tackling the root causes of childhood infections is needed to address growth faltering in the context of highly contaminated slum environments.

Social Conditions and Urban Health Inequities

September 2, 2011 · 0 comments

J Urban Health. 2011 Aug 18.

Social Conditions and Urban Health Inequities: Realities, Challenges and Opportunities to Transform the Urban Landscape through Research and Action.

de Snyder VN, Friel S, Fotso JC, Khadr Z, Meresman S, Monge P, Patil-Deshmukh A.

Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca Morelos, Mexico, nsnyder@insp.mx.

The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating
cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities.

Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a “natural” or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups.

Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic
vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health.

Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and
international NGOs, and city government are important mechanisms that can bereplicated in urban settings of different low- and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.

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