Journal of Neonatology Vol. 23, No. 3, July–Septemebr 2009

Improving urban newborn health: Challenges and the way forward

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Siddharth Agarwal,

Sids62@yahoo.com; siddharth@uhrc.in

89/4, Krishna Nagar, Lane# 4, Safdarjang Enclave, New Delhi – 110029

One-third of India’s urban population resides in slums and squatters, their vulnerability being characterized by poverty and powerlessness. Newborn care is sub-optimal among India’s urban poor, yet scarcely documented. Neonates born in urban poor settings are at high risk of death owing to multitudinous factors. This paper discusses the situation of neonatal care and survival among the urban poor across states which are at different levels of social development.

Challenges in addressing needs of the newborns in urban poor settings operate at community as well as program level and need to be addressed simultaneously. The paper describes these challenges and suggests a way forward in light of the existing opportunities and lessons from successful experiences. The following emerge imperative for improving newborn care among the urban poor in India:

  • i) development of comprehensive lead programs through close partnership among academic agencies like National Neonatology Forum, NGOs, socially committed private doctors, hospitals and city governments;
  • ii) improving demand, promoting household practices, service outreach through trained slum-based health volunteers and women group and encouraging slum-level health funds as a community risk pooling measure;
  • iii) enhancing competence of slum-based TBAs to improve home delivery practices and encourage hospital deliveries by linking them to affordable facilities;
  • iv) investment in building human resource capacity at all levels for providing improved newborn healthcare;
  • v) partnership with the private sector (private/charitable health facilities and non-government organizations) and academia for enhancing service delivery and for advocating for greater attention to the urban poor newborn;
  • vi) making the invisible visible and reaching the unreached and more vulnerable clusters.

J HEALTH POPUL NUTR 2010

Birth Preparedness and Complication Readiness among Slum Women in Indore City, India

Full-text: http://www.icddrb.org/uploads/originaluploads/1419-Siddharth%20Agarwal.pdf

Siddharth Agarwal1, Vani Sethi2, Karishma Srivastava1, Prabhat K. Jha3, and Abdullah H. Baqui4

1Urban Health Resource Center, New Delhi, India, 2Formerly with Urban Health Resource Center, New Delhi, India, 3Urban Health Resource Center, Indore, India, and 4International Center for Advancing Neonatal Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA

Three hundred twelve mothers of infants aged 2-4 months in 11 slums of Indore, India, were interviewed to assess birth preparedness and complication readiness (BPACR) among them. The mothers were asked whether they followed the desired four steps while pregnant: identified a trained birth attendant, identified a health facility, arranged for transport, and saved money for emergency. Taking at least three steps was considered being well-prepared. Taking two or less steps was considered being less-prepared. One hundred forty-nine mothers (47.8%) were well-prepared. Factors associated with well-preparedness were assessed using adjusted multivariate models.

Factors associated with well-preparedness were maternal literacy [odds ratio (OR)=1.9, (95%) confidence interval (CI) 1.1-3.4] and availing of antenatal services (OR=1.7, CI 1.05-2.8). Deliveries in the slum-home were high (56.4%). Among these, skilled attendance was low (7.4%); 77.3% of them were assisted by traditional birth attendants. Skilled attendance during delivery was three times higher in well-prepared mothers compared to less-prepared mothers (OR: 3.0, CI 1.6-5.4) Antenatal outreach sessions can be used for promoting BPACR. It will be important to increase the competency of slum-based traditional birth attendants, along with promoting institutional deliveries.

ECOHEALTH, Volume 7, Number 1, 78-90, Aug 2010

Ecological Links Between Water Storage Behaviors and Aedes aegypti Production: Implications for Dengue Vector Control in Variable Climates

H. Padmanabha, E. Soto, M. Mosquera, C. C. Lord and L. P. Lounibos

Understanding linkages between household behavior and Aedes aegypti (L.) larval ecology is essential for community-based dengue mitigation. Here we associate water storage behaviors with the rate of A. aegypti pupal production in three dengue-endemic Colombian cities with different mean temperatures. Qualitative, semi-structured interviews and pupal counts were conducted over a 7–15-day period in 235 households containing a water storage vessel infested with larvae.

Emptying vessels more often than every 7 days strongly reduced pupal production in all three cities. Emptying every 7–15 days reduced production by a similar magnitude as emptying <7 days in Armenia (21.9°C), has a threefold smaller reduction as compared to 90% of households regularly used stored water for washing clothes, generating a weaker correlation between emptying and usage. Emptying was less frequent in the households surveyed in the dry season in all three cities. These results show that A. aegypti production and human behaviors are coupled in a temperature-dependent manner. In addition to biological effects on aquatic stages, climate change may impact A. aegypti production through human behavioral adaptations. Vector control programs should account for geographic variation in temperature and water usage behaviors in designing targeted interventions.

Most maternity medical centres in Nairobi are no more than death traps, lacking in facilities, medicines and human skills.

A study carried out by the Nairobi-based African Population and Health Research Centre, the World Bank and two UK universities — Southampton and Liverpool John Moores — found high maternal deaths related to poor medical services.

In a study published in the Journal of Reproductive Health, the researchers surveyed 25 health centres in Korogocho, Viwandani and surrounding areas and found that not only were medicines, human skills and equipment lacking, but these centres are not supervised by any government authority.

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The principal theme to be addressed at the Ninth International Conference on Urban Health, Oct 27-29, 2010in New York City will be good governance for healthy cities, with special interest in the positive consequences in urban health interventions, as well as the social and public health policies that are required to address these issues.

The conference will address how governments can develop and implement policy that improves the health of all urban residents and reduces urban inequities. Although governance and health are the focus, these issues will be examined in a multitude of sectors: health services, violence and security, transportation and injuries, housing and infrastructure, neighborhoods and the urban environment, reproductive and maternal child health, the social determinants of health, substance use and homeless populations, and still others.

United Nations University

Solid Wastes, Poverty and the Environment in Developing Country Cities Challenges and Opportunities, 2010.

Full-text: http://www.rrojasdatabank.info/2010-23.pdf

Many cities in Africa, Asia, and Latin America face serious problems managing their wastes. Two of the major problems are the insufficient collection and inappropriate final disposal of wastes. Despite spending increasing resources, many cities – particularly in Africa and Asia – collect less than half of the waste generated.

Most wastes are disposed of in open dumps, deposited on vacant land, or burned by residents in their backyards. Insufficient collection and inadequate disposal generate significant pollution problems and risks to human health and the environment. Over one billion people living in lowincome communities and slums lack appropriate waste management services. Given the rapid population growth and urbanization in many cities, the management of wastes tends to further deteriorate. This paper examines the challenges and opportunities.

Journal of African Studies and Development Vol. 2 (2) pp. 015-026 March, 2010

Peri-urban dynamics and regional planning in Africa: Implications for building healthy cities

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Innocent Chirisa. Department of Rural and Urban Planning, University of Zimbabwe.
E-mail:  innocent.chirisa@gmail.com

Much as peri-urban zones in Africa are places of possible disaster outbreaks in terms of disease outbreaks and other social hazards due to their general lack of planning and institutional integration, they can act as cradles for building health cities. This is so for many practical reasons poised in the sustainable development framework – the prevalence of horticultural activities; their attractiveness to investment by the moneyed classes of society in the areas of housing, commerce and other big-time ventures; and attention by regional planners in their quest for tapping on the wealth of the rural-urban linkages. This article captures these various dynamic activities and developments in the peri-urban zones of some African countries towards building a case for building healthy cities in the sustainable development framework. The key questions addressed in the article are:

  • (a) To what extent are Africa peri-urban zones areas of possible disease outbreaks owing to the increased migration trends in different countries?
  • (b) What regional planning measures to be put in place so that the sustainability of peri-urban areas of the selected cities and towns to curb incidences of waterborne, airborne and other pandemic diseases?
  • (c) What housing options must be put in place towards addressing the slum conditions in these quintessential areas? (d) What is the contribution of developers and investors in the place making of peri-urban settlements?

In addressing these questions, the comparison of the different factors are key in determining whether or not the question of spatial scale matter; technologies to be employed and how best a stewardship approach will help in consensus-building by the different stakeholders so that harmonious places in the form of healthy and stable peri-urban African settlements are fostered. The case study approach was chosen in order to depict spatially  relevant details and dynamics that link the subject of peri-urban interfaces and their implications for regional planning in Africa.

Participants at a daylong advocacy workshop here on Tuesday emphasized the need for bringing all the poor and distressed women and children in the metropolis under primary healthcare activities for ensuring their sound health.

In this regard, they mentioned that proper management of the primary diseases could be effective tools for managing the secondary and other major diseases side by side with ensuring sound health for all.

The workshop titled “Health Service User Forum Awareness” was organized by the Second Urban Primary Healthcare Project under Local Government Division at Hotel Aristocrat.

Population Services and Training Center (PSTC) has been implementing the project in 10 administrative wards of Rajshahi City Corporation (RCC) with the RCC’s financial and administrative support.

Acting Mayor of RCC Shariful Islam Babu addressed the opening ceremony as the chief guest while Director of the project Abu Bakar Siddiqui as special guest with Chief Executive Officer of RCC Ajaher Ali in the chair.

The chief and the special guests noted that the project could be Implemented successfully with concerted efforts of all quarters and urged upon all including the public representatives to perform their duties with utmost sincerity and honesty to attain the cherished goal.

In address of welcome, Executive Director of PSTC Milon Bikash Pal and Chief Health Officer of RCC Dr Abul Fazal elaborated the project activities and, so far, achievements.

They mentioned that the main thrust of the program is to improve the health of the urban people especially poor women and children by improving access and changing the way in which health services are provided.

Besides, they added that provision of primary healthcare through partnership agreements and behavior change communication and marketing, strengthening urban primary healthcare infrastructure and environmental health, building capacity and policy support for urban primary healthcare and project implementation and operationally relevant research are the major components of the program.

http://nation.ittefaq.com/issues/2010/08/11/news0148.htm

Researchers study impacts of Valley’s extreme heat

The urban poor – already a vulnerable population – are the most susceptible to extreme heat. That is one of the findings from an interdisciplinary team of researchers from Arizona State University, NASA’s Johnson Space Center and the University of California at Riverside.

The team is engaged in a National Science Foundation-funded project exploring long-lasting heat waves and the relationship between temperature variations and socioeconomic variables in metropolitan Phoenix.

Remotely sensed imagery from NASA – taken from planes and satellites – is among the data being used to piece together a history of the metro Phoenix heat island, including how temperatures and vegetation patterns changed across the region from the early 1970s to 2000.

One finding is that poorer residents tend to live at the urban core, where vegetation is at a minimum and the presence of heat-absorbing and re-radiating asphalt and concrete is abundant, producing the most intense heat island effect. By contrast, people with higher incomes usually reside further away from the heart of the city and in homes surrounded by cooling vegetation.

Sharon Harlan, a sociologist in ASU’s College of Liberal Arts and Sciences’ School of Human Evolution and Social Change, is part of the team of educators, public health experts and social and natural scientists looking into how long-lived heat waves affect Phoenix residents. She stresses the seriousness of heat-related illness and death, as well as the likelihood that severity will rise. “Each year, heat fatalities in the U.S. occur in greater numbers than mortality from any other type of weather disaster. Global climate changes and rapidly growing cities are likely to compound and intensify the adverse health effects of heat islands around the world.”

She points out that the results of the team’s project could be used to help mitigate the damage, stating, “We want our research to be used to promote better decision-making about climate adaptation in cities.”

The remotely sensed data, which are used to not only look at past changes but also to build predictive simulations of what may occur, could be tools for, among others, city planners and emergency responders.

William Stefanov, senior geoscientist with Jacobs Technology in Johnson Space Center’s Astromaterials Research and Exploration Science Directorate, is providing the orbital view of the Phoenix area for the project.

“A lot of urban development is taking place around the world in arid or semiarid climates,” he says. “By studying Phoenix, researchers can better understand what these developing cities may face and how their environments may change as populations expand.”

More – http://asunews.asu.edu/20100811_NASA_heat

Smile Foundation launched its mobile hospital programme ‘Smile on Wheels‘ in Jaipur today. The newest mobile hospital was flagged off by Shri B.N.Sharma, the Hon’ble Principle Secretary-Health , from the Health ministry premises . This is the 10th mobile hospital in the Smile on Wheels programme. With this new unit the programme will be covering a population of 8,98,667 in 126 slums and villages across India.

New Delhi, Delhi, August 16, 2010 /India PRwire/ — Smile on Wheels is a community based self-sustainable heath delivery model. It will operate in Jaipur in association with Shikshit Rojgar Kendra Prabandhak Samiti (SRKPS) a non-government voluntary organisation engaged in developing sustainable programmes for the marginalized section especially women and children.

The project will be implemented in 22 slum areas of Jaipur district. The mobile hospital unit will visit 6 locations – Kalakar, Bhatta, Jagatpura,Jhalana, Bagrana and Idgah, twice every week. The unit will be covering 22,400 households and a total population of over 1,12,000 in these 6 locations. For the remaining 16 slum areas, a special health camp will be organised every Sunday.

In India we have a neonatal mortality rate of 70; 40% of the children under 5 years of age are malnourished and just 50% of the children receive complete recommended immunization. There are more than 1 million deaths in India annually, because of respiratory infections and preventive diseases like diahorrea, malaria and cholera, especially among the poorer sections of the society.

Smile Foundation had established this initiative – Smile on Wheels, in 2006 to facilitate affordable, accessible and accurate health care services to the underprivileged community. The programme is also operational in Delhi, Uttar Pradesh, Tamil Nadu, Andhra Pradesh, Gujarat, Madhya Pradesh and Jharkhand.

More – http://www.indiaprwire.com/pressrelease/health-care/2010081659240.htm