UK study says trees play major role in urban health

July 7, 2010 · 0 comments

UK study says trees play major role in urban health, air quality and flood protection

The British conservation charity Woodland Trust has published a report detailing the important role of native trees in urban environments.

The report, entitled, ‘Greening the concrete jungle’, claims that more trees and woods in urban areas are needed in order to improve general health and wellness, reduce the risk of surface water flooding, raise the quality of life, support wildlife and enhance conditions for inward investment.

Trees are an inexpensive way to provide a diverse range of benefits for urban dwellers, who currently make up 80% of the UK population.

Source – Greenfudge

Bamboo and housing for the urban poor

July 7, 2010 · 0 comments

Bamboo Houses to the Rescue

Bamboo houses combat climate change, encourage economic growth and protect the poor from natural disaster. Why aren’t there more of them?

Beyond increasing per capita income — the goal of many, if not all, development projects — what can be done to provide better infrastructure and reduce the death toll of natural disasters in developing nations? According to a set of specialized architects and builders, one answer involves permanent bamboo housing. They argue that bamboo cultivation and construction can protect people in disaster-prone areas. History suggests they may be correct.

A 7.5 earthquake in Limón, Costa Rica, in April 1991 destroyed homes built with concrete and rebar, but all 20 of the more-flexible bamboo houses at the earthquake’s epicenter remained standing. When three typhoons swept into the Cook Islands in 2005, one producing winds of 173 mph, they devoured everything in their path — everything, that is, except a group of bamboo houses on the beach.

But in the age of global warming, bamboo has a benefit beyond construction: Both young and mature bamboo plantations capture more carbon than similar stands of trees. In a 2007 paper titled “Sub-optimal Equilibriums in the Carbon Forestry Game: Why Bamboo Should Win and Why It Will Not,” energy specialist Raya Kühne said, “A non-tree species — bamboo — may be one of the species most well-suited to the Clean Development Mechanism’s goals of maximizing carbon revenues and promoting sustainable development.”

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Kenya's slum women risk health to avoid violence

July 7, 2010 · 1 comment

NAIROBI (Reuters) – Kenya’s poorest women risk the deadly diseases related to poor sanitation because “endemic” sexual violence in the capital’s sprawling slums keeps them away from its communal toilets, a rights group said on Wednesday.

About 60 percent of Nairobi residents, or some 2 million people, live in shantytowns with limited access to water, sanitation and other vital services. Sewage runs though ditches and pathways are littered with garbage and human waste.

“Women and girls in Nairobi’s slums live under the constant threat of sexual violence,” Amnesty International said in a statement attached to its new report on Kenyan women in slums.

“Unable to leave their one-roomed houses after dark, many women in informal settlements resort to ‘flying toilets’ – using plastic bags thrown from the home to dispose of waste.”

Amnesty International said these women were at high risk of communicable diseases such as cholera and dysentery.

The group criticised the slum’s lack of police and the government’s failure to enforce planning laws and regulations in the settlements.

“There is a huge gap between what the government commits to do, and what is going on in the slums everyday,” said Godfrey Odongo, Amnesty International’s east Africa researcher.

Kenya is east Africa’s largest economy and the population of its capital is seen doubling to nearly six million by 2025.

This is seen heaping pressure on the city’s slums. Already, Nairobi’s slum-dwellers live on just 5 percent of the city’s residential area.

During the violent crisis that engulfed Kenya following its disputed 2007 election, the shantytowns with their huge numbers of marginalised youths became notorious ethnic battlegrounds.

Aid workers say they are “ticking time bombs” ahead of the country’s next poll in 2012.

Source – Reuters, July 7, 2010

Knowledge, attitudes and practices of mosquito larval source management for malaria control

July 6, 2010 · 0 comments

Acta Trop. 2010 Sep;115(3):248-56.

An exploratory survey of malaria prevalence and people’s knowledge, attitudes and practices of mosquito larval source management for malaria control in western Kenya.

Imbahale SS, Fillinger U, Githeko A, Mukabana WR, Takken W.

Wageningen University and Research Centre, EH Wageningen, The Netherlands. sueimbahale@yahoo.com

A large proportion of mosquito larval habitats in urban and rural communities in sub-Saharan Africa are man-made. Therefore, community-based larval source management (LSM) could make a significant contribution to malaria control in an integrated vector management approach. Here we implemented an exploratory study
to assess malaria prevalence and people’s knowledge, attitudes and practices on malaria transmission, its control and the importance of man-made aquatic habitats for the development of disease vectors in one peri-urban lowland and two rural highland communities in western Kenya.

We implemented monthly cross-sectional malaria surveys and administered a semi-structured questionnaire in 90 households, i.e. 30 households in each locality. Malaria prevalence was moderate (3.2-6.5%) in all sites. Nevertheless, residents perceived malaria as their major health risk. Thirty-two percent (29/90) of all respondents did not know that mosquitoes are responsible for the transmission of malaria. Over two-thirds
(69/90) of the respondents said that mosquito breeding site could be found close to their homes but correct knowledge of habitat characteristics was poor. Over one-third (26/67) believed that immature mosquitoes develop in vegetation. Man-made pools, drainage channels and burrow pits were rarely mentioned. After
explaining where mosquito larvae develop, 56% (50/90) felt that these sites were important for their livelihood.

Peri-urban residents knew more about mosquitoes’ role in malaria transmission, could more frequently describe the larval stages and their breeding habitats, and were more likely to use bed nets even though malaria prevalence was only half of what was found in the rural highland sites (p<0.05). This was independent of their education level or socio-economic status. Hence rural communities are more vulnerable to malaria infection, thus calling for additional methods to complement personal protection measures for vector
control. Larval source management was the most frequently mentioned (30%) tool for malaria control but was only practiced by 2 out of 90 respondents.

Targeting the larval stages of malaria vectors is an underutilized malaria prevention measure. Sustainable elimination or rendering of such habitats unsuitable for larval development needs horizontally organized, community-based programs that take people's needs into account. Innovative, community-based training programs need to be developed to increase people's awareness of man-made vector breeding sites and acceptable control methods need to be designed in collaboration with the communities.

Improved health outcomes in urban slums through infrastructure upgrading

July 6, 2010 · 0 comments

Soc Sci Med. 2010 Jun 16.

Improved health outcomes in urban slums through infrastructure upgrading.

Butala NM, Vanrooyen MJ, Patel RB. Yale School of Medicine, USA.

The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortality. This growing problem creates a unique challenge for policymakers and public health practitioners. While the Millennium Development Goals (MDGs) aim to address these conditions and standards for water and sanitation as well as pertinent health outcomes, little evidence on interventions exists to guide policymakers.

Upgrades in slum household water and sanitation systems have not yet been rigorously evaluated to demonstrate whether there is a direct link to improved health outcomes.  This study aims to show that slum upgrading as carried out in Ahmedabad, India, led to a significant decline in waterborne illness incidence. We employ a quasi-experimental regression model using health insurance claims (for 2001-2008) as a proxy for passive surveillance of disease incidence.

We found that slum upgrading reduced a claimant’s likelihood of claiming for waterborne illness from 32% to 14% and from 25% to 10% excluding mosquito-related illnesses. This study shows that upgrades in slum household infrastructure can lead to improved health outcomes and help achieve the MDGs. It also provides guidance on how upgrading in this context using microfinance and a public-private partnership can provide an avenue to affect positive change.

India – USAID initiative on diarrhea prevention

June 28, 2010 · 0 comments

Slum kids taught basics of hygiene

VARANASI: For Shubham, a Class VI student of the city, becoming a part of the ‘Saathi Bachpan Ke‘ programme– the country’s first national alliance on diarrhoea prevention and management that started in one of the slums near DDU district hospital in Pandeypur area on Monday– was an eye-opener, making him understand the significance of personal hygiene and sanitation.

While the young student of UP Inter College was already washing his hands with soap after using the toilet, the programme taught a number of slum children like him the correct way to clean hands with soap that could reduce the risk of diarrhoea diseases by almost 50 per cent.

“Washing hands with soap is not new but knowing the correct way of using soap and cleaning hands is a great experience,” said Shubham, who was joined by a number of slum children, including girls, to show the right way of going about it. “Proper hand washing requires soap and only a small amount of water and one should cover wet hands with soap, scrub all the surfaces and rinse well with running water. The hand parts, including palms, back and especially area under fingernails must be thoroughly cleaned,” added the young lad like a trained student.

It may be mentioned here that ‘Saathi Bachpan Ke‘ alliance is a special project funded by the US Agency for International Development (USAID) Market-based Partnerships for Health (MBPH). The project focuses on simple and effective solutions like hand washing with soap, use of oral rehydration therapy (ORT) and purification of drinking water to reduce diarrhoea deaths in children.

“Till now, I was only washing my hands with soaps after using the toilet but now I have realised that hands should be washed properly before handling food, even during cooking and eating,” said Ramjani, who worked as a maid-servant. “Unfortunately, most of us do not use soap regularly at home and invite diseases that take a heavy toll on life and money,” she added.

Heavy presence of slum-dwellers, including women and children, in the area was also enough to ensure encouraging response to efforts. Officials from the health department were also present.

“We are trying to bring together diverse organisations, community health service providers and NGOs to ensure healthier children,” said Vani Khurana, one of the spokesperson of MBPH. “The project started in UP in July this year and has already covered rural and urban areas of Lucknow and Kanpur. We would like to spread it further while creating mass awareness on clean water, improved sanitation and better hygiene,” she concluded.

June 28, 2010 – Times of India

Urban Health Bulletin – June 2010

June 24, 2010 · 0 comments

Below are citations and abstracts to 13 urban health studies published in June 2010.

HYGIENE/SANITATION/WATER

1 – Arch Dis Child. 2010 Jun 22.

Reported care giver strategies for improving drinking water for young children.

McLennan JD, Farrelly A. University of Calgary, Calgary, Canada.

Objectives – Care givers may engage in a variety of strategies to try and improve drinking water for children. However, the pattern of these efforts is not well known, particularly for young children in high-risk situations. The objective of this study was to determine care giver-reported strategies for young children with (1) undernutrition and (2) living in an unplanned poor peri-urban community in the Dominican Republic.

Methods – Practices reported by care givers of young children from a community and clinic group were extracted from interviews conducted between 2004 and 2008 (n = 563). These results were compared to two previous similar samples interviewed in 1997 (n = 341).

Results – Bottled water is currently the most prevalent reported strategy for improving drinking water for young children. Its use increased from 6% to 69% in the community samples over the last decade and from 13% to 79% in the clinic samples. Boiling water continues to be a common strategy, particularly for the youngest children, though its overall use has decreased over time. Household-level chlorination is infrequently used and has dropped over time.

Conclusions – Care givers are increasingly turning to bottled water in an attempt to provide safe drinking water for their children. While this may represent a positive trend for
protecting children from water-transmitted diseases, it may represent an inefficient approach to safe drinking water provision that may place a financial burden on low-income families.

2 – Waste Manag. 2010 Jun;30(6):1138-48.

Solid waste workers and livelihood strategies in Greater Port-au-Prince, Haiti.

Noel C.

The University of the West Indies, Institute for Sustainable Development, Environmental Management Unit, 13 Gibraltar Camp Way, Mona Campus, Kingston, Jamaica. claudelnoel@gmail.com

The solid waste management industry in Haiti is comprised of a formal and an informal sector. Many basic activities in the solid waste management sector are being carried out within the context of profound poverty, which exposes the failure of the socioeconomic and political system to provide sufficient job opportunities for the urban population. This paper examines the involvement of workers in the solid waste management industry in Greater Port-au-Prince and the implications for livelihood strategies. The findings revealed that the Greater Port-au-Prince solid waste management system is very inclusive with respect to age, while highly segregated with regard to gender. In terms of earning capacity, the results showed that workers hired by the State agencies were the most economically vulnerable group as more than 50% of them fell below the official nominal minimum wage. This paper calls for better salary scales and work compensation for the solid waste workers.

3 – J Water Health. 2010 Jun;8(2):355-64.

Assessment of E. coli and Salmonella spp. infection risks associated with different fecal sludge disposal practices in Thailand.

Yajima A, Koottatep T.

Department of Global Agricultural Science, Graduate School of Agricultural and Life Science, University of Tokyo, 1-1-1 Yayoi, Tokyo 113-8657, Japan. yajimaa@gmail.com

The proper management of fecal sludge (FS), to block the transmission pathways of pathogens, is rarely enforced in many parts of the world. Health risks associated with different disposal practices of FS in peri-urban settings of a large metropolis in Thailand were assessed; Tha Klong sub-district with indiscriminate FS dumping, and Klong Luang sub-district which has an FS treatment system. The study showed that indiscriminate FS dumping from along the canal banks and discharge of market waste were likely the major sources of E. coli and Salmonella spp. in contamination of the canal water. The increased microbial pathogen concentrations near the FS treatment facility also indicated contamination risks from poorly designed treatment facilities. Quantitative microbial risk assessment (QMRA) indicated very high water-related infection risk levels compared to the actual locally recorded disease occurrences. These results indicated that the QMRA model needs to be modified to take account of immunological differences between populations in developed countries, where the model was developed, and developing countries. In addition, further sensitivity factors are needed to reflect different societal behavior patterns, and therefore contact with
potentially contaminated water, in different sub-populations of many less developed communities.

DIARRHEAL DISEASES

4 – Epidemiol Infect. 2010 Jun 14:1-7.

Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine.

Arvelo W, Blum LS, Nahar N, VON Seidlein L, Nahar L, Pack RP, Brooks AW, Pach A, Breiman RF, Luby SP, Ram PK. Centers for Disease Control and Prevention, Atlanta, GA, USA.

Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents
stated that they would opt to get the vaccine and would pay a median of $0.05 (range U.S.$0.01-0.15) for it, equivalent to <1% of their median weekly income. There was almost universal perception that an effective vaccine to prevent bloody diarrhoea was highly beneficial and acceptable. While respondents valued a vaccine for prevention of bloody diarrhoea, they were only willing to pay minimally for it. Therefore, achieving a high rate of Shigella vaccine coverage may require subsidy of vaccine purchase.

HIV/AIDS STUDIES

5 – AIDS Behav. 2010 Jun;14(3):721-30.

Community-based DOT-HAART accompaniment in an urban resource-poor setting.

Muñoz M, Finnegan K, Zeladita J, Caldas A, Sanchez E, Callacna M, Rojas C, Arevalo J, Sebastian JL, Bonilla C, Bayona J, Shin S. Socios En Salud Sucursal Perú, Lima, Peru.

From December 2005 to April 2007, we enrolled 60 adults starting antiretroviral therapy (ART) in a health district of Lima, Peru to receive community-based accompaniment with supervised antiretroviral (CASA). Paid community health workers performed twice-daily home visits to directly observe ART and offered additional medical, social and economic support to CASA participants. We matched 60 controls from a neighboring district by age, CD4 and primary referral criteria (TB status, female, neither). Using validated instruments at baseline and 12 months (time of DOT-HAART completion) we measured depression, social support, quality of life, HIV-related stigma and self-efficacy. We compared 12 month clinical and psychosocial outcomes among CASA versus control groups. CASA participants experienced better clinical and psychosocial outcomes at 12 months, including proportion with virologic suppression, increase in social support and reduction in HIV-associated stigma.

6 – AIDS. 2010 Jun 9.

Early immunologic response and subsequent survival among malnourished adults receiving antiretroviral therapy in Urban Zambia.

Koethe JR, Limbada MI, Giganti MJ, Nyirenda CK, Mulenga L, Wester CW, Chi BH, Stringer JS.

OBJECTIVE:: To evaluate the relationship between early CD4 lymphocyte recovery on antiretroviral therapy (ART) and subsequent survival among low body mass index (BMI) HIV-1-infected adults.

DESIGN:: Retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

METHODS:: We evaluated ART-treated adults enrolled in care for more than 6 months. We stratified this study population according to World Health Organization (WHO) malnutrition criteria: normal (BMI >/=18.5 kg/m), mild (17.00-18.49), moderate (16.00-16.99), and severe (<16.0). We used Cox proportional hazards regression to estimate the subsequent risk of death associated with absolute CD4 cell count change over the first 6 months on ART. To account for effect modification associated with baseline CD4 cell count, a weighted summary measure was calculated.

RESULTS:: From May 2004 to February 2009, 56 612 patients initiated ART at Lusaka district clinics; of these, 33 097 (58%) were included in this analysis. The median change in 0-6 month CD4 cell count in each baseline BMI strata varied from 127 to 131 cells/mul. There was a statistically significant, inverse association between baseline BMI and the post 6-month hazard for mortality only among those patients with less than 100 cells/mul increase in the first 6 months of ART. A CD4 cell count increase of at least 100 cells/mul over the first 6 months of ART was not associated with a higher hazard for mortality, regardless of baseline BMI.

CONCLUSIONS:: Low baseline BMI and attenuated CD4 cell count response at 6 months had a compounding, negative impact on post 6-month survival. Specific guidelines for monitoring ART response using immunologic criteria may be warranted for low BMI patients.

7 – Arch Gynecol Obstet. 2010 Jun;281(6):991-4.

Obstetric and perinatal outcome in HIV positive women receiving HAART in urban Nigeria.

Olagbuji BN, Ezeanochie MC, Ande AB, Oboro VO.

Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria.

PURPOSE: To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls.

METHODS: A prospective matched case-control study.

RESULTS: HIV positive women were significantly more likely to have anaemia in pregnancy [p < 0.001, odds ratio (95% CI) 5.66 (3.0-10.5)], intrauterine growth restriction [p = 0.002, odds ratio (95%CI) 13.82 (1.8-106.7)], preterm labour [p = 0.03, odds ratio (95% CI) 2.89 (1.2-7.0)] and birth weight less than 2,500 g [p < 0.0001, odds ratio (95% CI) 5.43 (2.4-12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups.

CONCLUSION: Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women.

MALARIA AND OTHER VECTOR-BORNE DISEASES

8 – BMC Infect Dis. 2010 Jun 16;10(1):173.

Geographical and environmental approaches to urban malaria in Antananarivo (Madagascar).

Rakotomanana F, Ratovonjato J, Randremanana RV, Randrianasolo L, Raherinjafy R, Rudant JP, Richard V.

BACKGROUND: Previous studies, conducted in the urban of Antananarivo, showed low rate of confirmed malaria cases. We used a geographical and environmental approach to investigate the contribution of environmental factors to urban malaria in Antananarivo.

METHODS: Remote sensing data were used to locate rice fields, which were considered to be the principal mosquito breeding sites. We carried out supervised classification by the maximum likelihood method. Entomological study allowed vector species determination from collected larval and adult mosquitoes. Mosquito infectivity was studied, to assess the risk of transmission, and the type of mosquito breeding site was determined. Epidemiological data were collected from November 2006 to December 2007, from public health centres, to determine malaria incidence. Polymerase chain reaction was carried out on dried blood spots from patients, to detect cases of malaria. Rapid diagnostic tests were used to confirm malaria cases among febrile school children in a school survey. A geographical information system was constructed for data integration. Altitude, temperature, rainfall, population density and rice field surface area were analysed and the effects of these factors on the occurrence of confirmed malaria cases were studied.

RESULTS: Polymerase chain reaction confirmed malaria in 5.1% of the presumed cases. Entomological studies showed An. arabiensis as potential vector. Rice fields remained to be the principal breeding sites. Travel report was considered as related to the occurrence of P. falciparum malaria cases.

CONCLUSION: Geographical and environmental factors did not show direct relationship with malaria incidence but they seem ensuring suitability of vector development. Absence of relationship may be due to a lack of statistical power. Despite the presence of An. Arabiensis, scarce parasitic reservoir and rapid access to health care do not constitute optimal conditions to a threatening malaria transmission. However, imported malaria case is suggestive to sustain the pocket transmission in Antananarivo.

9 – Trans R Soc Trop Med Hyg. 2010 Jun;104(6):406-11.

Sand flies naturally infected by Leishmania (L.) mexicana in the peri-urban area of Chetumal city, Quintana Roo, México.

Sánchez-García L, Berzunza-Cruz M, Becker-Fauser I, Rebollar-Téllez EA. Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Medicina Experimental, Hospital General de México, Dr Balmis 148, Col. Doctores, México D.F. 06726, México. zinacla 68@yahoo.com.mx

The surveillance of prevalent Leishmania sand fly vectors is an important issue for epidemiological studies in populated areas where leishmaniasis is endemic. In this study, we collected sand flies from a peri-urban area in the southeast of Mexico. Natural infection with Leishmania (L.) mexicana was studied by PCR using a Leishmania internal transcribed spacer of the ribosomal RNA gene for amplification. Infected Lutzomyia olmeca olmeca, Lu. shannoni and Lu. cruciata sand flies were collected mainly during the high transmission season (November to March), coinciding with the highest sand fly densities. Additionally, positive specimens of Lu. olmeca olmeca were also captured during July and August. The infected sand flies were from primary forest (subperennial forest) and secondary forest (18-25 years old and 10-15 years old respectively). Sand flies collected with Disney and Shannon traps were the ones found to be infected with L. (L.) mexicana. We conclude that the high-risk period in which L. (L.) mexicana is transmitted in the peri-urban area of Chetumal City is from July to March and that transmission is associated with both the subperennial forest and the secondary forest.

RESPIRATORY DISEASES

10 – Trop Med Int Health. 2010 Jun 1;15(6):762-71.

Prevalent high-risk respiratory hygiene practices in urban and rural Bangladesh.

Nasreen S, Azziz-Baumgartner E, Gurley ES, Winch PJ, Unicomb L, Sharker MA, Southern D, Luby SP. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.

Objectives – To identify existing respiratory hygiene risk practices, and guide the development of interventions for improving respiratory hygiene.

Methods – We selected a convenience sample of 80 households and 20 schools in two densely populated communities in Bangladesh, one urban and one rural. We observed and recorded respiratory hygiene events with potential to spread viruses such as coughing, sneezing, spitting and nasal cleaning using a standardized assessment tool.

Results – In 907 (81%) of 1122 observed events, households’ participants coughed or sneezed into the air (i.e. uncovered), 119 (11%) into their hands and 83 (7%) into their clothing. Twenty-two per cent of women covered their coughs and sneezes compared to 13% of men (OR 2.6, 95% CI 1.6-4.3). Twenty-seven per cent of persons living in households with a reported monthly income of >72.6 US$ covered their coughs or sneezes compared to 13% of persons living in households with lower income (OR 3.2, 95% CI 1.6-6.2). In 956 (85%) of 1126 events, school participants coughed or sneezed into the air and 142 (13%) into their hands. Twenty-seven per cent of coughs/sneezes in rural schools were covered compared to 10% of coughs/sneezes in urban schools (OR 2.3, 95% CI 1.5-3.6). Hand washing was never observed after participants coughed or sneezed into their hands.

Conclusion – There is an urgent need to develop culturally appropriate, cost-effective and scalable interventions to improve respiratory hygiene practices and to assess their effectiveness in reducing respiratory pathogen transmission.

OTHER STUDIES

11 – BMC Gastroenterol. 2010 Jun 16;10(1):62.

Helicobacter pylori in apparently healthy children aged 0-12 years in urban Kampala, Uganda: a community-based cross sectional survey.

Hestvik E, Tylleskar T, Kaddu-Mulindwa DH, Ndeezi G, Grahnquist L, Olafsdottir E, Tumwine JK.

BACKGROUND: Helicobacter pylori is one of the most common causes of bacterial infection in human beings. Studies have showed a high prevalence of Helicobacter pylori among people in low-income countries and colonization early in life. A monoclonal antigen test, performed on faeces, HpSA(R)ImmunoCardSTAT, has a high sensitivity, specificity and accuracy and the faecal test can be performed in all ages, also in resource-limited settings. The main objective of this study was to determine the prevalence and factors associated with Helicobacter pylori colonization in apparently healthy children aged 0-12 years in urban Kampala, Uganda.

METHOD: We tested 427 apparently healthy children, age 0-12 years (211 males, 216 females), in a cross sectional survey for Helicobacter pylori colonization using HpSA(R)ImmunoCardSTAT. A short standardized interview with socio-demographic information and medical history was used to assess risk factors. RESULTS: The overall prevalence of Helicobacter pylori in the 427 children was 44.3 % (189 out of 427). Early colonization was common, 28.7 %, in children younger than 1 year of age. The age specific rates were 46.0 % in children age 1-<3 years, 51.7 % in children age 3-<6 years, 54.8 % in children age 6-<9 years and 40.0 % in children age 9-<12 years. There was a significant difference in prevalence by gender; female 38.5 % versus male 49.8 % and by type of housing; permanent house 38.5 % versus semi-permanent house 48.6 %. Congestive living and education level of the female caretaker showed a clear trend for a difference in prevalence. Factors independently associated with Helicobacter pylori colonization included: drugs taken last three months, using a pit latrine, sources of drinking water and wealth index.

CONCLUSION: The prevalence of Helicobacter pylori colonization among urban Ugandan children is high at an early age and increases with age. The impact of Helicobacter pylori colonization on children's health in Uganda needs to be further clarified.

12 – Parasitol Res. 2010 Jun 8.

Gastrointestinal and ectoparasites from urban stray dogs in Fortaleza (Brazil): high infection risk for humans?

Klimpel S, Heukelbach J, Pothmann D, Rückert S. Biodiversity and Climate Research Centre (BiK-F), Johann Wolfgang Goethe-University, Georg-Voigt-Str. 14-16, 60325, Frankfurt am Main, Germany, sklimpel@gmx.net.

Dogs are important definite or reservoir hosts for zoonotic parasites. However, only few studies on the prevalence of intestinal parasites in urban areas in Brazil are available. We performed a comprehensive study on parasites of stray dogs in a Brazilian metropolitan area. We included 46 stray dogs caught in the urban areas of Fortaleza (northeast Brazil). After euthanization, dogs were autopsied. Ectoparasites were collected, and the intestinal content of dogs were examined for the presence of parasites. Faecal samples were collected and analysed using merthiolate iodine formaldehyde concentration method.

A total of nine different parasite species were found, including five endoparasite (one protozoan, one cestode and three nematode species) and four ectoparasite species (two flea, one louse and one tick species). In the intestinal content, 3,162 specimens of four helminth species were found: Ancylostoma caninum (prevalence, 95.7%), Dipylidium caninum (45.7%), Toxocara canis (8.7%) and Trichuris vulpis (4.3%). A total of 394 ectoparasite specimens were identified, including Rhipicephalus sanguineus (prevalence, 100.0%), Heterodoxus spiniger (67.4%), Ctenocephalides canis (39.1%) and Ctenocephalides felis (17.4%). In the faeces, intestinal parasites were detected in 38 stray dogs (82.6%), including oocysts of Giardia sp. (2.2%) and eggs of the nematode A. caninum (82.6%). Neither eggs nor larval stages of D. caninum, T. canis or T. vulpis were detected in dog faeces. Sensitivity of faecal examination for A. caninum was 86.4% (95% confidence interval, 72.0-94.3) but zero percentage for the other intestinal helminth species.

Our data show that stray dogs in northeast Brazil carry a multitude of zoonotic ecto- and endoparasites, posing a considerable risk for humans. With the exception of A. caninum, sensitivity of faecal examination was negligible.

13 – Trop Med Int Health. 2010 Jun 1;15(6):664-72.

Spatial analysis of tuberculosis in an Urban West African setting: is there evidence of clustering?

Touray K, Adetifa IM, Jallow A, Rigby J, Jeffries D, Cheung YB, Donkor S, Adegbola RA, Hill PC. Bacterial Diseases Programme, MRC Laboratories, Banjul, The Gambia.

Objectives – To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering.

Methods – In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents.

Results – Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region.

Conclusions – There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.

Dwindling water supply spells grim future for Nairobi

June 16, 2010 · 0 comments

The tea farms that surround the Ndakai-ini Dam on the slopes of Nyandarua ridges add to the beauty and serenity of the picturesque terrain that harvests 75 per cent of the water used in Nairobi— more than 60 kilometres away.

But behind this beautiful scenery lurks the sad story: This dam can no longer supply enough water to city residents as demand has outstripped supply.

While the water levels have been dwindling, thanks to deforestation on the upper slopes of the ridges, the rising population of Nairobi now means that Ndakai-ini will have to be supplemented by other sources.

The Athi Water Services Board (AWSB), which is charged with expanding the water infrastructure says daily demand by Nairobi residents alone stands at 750,000 cubic metres a day against the supply capacity of 530,000 cubic metres, leaving a daily deficit of up to 220,000 cubic metres.

“The board needs in excess of Sh40 billion to implement a long term project that would end water shortage in the city by 2030,” said Rose Nyaga, the Chief Executive Officer of Athi Water Services Board.

This situation mirrors the general failure by other water companies to plan ahead, thus dimming the country’s prospects of fresh water security.

According to the director of water sector reforms in the Water ministry, Mr Peter Ombogo, out of the 120 companies formed in 2002 as part of the changes in the water sector, only 22 can meet their expenditure.

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Adolescent Problem Behavior in Nairobi's Informal Settlements

June 10, 2010 · 0 comments

Journal of Urban Health, forthcoming article

Adolescent Problem Behavior in Nairobi’s Informal Settlements: Applying Problem Behavior Theory in Sub-Saharan Africa

Robert P. Ndugwa1, Caroline W. Kabiru2, John Cleland1, Donatien Beguy2, Thaddeus Egondi2, Eliya M. Zulu3 and Richard Jessor4

(1) Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK
(2) African Population and Health Research Centre, Nairobi, Kenya
(3) African Institute for Development Policy Research and Dialogue, Nairobi, Kenya
(4) Institute of Behavioral Science, University of Colorado at Boulder, Colorado, USA

Adolescent involvement in problem behaviors can compromise health, development, and successful transition to adulthood. The present study explores the appropriateness of a particular theoretical framework, Problem Behavior Theory, to account for variation in problem behavior among adolescents in informal settlements around a large, rapidly urbanizing city in sub-Saharan Africa.

Data were collected from samples of never married adolescents of both sexes, aged 12–19, living in two Nairobi slum settlements (N = 1,722). Measures of the theoretical psychosocial protective and risk factor concepts provided a substantial, multi-variate, and explanatory account of adolescent problem behavior variation and demonstrated that protection can also moderate the impact of exposure to risk.

Key protective and risk factors constitute targets for policies and programs to enhance the health and well-being of poor urban adolescents in sub-Saharan Africa.

ICDDRB – Essential healthcare services for urban street dwellers

June 10, 2010 · 0 comments

Recent ICDDR,B research revealed the extreme vulnerability of street dwellers in terms of their health needs and health-care seeking behaviours. Street dwellers are people who sleep on streets, railway terminals and platforms, bus stations, parks and open spaces, religious centres, construction sites around graveyards, and other public places. They are malnourished, routinely use illicit drugs and experience violence. There is no health service-delivery mechanism specifically tailored towards this marginalized group of people, as there is for other groups like slum dwellers, non-slum dwellers, and people living in hard-to-reach areas, and street dwellers are rarely accessing general essential healthcare services.

To begin addressing these health needs, ICDDR,B in collaboration with the Ministry of Health and Family Welfare (MOHFW), Dhaka City Corporation (DCC), 2nd Urban Primary Health Care Project (UPHCP), Bangladesh Railway, National Sports Council and non-government organizations launched a project funded by the German Technical Cooperation (GTZ), with the specific aim of developing a mechanism to provide essential healthcare services to urban street dwellers in Bangladesh.

The activities of the project included providing essential healthcare services to urban street dwellers through static and satellite clinics from 6:00 pm to 9:30 pm in three central locations of Dhaka city, with two paramedics (one female and male) providing the service. The locations are Karwan Bazar (static clinic), Kamlapur Railway Station and Mogdha Stadium (satellite clinics). Dhaka City Corporation provided a room at their Karwan Bazaar zone office for organizing the static clinic while Bangladesh Railway and National Sports Council provided suitable space at their premises for organizing satellite clinics.

A package of essential services (same package of HNPSP) is being provided to the street dwellers from the clinics at the evening time when the street dwellers are returning from work. All the components of primary health care are included as the components of essential services, with special focus on general health, reproductive and maternal health, child health, environmental issues, and health education and the service provision are free of cost. Services are being provided to the street dwellers who slept for last one week in the study areas. Patient cards are provided to all the clients so that it becomes easy to keep track in the subsequent visits.

For ensuring quality of services the paramedics were trained by the experts from the primary healthcare programme of MOHFW, Marie Stopes Clinic Society (MSCS) and ICDDR,B following the essential services delivery (ESD) protocol.  As the street dwellers are extremely vulnerable groups, special focus were given during training of the paramedics so that they become non-judgmental in providing services to the street dwellers. The paramedics were also oriented on their attitude and motivational aspects for dealing with street dwellers. The activities of the clinics and service providers are being monitored and supervised by study investigators using standard checklist.

The drug sellers of local pharmacies are being utilized to inform street dwellers about availability of services for them through the clinics. Name and addresses of the clinics and type of services available in the two types of clinics have been provided to the drug sellers of the local pharmacies. They are being motivated to inform the street dwellers about availability of services in the clinics and also to motivate the street dwellers to go to the clinics for services. A well decorated rickshaw van is being used for carrying clinic staff and materials and for publicity purposes.

A system of referral linkage has been established from these clinics to nearer health facilities of MSCS, UPHCP and MOHFW. The paramedics refer the cases to these referral points and follow up is being done by a project staff on the cases to know what happened after referral.

Since the beginning of the project, there has been surprisingly a strong demand for services: 45 to 50 patients use the services each day, somehow more than half of the patients are women. The main complains of the patients visiting the clinics included:  general health, STI/RTI, ANC, PNC, family planning methods, ARI, diarrhoea, dysentery and immunization.

In order to review and monitor the project activities and to start process about its sustainability a Project Management Committee (PMC) has been formed. The committee consists of the members from Directorate General of Health Services, Dhaka City Corporation, UPHCP, GTZ, Plan International, MSCS, Sajeda Foundation and ICDDR,B. The committee met twice and reviewed the performance of the project activities. Last PMC meeting decided that the committee will meet quarterly to review performance of the project and to guide the project implementation team.

The static and satellite clinics will be compared to each other in terms of their cost and effectiveness. This comparison will enable us to identify the model of choice-which is financially most affordable and programmatically most effective.

It is expected that after implementation of this 18 months project will develop a mechanism to provide essential healthcare services to urban street dwellers in Bangladesh.

Source – http://www.icddrb.org/news_detail.cfm?ID=419

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