Maternal mortality in the informal settlements of Nairobi

July 22, 2010 · 0 comments

Maternal mortality in the informal settlements of Nairobi city: what do we know?

Full-text: http://eprints.soton.ac.uk/71063/1/1742-4755-6-6.pdf

Ziraba, Abdhalah Kasiira, Nyovani, Madise, Samuel, Mills, Catherine, Kyobutungi and Alex, Ezeh. (2009) Reproductive Health, 6, (6)

Background: current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya.

Methods: we used data from verbal autopsy interviews conducted on nearly all female deaths aged 15–49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004–2005 to examine causes of maternal death.

Results: the maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia.

Conclusion: maternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal deaths

India – Over 100 health centres to be set up for urban poor

July 22, 2010 · 1 comment

State Health Minister Jay Narayan Vyas on Wednesday announced the launch of Urban Health Mission, a first of its kind initiative in the country, to provide healthcare to the urban poor of Gujarat.

“The Urban Health Mission is being fully funded by the state government under which 102 Urban Health Centres would be set up at various nagarpalikas,” said Vyas. He added, “Under the Rs 360-crore project, there would be one UHC for every 50,000 population; an outreach centre for every 10,000 population; and a health worker called USHA (Urban State Health Attendant) for every 2,000 population.”

The first stage of the mission has already begun and 11 UHCs have been set up, he said, adding that the state has also decided to include children requiring kidney transplant and suffering from physical disability under the State Health Programme.

“We have also decided to provide computerised health card to all school children during the Gujarat golden jubilee year.  These cards would be like smart cards having details of the children,” he added.  Vyas said it will be extended to urban areas also shortly.  Under the SHP last year, over 1.36 crore children from over 49,000 schools and 43,000 anganwadis were covered, he said. Over 18 lakh children were treated on the spot during health check up camps and 1.4 lakh children with weak eyesight were given spectacles.  Vyas said the government has also developed plans to promote ayurvedic and homeopathic medicine in the next 12-18 months at the cost of Rs 304 crore.

Source - http://www.indianexpress.com/news/Over-100-health-centres-to-be-set-up-for-urban-poor–Vyas/650125

Women's experiences in the slums of Nairobi, Kenya

July 22, 2010 · 0 comments

Kenya: Insecurity and indignity: Women’s experiences in the slums of Nairobi, Kenya, 2010.

Download Full-text (pdf, 486KB)

Amnesty International

More than half the residents of Nairobi live in informal settlements and slums. Their housing is inadequate and they have little access to clean water, health care and other essential public services. Violence against women is widespread where ineffective policing results in rape and other violence against women going largely unpunished.

This report examines the experiences of women living in four slums in Nairobi. It calls on the Kenyan government to address gender-based violence against women and to ensure women’s access to sanitation and public security services.

Social Determinants of Children’s Health in Urban Areas in India

July 22, 2010 · 0 comments

Journal of Health Care for the Poor and Underserved – Volume 20, Number 4, November 2009 Supplement, pp. 68-89

Social Determinants of Children’s Health in Urban Areas in India

Siddharth Agarwal, Aradhana Srivastava

Children of the urban poor in India suffer a much poorer health status than the urban non-poor, influenced to a large extent by social determinants. In this paper, National Family Health Survey-3 (2005–06) data were analyzed to assess the health status of urban poor children vis-à-vis the non-poor, and to identify the social determinants precipitating disparities.

The analysis shows sharp disparity between child health indicators between urban poor and non-poor. Key findings include under-five mortality per thousand (urban poor 72.7 and non-poor 41.8) and children under-five underweight for age (urban poor 47% and non-poor 26.2%). Significant demographic and social correlates of child health in urban areas included poverty, gender, caste status, religion, mother’s educational attainment, occupational status of parents, and women’s autonomy in the household. They influenced different facets of child health, such as nutritional status and access to immunization.

Newborn care practices in urban slums

July 22, 2010 · 1 comment

Journal of Neonatal-Perinatal Medicine, Issue Volume 2, Number 4 / 2009

Newborn care practices in urban slums: Evidence from central India

Siddharth Agarwal1, Vani Sethi1, Karishma Srivastava1, Prabhat K. Jha2, Abdullah H. Baqui3

1Urban Health Resource Centre, New Delhi, India
2Urban Health Resource Centre, Indore, Madhya Pradesh, India
3International Center for Advancing Neonatal Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

One-third of India’s urban population resides in slums and squatters, in extreme poverty conditions. Newborn care is sub-optimal among India’s urban poor, yet scarcely documented. We assessed newborn care practices in 11 urban slums of Indore in Central India. Practices such as clean cord care, thermal care, timely initiation of breastfeeding and exclusive breastfeeding upto neonatal period were enquired from 312 mothers of infants aged 2–4 months. Correlates of these practices were identified using multiple logistic regression. 72.1% births were home births (slum-home: 56.4%, native-village home: 15.7%).

Slum-based traditional birth attendants (sTBAs) conducted 77.3% slum-home births. Skilled assistance during slum-home births was low (7.4%). Clean cord care (22.2%) and thermal care (10.2%) practices were also low. Trained or skilled assistance during slum-home births was positively associated with clean cord care (OR 4.8 CI 1.7–13.6) and thermal care (OR 2.0 CI: 1.1–4.1). Timely initiation of breastfeeding was sub-optimal (50.6%) even in facility births. Exclusive breastfeeding upto neonatal period was higher for mothers counselled on exclusive breastfeeding by a health volunteer during neonatal period (OR 2.3, CI 1.4–3.8).

Following emerge imperative for improving newborn care in urban slums- i) antenatal and postnatal counselling by trained health volunteers, ii) enhancing competence of sTBAs and linking them to affordable facilities and iii) sensitizing and training public health facility staff.

Mercury poisoning, the dark side of Colombia's gold boom

July 20, 2010 · 0 comments

(Reuters) – Colombia’s gold bonanza has a dark side, U.N. experts said on Tuesday: mercury poisoning spreading from miners to the population of a northwest state where they use mercury to extract the precious metal, U.N. experts said on Tuesday.

Colombia is one of the world’s top mercury polluters, as 50 to 100 metric tons of mercury are lost annually in the process of capturing gold while soaring prices push miners and artisans to extract ever more of the yellow metal, analysts say.

“As prices of gold have been increasing, more artisanal miners are mining and processing gold using mercury which is accessible, easier and cheaper to use,” said Marcello Veiga, an adviser to the U.N. industrial development arm.

The Andean nation is the world’s No. 1 mercury polluter per capita from artisanal (small-scale) mining, Veiga said. “The number of artisanal miners in Colombia is also increasing.”

Miners have used mercury to separate gold for decades, but part of it is lost in the process, contaminating rivers and soils. The environment ministry currently allows mercury but may soon forbid it, with a few exceptions.

In northwest Antioquia state, they use the most damaging process, adding around 120 grams (4.2 ounces) of mercury to 60 kilograms (132 pounds) of ore, without condensing or capturing the mercury, Veiga said.

As a result, mercury levels in some urban areas of Remedios, Segovia and Zaragosa can be 1,000 times higher than the levels accepted by the World Health Organization, he said.

“Around 15 kidney transplants are carried out in Remedios every year … because mercury vapor stays in the kidneys, damaging them,” Veiga said, citing data from the Remedios department of health.

50 TONNES OF MERCURY

Antioquia — the country’s largest gold producer, according to the energy ministry — has about 15,000 to 30,000 artisanal miners producing between 10 and 20 metric tons of gold per year.

But the miners are releasing 50 metric tons of mercury annually in the municipalities of Remedios, Segovia, Zaragosa, El Bagre and Nice, where 90 percent of the population depends on gold mining or jewelry for their livelihood, Veiga said.

Colombia is experiencing a gold boom with more than 40 companies exploring for the metal and production likely to grow over the next two years to around 3 million troy ounces (93.3 kilograms) of gold, the mining regulator says.

The United Nations calls for a gradual elimination of mercury in mining as miners switch over to use of centrifuges, which allow for greater gold extraction than mercury.

“With the centrifuge, small miners can produce twice as much gold than using mercury without affecting their health or the environment,” said Monica Roeser, who leads the Global Mercury Project in Colombia for the United Nations.

Studies of children have detected attention deficit disorders, memory and language problems in Segovia and Remedios, the project has reported.

Among miners, mercury exposure can be linked to memory loss, language issues and chronic headaches, researchers say.

“We don’t know how many people may have died from mercury pollution because neither doctors nor nurses have instruments to analyze whether mercury is in the urine,” Veiga said.

Reuters, July 13, 2010

Stroke incidence in urban Tanzania significantly higher than in developed countries

July 20, 2010 · 0 comments

The incidence of strokes in rural Tanzania is similar to that reported in developed countries, but rates in urban Tanzania are almost three times higher. These findings highlight the urgent need for community-level health screening and improved prevention measures to reduce stroke incidence in urban areas, concludes the first study in sub-Saharan Africa to include community-based identification of strokes published Online first and in the August edition of the Lancet Neurology.

Stroke is an increasing problem in developing countries, but little is known about the occurrence and burden of stroke in sub-Saharan Africa. Additionally, most data on the incidence of stroke in sub-Saharan Africa are from hospital-based studies and are not necessarily typical of the wider community. Indeed, previous research into stroke deaths in Tanzania has shown that only 56% of people in rural Hai and 30% of people in urban Dar-es-Salaam who die from stroke do so in hospital.

To provide reliable population-based data, the Tanzanian Stroke Incidence Project (TSIP) was established to investigate stroke incidence in rural (Hai) and urban (Dar-es-Salaam) Tanzania between June 2003 and June 2006. Over 3 years, all patients who had a stroke in Hai (population 159 814) and Dar-es-Salaam (population 56 517) were enrolled. The researchers identified stroke patients using a system of community-based sources—community-based investigators and staff at local hospitals and medical centres. Deaths from stroke that occurred before recruitment into the study were identified using verbal autopsy.

Over the 3 years, 636 people had a stroke, 453 in Hai and 183 in Dar-es-Salaam. Crude yearly stroke incidence rates were 94.5 per 100 000 in rural Hai and 107.9 per 100 000 in urban Dar-es-Salaam. When age-standardised to the WHO world population, annual incidence rates were almost three times higher in Dar-es-Salaam (315.9 per 10 000) compared with Hai (108.6 per 100 000).

The authors suggest: “The reasons for the higher incidence of stroke in urban areas are not yet clear, although undiagnosed or inadequately treated hypertension is likely to be a major modifiable risk factor.” Previous research has found that two-thirds of patients who died from stroke in Tanzania had a history of high blood pressure, and that people who live in urban areas in sub-Saharan Africa have higher rates of hypertension than those from rural communities.

They conclude: “Urbanisation in Africa, as in other parts of the developing world, is increasing rapidly, and the results from this study suggest that, in the absence of effective preventive measures, this is likely to lead to substantial increases in stroke incidence and mortality.”

In an accompanying Comment, Thomas Truelsen from Copenhagen University Hospital in Denmark says that these results confirm those of other studies in African populations showing high rates of hypertension, especially in urban areas, and suggest that prevention of stroke in these populations should include control of high blood pressure.

He also praises the authors on their “stepwise” approach to collection of stroke data: “The present study from rural and urban Tanzania both sets new standards for stroke incidence studies in Africa and suggests that improved prevention is urgently needed to reduce the already high stroke incidence rates in these populations.”

Source - http://www.physorg.com/news197545677.html

Water for sustainable urban human settlements

July 16, 2010 · 0 comments

WWAP and UN-Habitat have released a joint Briefing Note ‘Water for sustainable urban human settlements‘ highlighting critical water challenges related to today’s unprecedented urban expansion – from providing access to basic services to ensuring environmental and human security. The paper, produced 16 June 2010, provides urban mayors, leaders and high-level decision makers with concrete policy options to meet these challenges, protect against potential water-related disasters and ensure the development of sustainable urban settlements.

With half the world’s population living in urban areas and forecasts that all regions of the world will be predominantly urban by the middle of this century, the issue of sustainable cities is obviously high on the international agenda. The theme has influenced a number of international events in 2010, including Shanghai Expo 2010 ‘Better Cities, Better Life’; Singapore International Water Week ‘Sustainable Cities, Clean and Affordable Water’; the IWA World Water Congress ‘Cities of the Future’ and many others.

WWAP and UN-HABITAT wish to reaffirm the critical role of water in ensuring sustainable cities. Clean drinking water, improved sanitation services and protection against water-related disasters are fundamental to environmental and human security and to sustainable urban development.

Though water supply and sanitation coverage increased between 1998 and 2008, the growth of the world’s urban populations jeopardizes those results. Keeping up with urban growth will be a tough challenge. But there can be no sustainable urban settlements without an efficient water policy. Mayors, leaders in all sectors, and high-level decision-makers must acknowledge the role of water and take action NOW!

“Water for Sustainable Urban Human Settlements” [English PDF - 2 MB]

July 20 – Meeting the Health Challenge of Urban Poverty and Slums

July 14, 2010 · 0 comments

Meeting the Health Challenge of Urban Poverty and Slums, Washington DC

Tuesday, July 20, 12:00 – 1:15 p.m.
B-340 Rayburn House Office Building, Washington DC
Please RSVP to onthehill@wilsoncenter.org or 202-691-4357

- JACOB KUMARESAN, M.D., PhD, Director, WHO Centre for Health Development, Kobe, Japan
- RICHARD B. LAMPORTE, Director of New Program Development, Jhpiego
- Moderated by: BLAIR A. RUBLE, Director, Comparative Urban Studies Project, Woodrow Wilson Center

The rapid urbanization of the developing world has brought the growth of slums and increases in urban poverty. Two leading experts — one who heads the WHO Centre for Health Development and its Healthy Urbanization Project and the other from an NGO affiliated with Johns Hopkins University that develops and implements new healthcare delivery systems for the world’s most vulnerable populations — examine how non-health- specific programs in urban areas such as housing, water and sanitation, infrastructure improvements and micro finance can improve the health conditions in slums.

Wilson Center on the Hill is a nonpartisan forum that focuses on current issues related to international trade and security, sustainable development, and globalization. It sponsors 15 to 20 seminar programs each year on Capitol Hill that feature leading independent analysts and experts from the 22 programs of the Woodrow Wilson International Center for Scholars. Funded by a grant from the William and Flora Hewlett Foundation, Wilson Center on the Hill also sponsors congressional study trips, allowing Members of the U.S. Congress and senior congressional staff to examine these issues first-hand.

June 25 launch of USAID Ethiopia urban health program

July 7, 2010 · 1 comment

June 25, 2010, Addis Ababa: The U.S Agency for International Development (USAID) and implementing partner John Snow Inc. (JSI) in support of the Ministry of Health ,are launching a three-year, $4.85 million Urban Health Extension Program expected to benefit approximately 2.6 million Ethiopians living in 19 cities and towns in the Amhara, Oromo, SNNPR and Tigray regions. The Ethiopian Government has designed this new program to improve access to health services in urban areas throughout the country by training and deploying one nurse for every 500 households. The program will provide services to household, neighborhood, school and youth centers.

The launch ceremony will take place at the Hilton Hotel at 8:30 AM on Friday, June 25. USAID Ethiopia’s Health Officer Ms. Meri Sinnitt and the General Director for Health Promotion and Disease Prevention of Ethiopia’s Federal Ministry of Health, Dr. Kesetebrihan Admasu, will be the keynote speakers.

The Ethiopia Urban Health Extension Program (USAID/UHEP) is funded through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). UHEP aims to strengthen the ability of urban health extension workers to identify the most at-risk populations in their communities and provide public health services to improve their overall health situation, including through HIV prevention, care, and support services.

Source – Nazret, June 25, 2010

← Previous Entries

Next Entries →