pakistanKARACHI: Viral diarrhoea has gripped the city’s second largest slum settlement, Machhar Colony and children are falling victim to this deadly disease.

The reasons for this outbreak include a lack of proper sanitation system, a huge open drain running in the centre of the colony and absence of clean potable water.

The health experts working in the colony have declared this an emergency situation and said if the government does not take any immediate safety measures, the condition could worsen. They also warned that the disease might spread in other parts of the city.

“Since last week, diarrhoea has become epidemic in the colony and children are dying,” said Dr Aisha Siddique, a young lady doctor at Mother and Child Heath Centre, which is run by a non profit and non government organisation Concern for Children Trust (CFC). She said that she receives 60 patients everyday, but since the spread of diarrhoea, the majority of the patients visiting the centre are children.

“A child in almost every home is suffering from diarrhoea in this colony, which has a population of about 0.7 million,” said Dr Siddique. She said that there are about 72 clinics working in different areas of the colony and almost every clinic is receiving large numbers of children with viral diarrhoea.

Located in the backwaters of Karachi Port, just off the edges of the Arabian Sea, Machhar Colony is the second largest slum settlement after Orangi Pilot Project and is home to approximately 0.7 million people of different ethnic backgrounds and nationalities including Biharis, Burmese, Bangladeshis, and Afghans. As the colony is illegal on government records, therefore it is suffering from a lack of basic facilities such as clean drinking water and proper sanitation.

“There is no water supply system in the colony, therefore the people get water from other localities through a network of plastic pipes, and you can see these pipes are spread amongst the garbage on the surface of the main sewerage drain passing from the middle of the colony, Dr Siddique explained. “Sometimes when the garbage catches fire, these pipes are burnt resulting in sewerage water getting mixed with drinking water causing the spread of diseases” She said that the practice is common in the colony, but the reasons for the diarrhoeal disease as well as its spread need to be ascertained through a study.

Official data from different international organisations reveals that in Pakistan, 38.5 million people lack accesses to safe drinking water, and 50.7 million lack access to improved sanitation, due to which 25 percent of the total hospital beds in Pakistan are occupied by the people suffering from waterborne diseases.

The study further reveals that diarrhoea is the leading cause of mortality and second leading cause of morbidity among children under five years of age.

“Due to poverty, there is almost one patient of tuberculosis in every house in the colony, besides this typhoid fever, viral fever and other diseases are also common, but this recent diarrhoeal epidemic could be very fatal if certain measures are not taken,” said Dr Siddique.

Source – Daily Times

The USAID Hygiene Improvement Project has prepared a “Water, Sanitation, and Hygiene Improvement Training Package for the Prevention of Diarrheal Disease” which provides information for organizations worldwide that seek to add WASH activities to their current programs or to start a diarrhea reduction program. It is intended to support the training of local outreach workers and their work in communities to promote improved WASH practices to reduce diarrhea.

The Training Package consists of three separate parts:

(1) a step-by-step “Guide for Training Outreach Workers,”

(2) an “Outreach Worker’s Handbook” for community outreach workers to use during and after training, and

(3) a “Collection of Resource Materials” to use as a source for visual aids.

This WASH training package is available on CD and online at http://www.hip.watsan.net/page/3396.

To request free copies of the CD send an e-mail to hip@aed.org.

Experts meet to fine-tune insurance for the deprived

New Delhi – The Capital’s urban poor will soon be able to afford healthcare up to Rs 1.5 lakh without paying a paisa. Set up as a registered society, the Delhi Sanjeevni Trust met for the first time on Wednesday to work out the finer details of the programme.

The ambitious insurance scheme aims to enroll the entire city’s population — starting with BPL families — within the next six months.

To put together the best health insurance scheme for people from the Economically Weaker Sections, public health experts from all spheres have been brought together as trustees of the Board. They include specialists like Dr Srinath Reddy, President of Public Health Foundation of India, Dr Ajit Nagpal, Chairman of Batra Hospital, Som Mittal, President of The National Association of Software and Service Companies and Dr Shyama Nagarajan, health specialist with the World Bank.

“This is a welcome initiative from the Delhi government, which is trying to ensure that economic barriers do not distance people from the essential healthcare,” said Reddy.

“The objective is to facilitate universal healthcare though third party financing mechanism,” said Dr Nagpal. “We are aiming to provide insurance for the city’s population but will be starting with the BPL families first.”

The health department is currently working on a Cabinet note, which will be tabled at the forthcoming Cabinet meeting.

The trust — headed by a chief executive officer — is modelled on the Rajiv Arogyashri Health Insurance Scheme run by the Andhra Pradesh government. Under it, the BPL beneficiaries can be treated at hospitals without making any payment there for procedures covered under the scheme. The same is the case for diagnostics, if eventually the patient does not need surgery or therapy. Plus, the hospitals have to conduct at least one free medical camp a month, taking advanced evaluation to the doorstep of patient.

The Delhi government’s ambitious project to provide low-cost healthcare was put on hold in 2005 and 2007.

Source – Express India, Nov. 5, 2009

Am J Trop Med Hyg. 2009 Nov;81(5):770-5.

Seasonal pattern of pneumonia mortality among under-five children in Nairobi’s informal settlements.

Ye Y, Zulu E, Mutisya M, Orindi B, Emina J, Kyobutungi C. African Population and Health Research CenterAPHRC, Nairobi, Kenya. yyazoume@aphrc.org

Using longitudinal data from the Nairobi Urban and Demographic Surveillance System (NUHDSS), we examined the seasonal pattern of pneumonia mortality among under-five children living in Nairobi’s slums. We included 17,787 under-five children resident in the NUHDSS from January 1, 2003 to December 31, 2005 in the analysis. Four hundred thirty-six deaths were observed and cause of death was ascertained by verbal autopsy for 377 of these deaths. Using Poisson regression, we modeled the quarterly mortality risk for pneumonia. The overall person-years (PYs) were 21,804 giving a mortality rate of 20.1 per 1,000 PYs in the study population.

Pneumonia was the leading cause of death contributing 25.7% of the total deaths. Pneumonia mortality was highest in the second quarter (risk ratio [RR] = 2.3, confidence interval [CI]: 1.2-4.2 compared with the fourth quarter). The study provides evidence that pneumonia-related mortality among under-fives in Nairobi’s slums is higher from April to June corresponding to the rainy season and the beginning of the cold season.

Trop Med Int Health. 2009 Nov 2.

Is mortality among under-five children in Nairobi slums seasonal?

Mutisya M, Orindi B, Emina J, Zulu E, Ye Y. African Population and Health Research Center, Nairobi, Kenya.

Objective: To investigate the seasonal pattern of overall mortality among children aged below 5 years living in two informal settlements in Nairobi City.

Methods: We used data collected from January 2003 to December 2005 in the Nairobi Urban Health and Demographic Surveillance System on demographic events (birth, death, and migration). Analyses of seasonal effects on under-five mortality are based on Poisson regression controlling for sex, age, study site and calendar year.

Results: During the study period, there were 17 878 children below 5 years in the study sites. Overall 436 under-five deaths were recorded. The overall death rate for the under-five children was 19.95 per 1 000 person years. There is a significant seasonal variation of under-five mortality. The mortality risk was significantly higher in the second and third quarters of year than in the fourth quarter (RR = 1.6, CI: 1.3-2.2 and RR = 1.5, CI: 1.1-2.0).

Conclusion: This paper demonstrates that overall mortality among under-five children in the urban poor is seasonal. Overall during the second quarter of the year, the death rate increases by nearly twofold. This evidence generated here may help to support well targeted interventions in reducing under-five mortality in the slums.

Needy Kenyans will soon get a monthly income to meet their basic needs in a programme similar to those carried out in welfare states.

However, before the programme dubbed Saidia Jamii (help the family) is rolled out, the government will first disburse Sh600 million to a group of vulnerable people living in the slums as a test project.

“The outcome of the pilot programme will inform the roll-out of Saidia Jamii programme in July 2010, Prime Minister Raila Odinga told journalists Wednesday at his Treasury office after receiving an interim report of a task force formed to come up with a food subsidy scheme to cushion the poor from increasing food prices and effects of famine.

The pilot programme, he said, will be implemented in three phases by the government and its development partners.

In the first phase, a group of 100,000 people drawn from 20,000 households in Mathare, Korogocho, Mukuru and Kibera slums in Nairobi will benefit.

“Each household will be receiving Sh1,500 per month delivered through mobile phone transfer and electronic card system,” the PM said.

The phase is expected to end in June next year.

The second phase of the programme, which will also end in June, Mr Odinga said, will be extended to Kisumu and Mombasa. This will be in the month of March next year.

In the two towns another 100 people, he added, will benefit before it extended to other parts of the country.

Beneficiaries of the project will be identified through community participation, said the PM.

The taskforce was formed in response to escalating food prices, which some of the poor cannot afford.

The entire Saidia Jamii programme, which the taskforce has developed, is aimed at protecting the vulnerable and poor households in urban and rural areas from the negative impacts of food insecurity.

Mr Odinga said the report will first be adopted by the Cabinet before it is taken to Parliament for debate.

If approved by Parliament, it will become law.

The Premier said that through the report, the government has emphasised its commitment to solving poverty across the country.

“A lot of emphasis has been put in the past to the rural poor, but we know that many Kenyans out there have difficulties in making ends meet. The urban poor, for instance, get seriously affected by fluctuations of food prices and need assistance,” Mr Odinga said.

He gave assurances that the programme would succeed.

The task force members, in their report, say that the government and its partners will first set up internal administrative mechanisms to deliver cash to the beneficiaries.

They will also test the design and implementation of a cash-transfer programme.

The programme will be evaluated, the report continues to say during a mid-term review planned for March next year.

Mr Odinga, however, pointed out that out of the Sh600 million 30 per cent of it will be used on administration.

Apart from the task force members, others present during the press briefing were ministers Dr Naomi Shaban (Special Programmes) and her Planning counterpart Wycliffe Oparanya.

Finance assistant minister Dr Oburu Oginga was also present as well as permanent secretaries Prof Karega Mutahi (Education) and Dr James Nyikal (Gender).

Source – Daily Nation, Nov. 4, 2009

Incrementalism in Addressing Challenges of Slums: Lessons from Urban Health Practice in India: Key Note Address, International Conference on Urban Health, October, 23, 2009.

Siddharth Agarwal, Urban Health Resource Centre (UHRC), India.

Link to presentaton – http://uhrc.in/name-CmodsDownload-index-req-getit-lid-124.html

The backyard dwellers of Cape Town rise up, By louise.cobbett

Something extraordinary is happening in the backyard shacks of Cape Town. Backyarders — people who live in back yards — are not only organizing themselves but are working together with shack dweller or informal settlement dweller organizations to gather information and propose joint citywide solutions to the city authorities. Here is a sneak-preview of the findings and the social political implications of the self-surveying exercise currently underway in the quintessential Cape Flats neighbourhood of Manenberg.

It is commonly acknowledged that those living in informal settlements are socially excluded and are in need of more interventions from Government, but the plight of the Backyard Dwellers in Cape Town is often forgotten entirely. They are neither heard nor seen by the broader Cape Town citizenry or even by the powers that be. Hidden behind vibo-crete walls and formal houses the shocking conditions that they have to endure remain virtually invisible. There are often as many as 3 families squeezed into a single backyard – with each family of about 4 members living in a shack that is no bigger than 3×6m. This is considerably smaller than the average shack in an informal settlement.. It is common to find much larger families in those same dimensions; in one case there were 11 individuals in one house, or Wendy house as they are often called.

These families are often female-headed households who find employment in the casual labour sector; specifically the factories that tend to surround these areas. This specific family would take turns sleeping through the night because there is not enough physical space for them all to sleep at the same time.

Problems facing the communities

When asked what the biggest problem facing the Backyarders, the response most commonly given was that of landlord-tenant relations. The landlords are the legal tenants of the housing provided by the local councils. It is common for the landlords to charge each family around R400 per month but there are instances of landlords charging as much as R700 per month. On top of this the Backyarders have to pay for electricity which amounts to an additional R160 per month. The landlords themselves are only required to pay R250 to the council for their houses, and a reoccurring problem is that they do not pay their rent. The council is often reluctant to evict for lack of payment, but are well aware of the business of the Backyard Dwellers. The council can only deal with the legal tenant, which therefore means the Backyarders have no voice in the council.

In addition to charging extortionate rent, the landlords also control the access between the street and the backyard. This means that should the tenant and the landlord have a disagreement over rent or access to the toilet which is normally in the main house, the landlord can stop people coming to see the tenant or refuse to allow the tenant to leave the property. Children are often forced to climb over fences to get out in order to go to school.

As the government builds new houses for the urban poor, the Backyarders are sidelined in favour of those in the informal settlements. This is mostly because the informal settlements are so visible both in terms of where they are and the numbers of dwellers. The Backyarders are hidden behind houses, and are not seen by the general public. Driving down the N2 from Cape Town’s international airport, which is lined by informal settlements, it becomes clear why politician’s efforts are focus on that rather on the far less visible Backyarders. Therefore there is no surprise that this causes feelings of resentment and animosity between the Backyarders and those from the informal settlements. The Backyarders tend to be native to the Western Cape and have been waiting longer than most for new housing. As they see it, they have been waiting patiently on the government’s waiting list, but those who start informal settlements are housed first.

So why stay as a Backyarder instead of moving to an informal settlement? One of the main reasons for staying is community. Many of these Backyard communities have been around for more than 20 years and have developed strong communal. Families tend to move within the community rather than away from it, and there is a sense of pride attached to their areas. Moving into the informal settlements would break these well-maintained bonds.

Other reasons for staying as a Backyarder include health and security. Although they do not have direct access to toilets, the Backyarders are in a better position in comparison with those people who live in the informal settlements. The housing set-up amongst the Backyarders provides a level of safety that cannot be replicated by the informal settlements. Because there is limited access to the Wendy houses, it means the families are a little safer. However, the crime rate in these areas cannot be understated.

The Western Cape areas where Backyarder houses are found such Mitchell’s Plain and Manenberg are rife with serious crime problems. There are significant problems with gang culture and the gangs are commonly thought of as the main perpetrators of the murders, rapes, assault and robbery in the areas. The communities feel that there is a direct and irrefutable link between the lack of houses and the crime rates. Adolescent youth, particularly boys, are drawn into the life of drug dealing and violent crime because of poor schooling and the lack of opportunities available to them. The final push can often come in the form of their living conditions, when the landlords refuse to allow families access to toilets or water. In contrast the council houses that have been taken over by the gangs become an attractive and seemingly viable alternative.

The creation of more housing would curb the crime rate because as the developments expand, with it comes increased infrastructure. As it currently stands, the majority of crimes happen in the open fields surrounding the communities, where it is dark and provides cover for the gangs. Members of the community are forced to move across these open plains in order to go to work and reach the main streets to reach public transport. By decreasing the amount of dark open plains with an increase of housing and infrastructure, not only will there be more housing opportunities but there will be less chance for gang culture to operate. Whilst this is not a silver bullet in terms of crime prevention, it does offer a way in which people could make themselves less vulnerable to crime.

An Organised Community

The problems facing the communities are undeniably complex and cannot be belittled, however they are not insurmountable. In the past the Backyarders have not really had an organization that champions their cause. Whatever voice they might have had was weakened by the utter lack of support from the ward councilors. Any member of the community can run for the position of ward councilor. Of course when they contest the position the candidates always highlight the problems of the community and promise solutions. This assurance that there will be material improvement is short lived, as it is all too common for the ward councilors to fail to deliver any real changes. Once they get absorbed into the system, they rarely come back to their roots. In short, the current ‘bottom-up’ system isn’t working. As soon as they are elected, the ties to the community are severed. With the governmental position comes the governmental paycheck, so ward councilors actually leave the area they are meant to be fighting for. As a result the community has been forced to fill the supportive role, and there are well-established members who are doing more for their community than their ward councilors.

In Manenberg, there is a group of women who work tirelessly to try better the situation of the community as a whole. They have now undertaken a community enumeration so they will have detailed information about the communities in which they live. It is also an opportunity for them to mobilize their neighbours. The enumerations allow the communities to own their information. It also means the community becomes aware of what their rights are, what services are available to them, and how to access them. A natural byproduct of the enumerations is increased participation and interest in the community by it’s members, and this significantly increases the possibilities for real delivery to happen.

This unified voice is vital when entering into negotiations with the City of Cape Town. The community of Manenberg has a good relationship with the City because of all the contact that they have had over the years – since they have been doing the job of the ward councilors.

In August of this year, there was a housing policy review that was undertaken without consulting the Backyarder communities. The change in policy has changed the criteria for those who qualify for houses. If an individual makes under R3500 per month, they then qualify for housing. This has meant that younger adults are being housed before the elders. When the older generation started their jobs, they joined the waiting lists, and as time continued, their wages went up. The policy does not take this into consideration, so the older members, who have families and therefore more dependents on their wages are technically making more money than the younger 20 year olds who tend to be the sole recipient of their wages who are being housed first. This also makes a mockery of the waiting lists. The older families have been on the waiting list for up to 20 plus years are not being housed in light of this shift.

All of this highlights the importance of the organization of the community. But one community on its own can never be as effective as networks or agglomerations of communities sharing the same or similar interests. As the community organizations in Manenberg arm themselves with the enumeration they will be looking for outside organizations to provide support.

Organisations supporting the Backyarders

The communities of these areas are coming together to work with the Community Organization Resource Centre (CORC) and the Federation of the Urban Poor (FEDUP), which is an affiliate of Slum/Shack Dwellers International. FEDUP mobilizes urban poor communities through savings. It has over 700 affiliates in informal settlements and urban poor neighbourhoods in cities and towns in all nine provinces. FEDUP has been able to secure tenure for more than 25,000 families and has facilitated the creation of grassroots housing associations that have constructed over 15,000 formal houses.

FEDUP seeks to engage state and private institutions in order to find people-centred solutions to challenges of land tenure, infrastructure and housing. This strategy has paid dividends with the National Department of Housing having pledged an annual allocation of 9000 capital subsidies to the Federation. FEDUP also partners the National Ministry in a Joint Working Group that meets regularly to monitor the progress of this agreement.

These alliances with different organizations allow the communities to learn from one another and see what is possible through organization and a unified voice. Once the communities have confidence in what they are doing, they are able to address the local government with their concerns and challenge the government to meet them half way.

Source – http://www.thecommentfactory.com/the-backyard-dwellers-of-cape-town-rise-up-2401

Risk Anal. 2009 Oct 29

Threshold Conditions for the Persistence of Plague Transmission in Urban Rats.

Durham DP, Casman EA. Department of Engineering & Public Policy, Carnegie Mellon University, Pittsburgh, PA 15232, USA.

In this article we derive a mathematical expression characterizing the tendency for Yersinia pestis, the etiologic agent of plague, to become established in an urban rat population upon introduction, and evaluate this risk for several cities. The expression gives a threshold condition for the persistence of Y. pestis transmission in terms of measurable attributes of a local urban rat population: the average flea density and the rat colony size. If the local rat and flea populations exceed this threshold, plague circulation is predicted to continue; if not, it will burn out of its own accord. This expression may be used to evaluate both the vulnerability of a specific neighborhood and the effect of pest control strategies upon that vulnerability.

Use of ash and mud for handwashing in low income communities. 2009. (pdf, 480KB) Professor Sally F. Bloomfield; Professor Kumar Jyoti Nath. International Scientific Forum on Home Hygiene (IFH).

Epidemiological and microbiological data show that, in low income communities, as elsewhere, handwashing is particularly important in reducing the burden of infectious and parasitic diseases. These data also suggest that the efficacy of the handwashing process itself has a significant impact on the risk of disease transmission. A key factor is the extent to which pathogens are detached from the skin surface, by rubbing with appropriate materials prior to rinsing. In low income communities in developing countries, soil, mud or ash are still frequently used as an alternative to soap.

In using mud, soil or ash as an alternative to soap, it is important to weigh the potential benefits, against the fact that these materials can become contaminated with pathogens and helminths, and can themselves act as a vehicle and source of gastrointestinal, parasitic and other infections. These materials can also contain potential toxic heavy metals such as arsenic, lead and chromium, as well as pesticides.

The objective of this review is to bring together the available scientific data on the benefits and potential risks of using mud, soil and ash, as against soap, as against water only, for handwashing, and evaluate the factors which inform choice of the most appropriate agent in relation to the needs and constraints in different communities. The review was prepared by Professor Sally Bloomfield and Professor KJ Nath. The report was peer reviewed by Dr Stephen Luby (International Centre for Diarrhoeal Diseases Research, Bangladesh) and Dr Bilqis Hoque (Environment and Population Research Centre, Bangladesh).