DAKAR, 26 January 2009 (IRIN) – As international agencies respond to the emergence of the deadly yellow fever virus in Guinea, experts say they are increasingly concerned about a rise in outbreaks across Africa.

Africa saw 13 yellow fever outbreaks in 2008, as opposed to an average two to five per year in recent years, according to Sergio Yactayo, adviser on the World Health Organization’s (WHO) yellow fever prevention team in Geneva.

There have been four outbreaks in sub-Saharan Africa since December 2008 – in Cameroon, Central African Republic, Guinea and Sierra Leone, according to Yactayo.

“We have never had so many outbreaks in such a short period as we have now. We are very worried there could be more on the way,” Yactayo told IRIN. “We must prepare for that.”

Yellow fever is a viral haemorrhagic fever transmitted by mosquitoes. The vast majority of cases and deaths take place in sub-Saharan Africa, with 32 African countries considered to be “at risk.”

West Africa is the continent’s most-affected region, with 72 percent of the region experiencing outbreaks since 2000, according to WHO.

The fight

Agencies including WHO, the UN Children’s Fund (UNICEF), NGOs such as Médecins Sans Frontières and the International Federation of the Red Cross, and health ministries are working to control the disease in West Africa through the Yellow Fever Initiative. They plan to vaccinate 49 million people in 12 yellow fever-endemic countries by 2010 — Benin, Burkina Faso, Cameroon, Cote d’Ivoire, Ghana, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone and Togo.

To date, vaccinations have been completed in Burkina Faso, Mali, Senegal and Togo and Cameroon is next up, according to Yactayo.

Why the rise

The reasons for the explosion are unclear but WHO’s Yactayo said it could be linked to climate change, which in some settings can expand breeding grounds for mosquitoes.

Growing urban populations in West and Central Africa – many of them with no access to clean drinking water or sanitation facilities – also pose an increased risk, according to WHO.

“Increased virus circulation among insufficiently immunized populations in combination with the region’s rampant urbanization set the scene for an explosion of urban epidemics,” WHO reports on its website.

Urban populations in Africa are growing at 4 percent per year – the most rapid pace in the world, according to WHO.

Guinea outbreak

Following confirmation of two cases of the yellow fever virus in Faranah, central Guinea, international agencies on 26 January launched a mass vaccination campaign.

The campaign follows an emergency response in Sierra Leone that targeted over half a million people in Bo District.

Agencies including WHO and UNICEF, alongside NGOs, the Guinean Ministry of Health and the Global Alliance for Vaccines and Immunization network aim to vaccinate 60,485 people, or 36 percent of Faranah’s population, over the next week.

The campaign will target only those not covered in a 2003 vaccination campaign, and will focus on high-risk areas such as markets and on vulnerable groups including children aged 9 months to six years, Yactayo said.

He said that in some pockets of Faranah just half of the population was covered in the 2003 campaign. “This is often the case, because people may be ill, they may not show up, or they may be away at the time, so you can rarely vaccinate everyone,” he said.

Source – IRIN Africa

BANGLADESH is considered highly vulnerable climate change and climate variability. Various predictions of sea level rise puts 55% of its population on the threat of inundation. It will affect infrastructures including water systems, housing and settlements, transport networks, utilities, and industry. In recent years the recurrence of natural disasters has increased the vulnerability of the urban poor who are considered to be most affected by climate change and climate variability. The prevalence of diseases will increase their vulnerability and constrain economic activities.

Urban poverty in Bangladesh is evident in all the towns and cities. It is estimated that 43% of urban households live below the poverty line among which 23% are considered extreme poor. Around 35% of the population of six major cities live in slums which cover only 4% of their land area with limited or no access to services. Fighting poverty in urban area requires a multi faceted approach of economic, social, cultural, political as well as physical agenda. The development practitioners and designers of built environment, working to improve the condition of the urban poor, now face new challenge to accommodate issues arising from climate change and climate variability.

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Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso

Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas.

Methods: The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso.

Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected.

Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas.

Results: Overall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou.

Conclusion: Malaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network.

Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.

Author: Meili Baragatti, Florence Fournet, Marie-Claire Henry, Serge Assi, Herman Ouedraogo, Christophe Rogier and Gerard Salem, Credits/Source: Malaria Journal 2009, 8:13.

From – 7th Space.com

Water (never) for all

Sri Wahyu Safitri, a primary school teacher who lives in Marunda, near North Jakarta’s coast, never feels clean, even after a bath.

“My skin always feels sticky — as if there is a layer of something on it — even after bathing. Perhaps it is because the water is already contaminated by salt water and the industrial waste around here so the substances stick on me,” she said.

Like many in the area, she gets water for her daily activities primarily from shallow groundwater wells, affected by saltwater intrusion. She has little choice as most coastal areas still have no access to piped water.

“It is not unusual to find students absent because of diarrhea. It can be from the food they take or from the water they drink.”

Jakarta’s centralized water supply is over 100 years but piped water does not to reach everyone, most notably the poor.

Why? One of the reasons is because it was never designed to reach all, Michelle Kooy, a Canadian researcher, told The Jakarta Post.

Michelle has spent three years researching Jakarta’s water supply from documents and field work. This report is based on her research and interviews with her.

“During the Dutch era it was for the Dutch people. During the Sukarno period, it is for the new rich so they could show the modern Indonesia. During the Soeharto period, water service was meant to serve economic growth rather than social fairness. Universal coverage has never been the goal,” Michelle said.

Jakarta’s water supply began with seven artesian wells in the 1870s. Before that, all the city’s residents — then called Batavia — relied on river water and shallow groundwater, using different purification methods.

However, the growing European studies linking cholera with water consumption — coupled with the sense of European cultural superiority — created a demand for an urban water supply system that would provide superior water quality to select citizens — the Europeans.

The supply went to their residences located near the now Monument National, to the north toward the Old Town and to the south toward Menteng area.

“The city’s first water supply infrastructure facilitated the desired division between races (European versus native) and the urban area residences (European suburbs and well-planned residential areas versus the villages),” Michelle wrote.

Between 1910 and 1920, long after the 1901 Ethical Policy, four hydrants were installed for the indigenous urban population of over 116,740 residents.

The hydrants were located near the European residential and commercial areas, ignoring the north area where the need was great due to floods and poor groundwater quality.

During that period, some 60,000 native residents died in one year due to cholera and typhus pandemics.

In the 1920s, the city began using spring water from Bogor. This time, other urban populations received their share, albeit at a higher price and at a lower allocation.

“Design criteria explicitly stated a production capacity that could serve 90 percent of the European households with 140 liters/capita/day, 60 percent of Chinese and Foreign Easterner households with 100 liters and 30 percent of native households with 65,” Michelle wrote.

The Dutch council also decided to give free hydrant water to the locals, but not for long.

They were losing money and began charging local water vendors. When it reached the customers, the price was double what the piped water users paid. As expected, the consumers fell back to their former ways of obtaining water.

In a six-year span, from 1924 to 1930, the amount of money the municipality spent to supply water to hydrants had decreased by 95 percent.

The supply system was destroyed during the war for independence. It was rebuilt in the early 1950s, with the construction of the first large scale surface water treatment plants, Pejompongan 1 and Pejompongan 2 in Central Jakarta.

The amount of water increased tenfold but distribution still was through the existing infrastructure to the ex-European residential areas which were now occupied by local elites. A new water network was laid to new areas such as Senayan and Kebayoran Baru in South Jakarta.

“Sukarno’s idea to build up selective areas in the city to world-class standards to show off Indonesia did not improve the water supply,” Michelle said.

In 1959, only 15 percent of the population was served with piped water.

“The exclusion forced people to continue their traditional way of relying on shallow wells and using surface water for washing and bathing,” Kooy said.

The beginning of the Soeharto era was no better, she said. At that time water was channeled to economically productive industrial and commercial areas and to upper-class areas in Menteng, Kuningan, Kebayoran Baru and later to new elite residential compounds such as Pondok Indah in South Jakarta.

There was a sufficient volume of water to service up to 60 percent of the population, but it was limited to 15 percent.

By 1992, a 24-hour water supply was still considered an amenity when purchasing property. Water was channeled to gated residential areas. Again people without access to piped water were paying more as the few water hydrants available created water cartels who sold water to the urban poor. Water theft became widespread.

In 1998, PAM Jaya signed contracts with private water supply companies from France and the UK; distribution expansion was one of the contract terms.

“Jakarta’s case is special, different from other privatizations. The private companies wanted to get the water to the people because they charged PAM Jaya based on the volume of water they sold, not the price of water sold to the customers.

“But there were problems. The very rich (in the South) did not want piped water because they still had good ground water. The poor who wanted water did not get it because the government wouldn’t let them — due to higher costs. Besides, many of the poor do not have proper documentation for their houses,” she said.

Water provision still divides the haves from the have-nots, the legal from the illegal, she said.

“It has been the government’s policy to not service any kampung with illegal residents, nor is it in PAM Jaya’s mandate.”

PAM Jaya said its goal is to have all the residents without access to quality water to have piped water by 2020 and the water companies plan to expand their networks north in the next four years.

Marunda teacher Sri and her diarrhea-vulnerable students still have to shower with salty water for at least another 1,460 days.

Source – Jakarta Post

ABIDJAN, 13 January 2009 (IRIN) – Seven-year-old Ali Sangaré held up two unopened packages of biscuits as if he had just won a prize.

“This will be our breakfast tomorrow,” he said gleefully.

Then he shoved his hands back into the rubbish pile to search for more edibles.

The mounting piles of rubbish in Côte d’Ivoire’s commercial capital Abidjan are a health hazard, but many children told IRIN they are also a daily source of food.

Scavenging in rubbish tips is nothing new – plastic bottles and other saleable items abound and can yield cash. But the children IRIN spoke to said that more and more they are sifting through the rubbish in search of food.

“We bring it all home to sort out among the family,” 12-year-old Mamoudou Traoré told IRIN. “We do not have money and we have to eat.”

Poverty is on the rise in Côte d’Ivoire. Slightly under half of the country’s 20 million people are now below the poverty threshold, living on less than about US$1.25 per day – up from 38.4 percent in 2000 and the highest in 20 years, according to survey results released by the national statistics institute in November.

“Up to a few months ago we begged at the big intersections,” Traoré told IRIN. “We used to be able to bring some money back to our families to buy food. But this no longer provides much because people are not so generous any more.”

He said he and his friends used to be able to find plenty of leftovers at restaurants. “But for a long time now, it is rare to see people leaving much on their plates. So we have had to look elsewhere.”

Photo: Alexis Adele/IRIN
Youths seeking recyclables and food at a municipal dump in Abidjan
Traoré and his friends said they often find in the rubbish stale or expired foods that shop- and restaurant-owners throw out, as well as produce like carrots, onions, oranges and bananas.

Risk

One hygiene expert told IRIN the health risk from the mounting trash heaps is greatest for the poorest groups.

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Kampala — THE National Water and Sewerage Corporation (NW&SC) has introduced a pre-paid metering system to address water needs of the urban poor and curb the increasing number of unscrupulous dealers.

Under the new system a 20-litre jerrican of water costs about sh18 as oppossed to sh100 and sh 200 in other areas.

The metering system which is under the slogan ‘pay as you drink’ is currently operational in Ndeeba, Kisenyi 1 and Kisenyi 2 slums.

The system has been tested in other parts of the world like India and South Africa.

Source – New Vision

Zambia – Street vending contributes to cholera – Mangani

Government has observed that street vending and unsanitary conditions at public places were some of the major contributing factors to the out break of cholera in the country.

Lusaka Province Minister, Lameck Mangani, said the general public should be mindful of the manner they dispose off refuse in order to avoid and control diarrheal diseases.

Mr. Mangani said this yesterday when a 33 member committee of the Soweto Market Development committee paid a courtesy call on him to urge government to open the market soon.

He has meanwhile, pledged government’s commitment to improving the social sector aimed at uplifting the welfare of Zambians by encouraging them to participate in income generating activities.

He said government would soon work on the access road leading to the new market and establish a bus station in line with Bus Station and Market Act.

Lusaka province minister Lameck Mangani is mobbed by marketeers at the newly erected soweto market when he went to inspect the facility.

Lusaka province minister Lameck Mangani is mobbed by marketeers at the newly erected Soweto market when he went to inspect the facility

Mr. Mangani said government was ready to open the market to the public.

He reiterated that government would ensure that transparency prevails in the allocation of trading spaces especially to those who had their stalls razed down to pave way for the construction of the market.

Earlier, Soweto Market Development Committee Chairperson, Albert Phiri appealed to the government to expedite the commissioning of the market to curb street vending in town.

Mr. Phiri told the minister that his committee had also identified two sites in Lusaka which have about 5,000 trading spaces, adding that one of them has all the necessary social amenities for use by the marketeers.

Yesterday, Mr. Mangani toured the new Soweto market to ensure that everything was in place before President Rupiah Banda commissions it.

Source – Lusaka Times

Urban Health Buletin, Nov/Dec 2008 (pdf, 125KB).

Compiled by Environmental Health at USAID, this issue contains an introduction by Anthony Kolb, USAID’s Urban Health Advisor and abstracts of 11 recently published studies on urban health issues.

Below are links to Fact Sheets posted today on the Environmental Health at USAID website:

- Boiling: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 538KB). Boiling is arguably the oldest and most commonly practiced household water treatment method, and it has been widely promoted for decades. Organizations recommend boiling both for water treatment in developing countries and to provide safe drinking water in emergency situations throughout the world.

- Filtration & Chlorination Systems: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 150KB). Several household water treatment systems incorporate both a physical filtration step for particle removal and a chlorination step for disinfection. This dual approach leads to high quality treated water.

Safe Storage of Drinking Water: Preventing Diarrheal Disease in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 254KB). Safe storage options fall into three general categories: 1) existing water storage containers in the home; 2) water storage containers used in the community and modified by an intervention program; or, 3) commercial safe storage containers purchased by the program and distributed to users.

- Simple Options to Remove Turbidity: Preventing Diarrheal Disease in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 173KB). Filtration or flocculation remove particles and reduce turbidity. These pretreatment methods may also increase the efficacy of household water treatment products by removing contaminants that interfere with disinfection and physical filtration processes.

Sewerage Works: Public investment in sewers saves lives’, Public Services International Research Unit, by David Hall and Emanuele Lobina, 2008 (PDF)

Donor insistence that poor householders pay the cost of connection to sewerage systems is short-sighted. In 19th Century Europe, governments realised water-borne diseases could only be eradicated by public investment and compulsory connection to sewers. Sewers have been proven to promote health and are an affordable investment that will benefit many generations to come.

A report from UNISON – the UK’s largest public service trade union – and Public Services International – the global federation for public sector trade unions – argues that the inability of the private sector to invest in sewerage systems requires governments to take the lead. It also argues that the costs of urban sewerage are affordable, contrary to the usual assertions.

The benefits of sewerage systems are too great for them to be treated as an optional extra. The authors urge:

– developing countries to use public finance to extend sewerage systems, raise tax revenues to finance them and resist external advice to achieve full cost recovery,
– donors to target funding and capacity building at countries most in need, not those where the private sector sees opportunities for profit,
– all sanitation stakeholders to acknowledge that the private sector has proven unable to sufficiently invest in sanitation improvements,
– acknowledgement that the countries leading the way in building sewers and expanding connections are those such as China, Brazil and India which are most independent of pressures from international financial institutions or donors.

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