The roles of water, sanitation and hygiene in reducing schistosomiasis: a review. Parasites & Vectors (2015) 8:156.
Jack ET Grimes, et al.
We recently completed a systematic review andmeta-analysis pertaining to WASH and schistosomiasis and found that people with safe water and adequate sanitationhave significantly lower odds of a Schistosoma infection. Importantly though, the transmission of schistosomiasis isdeeply entrenched in social-ecological systems, and hence is governed by setting-specific cultural and environmentalfactors that determine human behaviour and snail populations. Here, we provide a comprehensive review of theliterature, which explores the transmission routes of schistosomes, particularly focussing on how these might bedisrupted with WASH-related technologies and human behaviour. Additionally, future research directions in thisarea are highlighted.
Trends in Causes of Adult Deaths among the Urban Poor: Evidence from Nairobi Urban Health and Demographic Surveillance System, 2003–2012. Journal of Urban Health, March 2015.
Authors: Blessing Mberu, Marylene Wamukoya, Samuel Oti, and Catherine Kyobutung
In this paper, we examine the trends in the causes of death among the urban poor in two informal settlements in Nairobi by applying the InterVA-4 software to verbal autopsy data. Over the 10-year period, the three major causes of death are tuberculosis (TB), injuries, and HIV/AIDS, accounting for 26.9, 20.9, and 17.3 % of all deaths, respectively. In 2003, HIV/AIDS was the highest cause of death followed by TB and then injuries. However, by 2012, TB and injuries had overtaken HIV/AIDS as the major causes of death. When this is examined by gender, HIV/AIDS was consistently higher for women than men across all the years generally by a ratio of 2 to 1. In terms of TB, it was more evenly distributed across the years for both males and females. We find that there is significant gender variation in deaths linked to injuries, with male deaths being higher than female deaths by a ratio of about 4 to 1. Emerging at this stage is evidence that HIV/AIDS, TB, injuries, and cardiovascular disease are linked to approximately 73 % of all adult deaths among the urban poor in Nairobi slums of Korogocho and Viwandani in the last 10 years. While mortality related to HIV/AIDS is generally declining, we see an increasing proportion of deaths due to TB, injuries, and cardiovascular diseases. In sum, substantial epidemiological transition is ongoing in this local context, with deaths linked to communicable diseases declining from 66 % in 2003 to 53 % in 2012, while deaths due to noncommunicable causes experienced a four-fold increase from 5 % in 2003 to 21.3 % in 2012, together with another two-fold increase in deaths due to external causes (injuries) from 11 % in 2003 to 22 % in 2012. It is important to also underscore the gender dimensions of the epidemiological transition clearly visible in the mix. Finally, the elevated levels of disadvantage of slum dwellers in our analysis relative to other population subgroups in Kenya continue to demonstrate appreciable deterioration of key urban health and social indicators, highlighting the need for a deliberate strategic focus on the health needs of the urban poor in policy and program efforts toward achieving international goals and national health and development targets.
Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh. Health Policy Plan. (2015) 30 (suppl 1): i32-i45. doi: 10.1093/heapol/czu094.
Authors: Alayne M Adams, Rubana Islam and Tanvir Ahmed
In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside.
Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%.
Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5–6 days/week, but close by 4–5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor.
Sharing reflections on inclusive sanitation. Environment & Urbanization, Feb 2015.
Authors: Evans Banana, Patrick Chikoti, Chisomo Harawa, Gordon Mcgranahan, Diana Mitlin, Stella Stephen, Noah Schermbrucker, Farirai Shumba, Anna Walnycki
This paper draws on sanitation innovations in Blantyre (Malawi), Chinhoyi (Zimbabwe), Dar es Salaam (Tanzania) and Kitwe (Zambia) driven by slum(1)/shack dweller federations to consider what an inclusive approach to sanitation would involve. This includes what is possible for low-income households when there is little or no external support, no piped water supply and no city sewers to connect to.
The paper discusses low-income households’ choices in situations where households can only afford US$ 3–4 per month for sanitation (for instance between communal, shared and household provision). It also considers the routes to both spatial and social inclusion (including the role of loan finance in the four cities) and its political underpinnings. In each of the four cities, the community engagement in sanitation intended from the outset to get the engagement and support of local authorities for city-wide sanitation provision.
Co-producing inclusive city-wide sanitation strategies: lessons from Chinhoyi, Zimbabwe. Environment & Urbanization, Mar 2015.
Authors: Evans Banana, Beth Chitekwe-Biti, Anna Walnycki
This paper explores how communities in Chinhoyi, Zimbabwe have used community-led mapping and enumerations(1) to build partnerships with local government to support the development and co-production of innovative pro-poor city-wide sanitation strategies as part of the SHARE City-Wide Sanitation Project. This action research project is being conducted in four cities across sub-Saharan Africa: Chinhoyi (Zimbabwe), Kitwe (Zambia), Blantyre (Malawi) and Dar es Salaam (Tanzania).
This programme of work responds to the failure of conventional approaches to urban sanitation to meet the needs of low-income urban communities in sub-Saharan Africa. Over three years it has supported Shack/Slum Dwellers International affiliates to develop and test pro-poor sanitation strategies that can be adopted and driven by networks of community organizations and residents’ associations, and supported by public authorities and private providers.
Gender-Responsive Sanitation Solutions in Urban India, 2015.
Authors: Miriam Hartmann, Suneeta Krishnan, Brent Rowe, Anushah Hossain, and Myles Elledge. RTI International.
In this research brief, we provide an overview of recent literature on women and sanitation in urban India. In particular, we consider possible improvements to the design and location of toilet facilities based on articulated needs and current solutions. We also highlight the need for further research evaluating the potential benefits of female-targeted interventions for women and their communities.
The issues we consider are context specific, because women’s preferences vary across caste, religion, and region. Furthermore, the improvements we discuss respond primarily to existing gender norms. Broader efforts are needed to transform gender norms and meet the dual goals of higher sanitation adoption and better outcomes for women.
Urbanisation, the Peri-urban Growth and Zoonotic Disease. IDS Practice Paper in Brief, Feb 2015.
Author: L. Waldman.
Ebola has had significant, negative effects in the rapidly expanding, unregulated areas of peri-urban and urban West Africa. The residents of these areas maintain vital connections with rural populations while intermingling with and living in close proximity to urban and elite populations. These interconnections fuel the spread of Ebola. The degradation of natural resources, temporary housing, inadequate water supplies, hazardous conditions and dense concentrations of people in peri-urban areas exacerbate the potential for zoonotic disease spread.
Yet the peri-urban remains largely unacknowledged and under addressed in development. In considering the intersections between Ebola, peri-urban settlements and urbanisation, we must recognise that: basic hygiene and isolation of the sick are frequently impossible; disease control through quarantine often ignores poor people’s patterns of movement and immediate
material needs; quarantine can reinforce the political exclusion of peri-urban residents; and there exists the potential for future zoonotic disease emergence in peri-urban contexts.
Development must acknowledge these ever-burgeoning settlements and address the ability of the poor to live safely. This
includes the provision of decent hygiene and sanitation, context-appropriate forms of disease containment, the recognition of the peri-urban poor as legitimate citizens, and improved understandings of human/animal interactions.
Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania. Int. J. Environ. Res. Public Health, Feb 2015.
Authors: Marion W. Jenkins, Oliver Cumming and Sandy Cairncross
Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar), Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines.
A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like ‘flooding out’. We measured strong interest in and willingness to pay (WTP) for the new pit emptying service at 96% of residences; 57% were WTP ≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed.
Editorial – Urban health post-2015. Lancet, Feb 28, 2015.
An excerpt: There are three opportunities to address urban health post-2015. First, governments committed to improving urban health must prioritise equitable access and adapted delivery of health and related services to the urban poor— including to non-legal residents. Slum dwellers make up the informal employment sector of cities, and are often not present in slums during regular clinic hours. Health services must adapt delivery to reach them.
Correspondence: Urban health in the post-2015 agenda
Authors: Shamim Talukderemail, Anthony Capon, Dhiraj Nath, Anthony Kolb, Selmin Jahan, Jo Boufford
An excerpt: The transformative approach stated in the post-2015 development agenda necessitates innovative and strong partnerships between civil society and private sectors, institutions that can work in an integrated manner, transfer of technology, capacity building, and greater attention than previously given to information access, monitoring, and reporting for accountability. A worldwide shared ambition should be to bring health to the centre of sustainable urban development.
Urban WASH in Emergencies, 2014.
From the 24 – 28 March 2014, RedR held a pilot course for 24 WASH experts on the subject of addressing the social, institutional and technical gaps that currently exist for water, sanitation and hygiene provision in the urban emergency context. This document, produced as a partnership between ALNAP and RedR, captures the key messages, lessons and experiences of both course facilitators and participants on the topic of WASH in urban emergency response.
Many specific lessons for the WASH sector in the urban context can be drawn from this discussion, including:
• Solid waste management can be of particular importance and there are multiple new technologies that can assist in this sector. • Vector control is more complex but just as essential in the urban environment, especially when considering dengue fever, which is on the rise across the developing world and particularly a threat to urban populations.
• Hygiene promotion remains a critical part of the WASH response but is potentially far more complicated, owing to the diverse target groups in urban settings. Schools are a particular asset for hygiene promotion.
• Diverse target groups may also mean a more responsive and greater range of WASH options may be needed to ensure effective service provision.
A recurring lesson from this discussion has been the emphasis on the interconnected and dynamic nature of the urban setting, and how this challenges ‘silo’-based, sector-structured responses. Recognising this characteristic, many lessons have wider applicability for humanitarian response more generally. Vector control, solid waste management and drainage are key examples of where success or failure in one area could greatly determine results in other sectors. These specialist and technical areas also clearly demonstrate the need for humanitarian agencies to ‘ know their limits and utilise external expertise – including potentially the private sector
