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Kioko P, De Meijer F, Lusambili A, Gathu C. Implementing a community rotation to the internship training in Kenya: barriers and enablers. EDUCATION FOR PRIMARY CARE 2024:1-10. [PMID: 38989546 DOI: 10.1080/14739879.2024.2370537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
Community placements among trainee doctors have proven beneficial in understanding community problems, the role of primary care in health, and increasing the likelihood of pursuing a primary care career, albeit with some challenges. In 2020, Kenya started community rotations as part of the mandatory internship programme. This study aimed to describe the experiences among medical interns and their educational supervisors during the rotation from which insights on how to improve the community rotation may be drawn. A qualitative analysis of 13 in-depth interviews carried out among medical interns and their supervisors was undertaken in the first year of the implementation of the community rotation. Factors that enabled a successful rotation were an increased awareness amongst interns about patient health in the context of the community, presence of existing primary care structures, and the use of technology for patient follow-up during the COVID-19 pandemic. Conversely, challenges experienced by participants included insufficient communication prior to implementing the community health rotation, limited community health exposure among medical graduates before the internship, and fear of contracting or spreading COVID-19. The study identified opportunities to improve the community rotation through stakeholder engagement, timely government communication, and strengthening undergraduate medical training in community health competencies.
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Affiliation(s)
- Peter Kioko
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
| | - Fleur De Meijer
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
| | | | - Catherine Gathu
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
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Balakrishnan AK, Otieno S, Dzombo M, Plaxico L, Ukoh E, Obara LM, Brown H, Musyimi C, Lincoln C, Yang LS, Witte SS, Winter SC. Socio-ecological impacts of extreme weather events in two informal settlements in Nairobi, Kenya. Front Public Health 2024; 12:1389054. [PMID: 38887261 PMCID: PMC11180900 DOI: 10.3389/fpubh.2024.1389054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Climate change is expected to profoundly impact health and coping and widen social and environmental inequalities. People living in informal settlements are especially vulnerable to climate change as they are often located in ecologically sensitive areas more susceptible to extreme weather events (EWEs), such as floods, droughts, and heat waves. Women residing in informal settlements are especially vulnerable to climate change and related EWEs because they are more likely to experience worse health-related impacts than men but are less likely to have access to health-related services. Despite this inequality, there is a dearth of research that focuses on the impacts of EWEs on women in informal settlements. This study aims to explore the multidimensional impacts of EWEs on the daily lives of women in informal settlements through the lens of socio-ecological theory. Study data is from six monthly surveys (1 September 2022-28 February 2023) collected from a probability sample of 800 women living in two of the largest informal settlements in Nairobi, Kenya. This data is part of an ongoing longitudinal study that uses community participatory methods to investigate the effects of climate change on health and wellbeing in informal settlements by a team of 16 community health volunteers who lead data collection and provide expertise in ongoing analysis. Findings show profound impacts on women's health and wellbeing across individual, micro-, meso-, exo-, and macrosystems. These include physical and mental health, financial disruptions, property issues, social impacts, and impacts on their surrounding physical environment, such as disrupted food or water access, poor air quality, drainage issues, and safety concerns. In addition, findings highlight the critical importance of the chrono- and biosphere systems in research focused on the impacts of climate change and related EWEs among climate-vulnerable communities and marginalized populations within them.
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Affiliation(s)
| | | | | | - LaNae Plaxico
- School of Social Work, Columbia University, New York, NY, United States
| | - Ebuka Ukoh
- School of Social Work, Columbia University, New York, NY, United States
| | - Lena Moraa Obara
- Rutgers, School of Social Work, The State University of New Jersey, New Brunswick, NJ, United States
| | - Haley Brown
- School of Social Work, Columbia University, New York, NY, United States
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Chloe Lincoln
- School of Social Work, Columbia University, New York, NY, United States
| | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY, United States
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Amouzou A, Melesse DY, Wehrmeister FC, Ferreira LZ, Jiwani SS, Kassegne S, Maïga A, Faye CM, Ca T, Boerma T. Erosion of the Capital City Advantage in Child Survival and Reproductive, Maternal, Newborn, and Child Health Intervention Coverage in Sub-Saharan Africa. J Urban Health 2024:10.1007/s11524-023-00820-0. [PMID: 38767766 DOI: 10.1007/s11524-023-00820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 05/22/2024]
Abstract
The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.
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Affiliation(s)
- Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Dessalegn Y Melesse
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Safia S Jiwani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Abdoulaye Maïga
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Cheikh M Faye
- African Population and Health Research Center, Dakar, Senegal
| | - Tome Ca
- West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Ties Boerma
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Kibuchi E, Chumo I, Kabaria C, Elsey H, Phillips-Howard P, de Siqueira-Filha NT, Whittaker L, Leyland AH, Mberu B, Gray L. Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002931. [PMID: 38422055 PMCID: PMC10903897 DOI: 10.1371/journal.pgph.0002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as "not applicable". The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need.
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Affiliation(s)
- Eliud Kibuchi
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | - Lana Whittaker
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Alastair H. Leyland
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Linsay Gray
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Sitawa R, Tenge E, Chepkorir K, Nanyingi M, Okuthe S, Lockhart C, Oyas H, Njagi O, Agutu MT, Omolo J, Okumu T, Bebay C, Fasina FO. Building subnational capacities in animal health to deliver frontline cross-sectoral health services in Kenya. Front Vet Sci 2023; 10:1150557. [PMID: 37601759 PMCID: PMC10436308 DOI: 10.3389/fvets.2023.1150557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Operationalizing effective subnational veterinary services as major contributor to disease surveillance, reporting, diagnoses and One Health requires resources and mindset change. Here we describe workforce capacity building in animal health in Kenya and an approach that can be used to skill-up this workforce to respond beyond animal health challenges to emergent One Health realities and public health emergencies. Furthermore, triggering a paradigm shift has been identified for impactful delivery of health services, thus mindset change are important for learning new skills, but they also affect the way that we think about everything, for instance training in field epidemiology. Emphasis was therefore placed on skills, beliefs, and mindset shift. Methods Contextualized within the Kenyan environment, this description identifies problems likely to be found elsewhere: They are (a) The limited programs that offer structured and routine on-the-job training for animal health workers; (b) Unequal distribution and inadequate quantity and quality of highly skilled workforce with appropriate technical training and scientific skills to combat public (and animal) health challenges at the frontline; (c) Health challenges occasioned by climate change and drought, including feed, and water scarcity; and (d) Inadequate contingency, preparedness, and response planning for effective deployment of ready-to-trigger workforce capacity. In-Service Applied Veterinary Epidemiology Training (ISAVET) is a four-month long training program targeted at capacity building of frontline animal health professionals. The training, which is currently implemented in 17 African countries, is innovative and a customized field epidemiology program, which responds to specific needs in animal health and contribute to approaches utilizing One Health. Results Several trainees have marked mindset change as shown in the outputs and outcomes. Positive attitudes towards improving animal health surveillance were noted during the evaluation process. Discussion and Conclusion Most existing workforce capacities in the animal and public health systems were built for specific fields, and hardly respond optimally for cross-sectoral purposes. We proposed customised in-service applied veterinary epidemiology training that bypasses narrow-scoped workforce development but meets multifunctional, multidisciplinary and multisectoral needs before and during emergencies.
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Affiliation(s)
- Rinah Sitawa
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
| | - Evans Tenge
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
| | - Khadija Chepkorir
- Directorate of Veterinary Services, Ministry of Agriculture and Livestock Development, Nairobi, Kenya
| | - Mark Nanyingi
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
- Department of One Health, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sam Okuthe
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
| | - Caryl Lockhart
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Harry Oyas
- Directorate of Veterinary Services, Ministry of Agriculture and Livestock Development, Nairobi, Kenya
| | - Obadiah Njagi
- Directorate of Veterinary Services, Ministry of Agriculture and Livestock Development, Nairobi, Kenya
| | | | - Jack Omolo
- Department of Agriculture, Livestock Development and Fisheries, Kilifi, Kenya
| | - Tequiero Okumu
- University of Nairobi College of Agriculture and Veterinary Sciences, Nairobi, Kenya
| | - Charles Bebay
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
| | - Folorunso O. Fasina
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Nairobi, Kenya
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Winter S, Musyimi C, Mutiso V, Ndetei D. Depressive symptoms and associated social and environmental factors among women living in informal settlements in Nairobi, Kenya. Glob Public Health 2023; 18:2200499. [PMID: 37054444 DOI: 10.1080/17441692.2023.2200499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower - and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18-75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict.
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Affiliation(s)
- Samantha Winter
- School of Social Work, Columbia University, New York, NY, USA
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- African Mental Health Research and Training Foundation, Nairobi, Kenya
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Zanganeh A, Ziapour A, Naderlou R, Teimouri R, Janjani P, Yenneti K. Evaluating the access of slum residents to healthcare centers in Kermanshah Metropolis, Iran (1996-2016): A spatial justice analysis. Heliyon 2022; 9:e12731. [PMID: 36685373 PMCID: PMC9849978 DOI: 10.1016/j.heliyon.2022.e12731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
Background Proper access to health care centres and services is one of the key indicators of health justice, and it is more than ever important in slums. Objective This aim of this research is to evaluate the accessibility of health care centres to slum residents in the Kermanshah metropolis, Iran during the period 1996-2016. Methods In this cross-sectional study, data was obtained from the Census of Iran for the periods 1996, 2006 and 2016. Information on the number and location of health care centres was collected from the Kermanshah University of Medical Sciences. Network Analysis modelling method in Arc/GIS10.6 software was used to evaluate the accessibility of people to health centres. Results The results show that the spatial pattern of health centres in Kermanshah was random during 1996, 2006 and 2016, but the spatial pattern of poverty in the metropolis was clustered. In addition, the distribution of health centres was not consistent with the population densities. However, the overall population with inappropriate access to health centres in the slums of Kermanshah metropolis decreased over the study period (1996-54.02%, 2006-51.09%, and 2016-34.71%). Conclusions The findings of the study reveal that access to health care services by the slum population is not consistent with the increase of health care centres. This means that health policymakers were unsuccessful to provide the required health care services for the slums.
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Affiliation(s)
- Alireza Zanganeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran,Corresponding author.
| | | | - Raziyeh Teimouri
- UniSA Creative, University of South Australia, Adelaide, Australia
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Komali Yenneti
- School of Architecture and the Built Environment, University of Wolverhampton, UK
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Kitole FA, Lihawa RM, Mkuna E. Comparative Analysis on Communicable and Non-Communicable Diseases on Catastrophic Spending and Impoverishment in Tanzania. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022:1-12. [PMID: 36043157 PMCID: PMC9412805 DOI: 10.1007/s40609-022-00241-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 05/23/2023]
Abstract
The question of whether communicable or non-communicable diseases have higher economic effects on households is rarely explored from the global to local level despite of their significant contribution in increasing household catastrophic spending and impoverishment. To shed light into this, therefore, this paper comparatively examines the economic effects of communicable and non-communicable diseases in Tanzania by the use of Tanzania Panel Survey data of 2019/2020 which has been used to analyze different parameters to provide needful information. The empirical analysis employed probit, two-stage residual inclusion (2SRI), and control function approachf (CFA) helpful in controlling endogeneity issues. Findings showed that, comparatively, non-communicable diseases have higher economic effects in endangering households into catastrophic spending and impoverishment comparing to communicable diseases. Conclusively, neglecting developing countries to fights against multiplicative effects of these diseases alone will result in killing their economies since most of these countries depend on donors and household as a means of healthcare financing. However, this paper recommends for global initiatives in reducing the burden of disease by funding on palliative care costs and enhancing the availability of affordable health insurance schemes to reduce household economic burden.
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Affiliation(s)
| | | | - Eliaza Mkuna
- Department of Economics, Mzumbe University, P.O. Box 5, Morogoro, Tanzania
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Kibuchi E, Barua P, Chumo I, Teixeira de Siqueira Filha N, Phillips-Howard P, Mithu MIH, Kabaria C, Quayyum Z, Whittaker L, Dean L, Forsyth R, Selim T, Aktar B, Sai V, Garimella S, Saidu S, Gandi I, Josyula LK, Mberu B, Elsey H, Leyland AH, Gray L. Effects of social determinants on children's health in informal settlements in Bangladesh and Kenya through an intersectionality lens: a study protocol. BMJ Open 2022; 12:e056494. [PMID: 35667712 PMCID: PMC9171224 DOI: 10.1136/bmjopen-2021-056494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Several studies have shown that residents of urban informal settlements/slums are usually excluded and marginalised from formal social systems and structures of power leading to disproportionally worse health outcomes compared to other urban dwellers. To promote health equity for slum dwellers, requires an understanding of how their lived realities shape inequities especially for young children 0-4 years old (ie, under-fives) who tend to have a higher mortality compared with non-slum children. In these proposed studies, we aim to examine how key Social Determinants of Health (SDoH) factors at child and household levels combine to affect under-five health conditions, who live in slums in Bangladesh and Kenya through an intersectionality lens. METHODS AND ANALYSIS The protocol describes how we will analyse data from the Nairobi Cross-sectional Slum Survey (NCSS 2012) for Kenya and the Urban Health Survey (UHS 2013) for Bangladesh to explore how SDoH influence under-five health outcomes in slums within an intersectionality framework. The NCSS 2012 and UHS 2013 samples will consist of 2199 and 3173 under-fives, respectively. We will apply Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy approach. Some of SDoH characteristics to be considered will include those of children, head of household, mothers and social structure characteristics of household. The primary outcomes will be whether a child had diarrhoea, cough, fever and acute respiratory infection (ARI) 2 weeks preceding surveys. ETHICS AND DISSEMINATION The results will be disseminated in international peer-reviewed journals and presented in events organised by the Accountability and Responsiveness in Informal Settlements for Equity consortium and international conferences. Ethical approval was not required for these studies. Access to the NCSS 2012 has been given by Africa Population and Health Center and UHS 2013 is freely available.
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Affiliation(s)
- Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Proloy Barua
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Md Imran Hossain Mithu
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Zahidul Quayyum
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Lana Whittaker
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ross Forsyth
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Tasmiah Selim
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Bachera Aktar
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Varun Sai
- The George Institute for Global Health India, New Delhi, Delhi, India
| | - Sureka Garimella
- The George Institute for Global Health India, New Delhi, Delhi, India
| | | | - Ibrahim Gandi
- Centre Of Dialogue On Human Settlement And Poverty Alleviation (CODOHSAPA), Freetown, Sierra Leone
| | | | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
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Alnwisi SMM, Chai C, Acharya BK, Qian AM, Zhang S, Zhang Z, Vaughn MG, Xian H, Wang Q, Lin H. Empirical dynamic modeling of the association between ambient PM 2.5 and under-five mortality across 2851 counties in Mainland China, 1999-2012. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 237:113513. [PMID: 35453020 PMCID: PMC9061697 DOI: 10.1016/j.ecoenv.2022.113513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/01/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM2.5) pollution has been associated with mortality from various diseases, however, its association with under-five mortality rate (U5MR) has remained largely unknown. METHODS Based on the U5MR data across 2851 counties in Mainland China from 1999 to 2012, we employed approximate Bayesian latent Gaussian models to assess the association between ambient PM2.5 and U5MR at the county level for the whole nation and sub-regions. GDP growth rate, normalized difference vegetation index (NDVI), temperature, and night-time light were included as covariates using a smoothing function. We further implemented an empirical dynamic model (EDM) to explore the potential causal relationship between PM2.5 and U5MR. RESULTS We observed a declining trend in U5MR in most counties throughout the study period. Spatial heterogeneity in U5MR was observed. Nationwide analysis suggested that each 10 µg/m3 increase in annual concentration of PM2.5 was associated with an increase of 1.2 (95% CI: 1.0 - 1.3) per 1000 live births in U5MR. Regional analyses showed that the strongest positive association was located in the Northeastern part of China [1.8 (95% CI: 1.4 - 2.1)]. The EDM showed a significant causal association between PM2.5 and U5MR, with an embedding dimension of 5 and 7, and nonlinear values θ of 4 and 6, respectively. CONCLUSION China exhibited a downward trend in U5MR from 1999 to 2012, with spatial heterogeneity observed across the country. Our analysis reveals a positive association between PM2.5 and U5MR, which may support a causal relationship.
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Affiliation(s)
- Sameh M M Alnwisi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengwei Chai
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Bipin Kumar Acharya
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Aaron M Qian
- Department of Psychology, College of Arts and Sciences Saint Louis University, 3700 Lindell Boulevard, Saint Louis, MO 63108, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, Saint Louis, MO 63103, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Qinzhou Wang
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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11
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Bakibinga P, Kisia L, Atela M, Kibe PM, Kabaria C, Kisiangani I, Kyobutungi C. Demand and supply-side barriers and opportunities to enhance access to healthcare for urban poor populations in Kenya: a qualitative study. BMJ Open 2022; 12:e057484. [PMID: 35523490 PMCID: PMC9083429 DOI: 10.1136/bmjopen-2021-057484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya. DESIGN AND PARTICIPANTS This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April-June 2021. SETTING Korogocho and Viwandani urban slums in Nairobi, Kenya. RESULTS The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers' attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed. CONCLUSION Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers' abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.
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Affiliation(s)
| | - Lyagamula Kisia
- African Population and Health Research Center, Nairobi, Kenya
| | - Martin Atela
- Peterhouse, University of Cambridge, Cambridge, UK
- Research & Policy Unit, Partnership for African Social and Governance Research, Nairobi, Kenya
| | - Peter M Kibe
- African Population and Health Research Center, Nairobi, Kenya
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12
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Jennings Mayo-Wilson L, Kang BA, Mathai M, Mak'anyengo MO, Ssewamala FM. Mobile phone access, willingness, and usage for HIV-related services among young adults living in informal urban settlements in Kenya: A cross-sectional analysis. Int J Med Inform 2022; 161:104728. [PMID: 35228007 PMCID: PMC8940651 DOI: 10.1016/j.ijmedinf.2022.104728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults' differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV. METHODS This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use. RESULTS The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR = 1.84, 95 %CI:1.14-2.97) and employed (OR = 1.70, 95 %CI:1.02 = 2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR = 0.47, 95 %CI:0.24-0.921), were religious minorities (OR = 0.56, 95 %CI:0.32-0.99), partnered/married (OR = 0.30, 95 %CI:0.10-0.91), or female (OR = 0.29, 95 %CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed. CONCLUSION Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, 1025 E. 7th Street, Bloomington, IN 47405, USA; Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Bee-Ah Kang
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Muthoni Mathai
- University of Nairobi, College of Health Sciences, Department of Psychiatry. Kenyatta National Hospital, Off-Ngong Road, Nairobi, Kenya; National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453 Nairobi, Kenya
| | - Margaret O Mak'anyengo
- National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453 Nairobi, Kenya
| | - Fred M Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, Room 235, Campus Box 1196, One Brookings, Drive, St. Louis, MO 63130, USA.
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13
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Larson PS, Espira L, Glenn BE, Larson MC, Crowe CS, Jang S, O’Neill MS. Long-Term PM 2.5 Exposure Is Associated with Symptoms of Acute Respiratory Infections among Children under Five Years of Age in Kenya, 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052525. [PMID: 35270217 PMCID: PMC8909525 DOI: 10.3390/ijerph19052525] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 02/06/2023]
Abstract
Introduction: Short-term exposures to air pollutants such as particulate matter (PM) have been associated with increased risk for symptoms of acute respiratory infections (ARIs). Less well understood is how long-term exposures to fine PM (PM2.5) might increase risk of ARIs and their symptoms. This research uses georeferenced Demographic Health Survey (DHS) data from Kenya (2014) along with a remote sensing based raster of PM2.5 concentrations to test associations between PM2.5 exposure and ARI symptoms in children for up to 12 monthly lags. Methods: Predicted PM2.5 concentrations were extracted from raster of monthly averages for latitude/longitude locations of survey clusters. These data and other environmental and demographic data were used in a logistic regression model of ARI symptoms within a distributed lag nonlinear modeling framework (DLNM) to test lag associations of PM2.5 exposure with binary presence/absence of ARI symptoms in the previous two weeks. Results: Out of 7036 children under five for whom data were available, 46.8% reported ARI symptoms in the previous two weeks. Exposure to PM2.5 within the same month and as an average for the previous 12 months was 18.31 and 22.1 µg/m3, respectively, far in excess of guidelines set by the World Health Organization. One-year average PM2.5 exposure was higher for children who experienced ARI symptoms compared with children who did not (22.4 vs. 21.8 µg/m3, p < 0.0001.) Logistic regression models using the DLNM framework indicated that while PM exposure was not significantly associated with ARI symptoms for early lags, exposure to high concentrations of PM2.5 (90th percentile) was associated with elevated odds for ARI symptoms along a gradient of lag exposure time even when controlling for age, sex, types of cooking fuels, and precipitation. Conclusions: Long-term exposure to high concentrations of PM2.5 may increase risk for acute respiratory problems in small children. However, more work should be carried out to increase capacity to accurately measure air pollutants in emerging economies such as Kenya.
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Affiliation(s)
- Peter S. Larson
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
- Correspondence: (P.S.L.); (L.E.); Tel.: +1-734-730-2372 (P.S.L.)
| | - Leon Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI 48105, USA
- Correspondence: (P.S.L.); (L.E.); Tel.: +1-734-730-2372 (P.S.L.)
| | - Bailey E. Glenn
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA;
| | | | - Christopher S. Crowe
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
| | - Seoyeon Jang
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Marie S. O’Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA;
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14
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Suliman Q, Lim PY, Md Said S, Tan KA, Mohd Zulkefli NA. Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia. Sci Rep 2022; 12:745. [PMID: 35031658 PMCID: PMC8760252 DOI: 10.1038/s41598-021-04742-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/29/2021] [Indexed: 12/01/2022] Open
Abstract
TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.
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Affiliation(s)
- Qudsiah Suliman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.,Ministry of Health, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
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15
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Osuh ME, Oke GA, Lilford RJ, Owoaje E, Harris B, Taiwo OJ, Yeboah G, Abiona T, Watson SI, Hemming K, Quinn L, Chen YF. Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000297. [PMID: 36962169 PMCID: PMC10021815 DOI: 10.1371/journal.pgph.0000297] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/06/2022] [Indexed: 11/19/2022]
Abstract
Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.
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Affiliation(s)
- Mary E Osuh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Faculty of Dentistry, Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Gbemisola A Oke
- Faculty of Dentistry, Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Richard J Lilford
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- Institute of Applied Health Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, United Kingdom
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Olalekan John Taiwo
- Faculty of Social Sciences, Department of Geography, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Godwin Yeboah
- Warwick Information and Digital Group, University of Warwick, Coventry, United Kingdom
| | - Taiwo Abiona
- Institute of Applied Health Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, United Kingdom
| | - Samuel I Watson
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Karla Hemming
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Laura Quinn
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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16
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Casanovas-Massana A, Souza FN, Curry M, de Oliveira D, de Oliveira AS, Eyre MT, Santiago D, Santos MA, Serra RMR, Lopes E, Xavier BIA, Diggle PJ, Wunder EA, Reis MG, Ko AI, Costa F. Effect of Sewerage on the Contamination of Soil with Pathogenic Leptospira in Urban Slums. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:15882-15890. [PMID: 34767339 PMCID: PMC9302045 DOI: 10.1021/acs.est.1c04916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Leptospirosis is an environmentally transmitted zoonotic disease caused by pathogenic Leptospira spp. that affects poor communities worldwide. In urban slums, leptospirosis is associated with deficient sanitary infrastructure. Yet, the role of sewerage in the reduction of the environmental contamination with pathogenic Leptospira has not been explored. Here, we conducted a survey of the pathogen in soils surrounding open and closed sewer sections in six urban slums in Brazil. We found that soils surrounding conventionally closed sewers (governmental interventions) were 3 times less likely to contain pathogenic Leptospira (inverse OR 3.44, 95% CI = 1.66-8.33; p < 0.001) and contained a 6 times lower load of the pathogen (0.82 log10 units difference, p < 0.01) when compared to their open counterparts. However, no differences were observed in community-closed sewers (poor-quality closings performed by the slum dwellers). Human fecal markers (BacHum) were positively associated with pathogenic Leptospira even in closed sewers, and rat presence was not predictive of the presence of the pathogen in soils, suggesting that site-specific rodent control may not be sufficient to reduce the environmental contamination with Leptospira. Overall, our results indicate that sewerage expansion to urban slums may help reduce the environmental contamination with the pathogen and therefore reduce the risk of human leptospirosis.
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Affiliation(s)
- Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States
| | - Fabio Neves Souza
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Melanie Curry
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States
| | - Daiana de Oliveira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Anderson S. de Oliveira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Max T. Eyre
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil; Centre for Health Informatics, Computing, and Statistics, Lancaster University Medical School, Lancaster LA1 4YW, United Kingdom
| | - Diogo Santiago
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil
| | - Maísa Aguiar Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Rafael M. R. Serra
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Evelyn Lopes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil
| | - Barbara IA Xavier
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil
| | - Peter J. Diggle
- Centre for Health Informatics, Computing, and Statistics, Lancaster University Medical School, Lancaster LA1 4YW, United Kingdom
| | - Elsio A. Wunder
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Mitermayer G. Reis
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia 40026-010, Brazil
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 06511, United States; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia 40110-040, Brazil; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
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17
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Kariuki S, Dyson ZA, Mbae C, Ngetich R, Kavai SM, Wairimu C, Anyona S, Gitau N, Onsare RS, Ongandi B, Duchene S, Ali M, Clemens JD, Holt KE, Dougan G. Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya. eLife 2021; 10:67852. [PMID: 34515028 PMCID: PMC8494480 DOI: 10.7554/elife.67852] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/08/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control. Methods: In a 3-year case-control study, we investigated typhoid among children aged <16 years (4670 febrile cases and 8549 age matched controls) living in an informal settlement, Nairobi, Kenya. Results: 148 S. Typhi isolates from cases and 95 from controls (stool culture) were identified; a carriage frequency of 1 %. Whole-genome sequencing showed 97% of cases and 88% of controls were genotype 4.3.1 (Haplotype 58), with the majority of each (76% and 88%) being multidrug-resistant strains in three sublineages of the H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled. Conclusions: The high rate of multidrug-resistant H58 S. Typhi, and the close phylogenetic relationships between cases and controls, provides evidence for the role of carriers as a reservoir for the community spread of typhoid in this setting. Funding: National Institutes of Health (R01AI099525); Wellcome Trust (106158/Z/14/Z); European Commission (TyphiNET No 845681); National Institute for Health Research (NIHR); Bill and Melinda Gates Foundation (OPP1175797).
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Zoe A Dyson
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom.,Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ronald Ngetich
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Susan M Kavai
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Celestine Wairimu
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen Anyona
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Naomi Gitau
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Sanaya Onsare
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Beatrice Ongandi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sebastian Duchene
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mohamed Ali
- Department of International Health, John's Hopkins University, Baltimore, United States
| | | | - Kathryn E Holt
- London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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18
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Shrum W, Mbatia PN, Yevuyibor JT, Schafer M, Walker M, Miller P, Palackal A. The Burden of Elders: Anxiety, Depression, and Personal Networks in Two African Slums. J Nerv Ment Dis 2021; 209:533-536. [PMID: 34170862 DOI: 10.1097/nmd.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although anxiety and depression have been central topics for scholars and clinicians in the United States, few studies have examined their correlates in sub-Saharan Africa and none have examined large urban slums. Using face-to-face interviews in two African cities, we analyze self-reported symptoms of anxiety and depression in a community-based sample (n = 495). Ordinary least squares regression was used to analyze a variety of demographic and social predictors including sex, child-rearing, marital status, education, income, age, and neighborhood for residents of Agbogbloshie (Accra, Ghana) and Kangemi (Nairobi, Kenya). Controlling for other factors, two personal network dimensions were significant. Total network size is positively associated with symptoms of anxiety and depression in Kenya but not in Ghana. However, one factor was predictive of symptoms of anxiety and depression in both locations: the reported percentage of ties with older persons. Higher levels of anxiety and depression are associated with a larger share of older individuals in one's personal network.
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Affiliation(s)
- Wesley Shrum
- Department of Sociology, Louisiana State University, Baton Rouge, Louisiana
| | - Paul N Mbatia
- Department of Sociology and Social Work, University of Nairobi, Nairobi, Kenya
| | | | - Mark Schafer
- Department of Sociology, LSU AgCenter, Louisiana State University, Baton Rouge, Louisiana
| | - Mark Walker
- Department of Sociology, Louisiana State University, Baton Rouge, Louisiana
| | - Paige Miller
- Department of Sociology, Criminology, and Anthropology, University of Wisconsin, River Falls, Wisconsin
| | - Antony Palackal
- Department of Sociology, University of Kerala, Kariyavattom, Kerala, India
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19
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Borg FH, Greibe Andersen J, Karekezi C, Yonga G, Furu P, Kallestrup P, Kraef C. Climate change and health in urban informal settlements in low- and middle-income countries - a scoping review of health impacts and adaptation strategies. Glob Health Action 2021; 14:1908064. [PMID: 33847256 PMCID: PMC8049459 DOI: 10.1080/16549716.2021.1908064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Climate change affects human health with those with the least resources being most vulnerable. However, little is known about the impact of climate change on human health and effective adaptation methods in informal settlements in low- and middle-income countries. Objective: The objective of this scoping review was to identify, characterize, and summarize research evidence on the impact of climate change on human health in informal settlements and the available adaptation methods and interventions. Method: A scoping review was conducted using the Arksey and O’Malley framework. The four bibliographic databases PubMed, Web of Science, Embase, and the Cochrane library were searched. Eligibility criteria were all types of peer-reviewed publications reporting on climate change or related extreme weather events (as defined by the United Nations Framework Convention on Climate Change), informal settlements (as defined by UN-Habitat), low- and middle-income countries (as defined by the World Bank) and immediate human health impacts. Review selection and characterization were performed by two independent reviewers using a predefined form. Results: Out of 1197 studies initially identified, 15 articles were retained. We found nine original research articles, and six reviews, commentaries, and editorials. The articles were reporting on the exposures flooding, temperature changes and perceptions of climate change with health outcomes broadly categorized as mental health, communicable diseases, and non-communicable diseases. Six studies had a geographical focus on Asia, four on Africa, and one on South America, the remaining four articles had no geographical focus. One article investigated an adaptation method for heat exposure. Serval other adaptation methods were proposed, though they were not investigated by the articles in this review. Conclusion: There is a paucity of original research and solid study designs. Further studies are needed to improve the understanding of the impact, the most effective adaptation methods and to inform policy making.
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Affiliation(s)
| | - Johanne Greibe Andersen
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark
| | - Catherine Karekezi
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya.,Non-communicable Diseases Alliance Kenya, Nairobi, Kenya
| | - Gerald Yonga
- Non-communicable Diseases Alliance Kenya, Nairobi, Kenya.,Medical Faculty, University of Nairobi, Nairobi, Kenya
| | - Peter Furu
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark
| | - Christian Kraef
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark.,Heidelberg Institute of Global Health, University of Heidelberg, Germany
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20
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An assessment of non-communicable disease mortality among adults in Eastern Uganda, 2010-2016. PLoS One 2021; 16:e0248966. [PMID: 33739993 PMCID: PMC7978282 DOI: 10.1371/journal.pone.0248966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/08/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is a dearth of studies assessing non-communicable disease (NCD) mortality within population-based settings in Uganda. We assessed mortality due to major NCDs among persons ≥ 30 years in Eastern Uganda from 2010 to 2016. METHODS The study was carried out at the Iganga-Mayuge health and demographic surveillance site in the Iganga and Mayuge districts of Eastern Uganda. Information on cause of death was obtained through verbal autopsies using a structured questionnaire to conduct face-face interviews with carers or close relatives of the deceased. Physicians assigned likely cause of death using ICD-10 codes. Age-adjusted mortality rates were calculated using direct method, with the average population across the seven years of the study (2010 to 2016) as the standard. Age categories of 30-40, 41-50, 51-60, 61-70, and ≥ 71 years were used for standardization. RESULTS A total of 1,210 deaths among persons ≥ 30 years old were reported from 2010 to 2016 (50.7% among women). Approximately 53% of all deaths were due to non-communicable diseases, 31.8% due to communicable diseases, 8.2% due to injuries, and 7% due to maternal-related deaths or undetermined causes. Cardiovascular diseases accounted for the largest proportion of NCD deaths in each year, and women had substantially higher cardiovascular disease mortality rates compared to men. Conversely, women had lower diabetes mortality rates than men for five of the seven years examined. CONCLUSIONS Non-communicable diseases are major causes of death among adults in Iganga and Mayuge; and cardiovascular diseases and diabetes are leading causes of NCD deaths. Efforts are needed to tackle NCD risk factors and provide NCD care to reduce associated burden and premature mortality.
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21
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Lambert JE, Denckla C. Posttraumatic stress and depression among women in Kenya's informal settlements: risk and protective factors. Eur J Psychotraumatol 2021; 12:1865671. [PMID: 34992747 PMCID: PMC8725741 DOI: 10.1080/20008198.2020.1865671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Approximately 56% of Kenya´s population resides in informal settlements (UN-Habitat, 2016). Female residents experience a range of psychosocial stressors including chronic poverty and high rates of interpersonal violence. Despite evidence that this population has some of the worst physical health outcomes in the country (APHRC, 2014), few studies have evaluated their mental health status and its correlates. Objective: The purpose of this study was to identify risk and protective factors associated with mental health problems (posttraumatic stress & depression) among women living in informal settlements in Kenya. Hypothesized risk factors included economic stress, a history of experiencing childhood abuse and sexual violence, as well as partner-perpetrated psychological and physical abuse. Hypothesized protective factors were supportive relationships with family members and friends and having a sense community connection. Method: Local community health workers were trained to collect data via individual interviews using validated measures. Participants were recruited using systematic random sampling in two informal settlements in Nakuru County. We used path analysis to test the hypothesized model among a sample of 301 women. Results: The model had an excellent fit (χ2 = 13.391, df = 8, p =.099; GFI =.99; CFI =.99; RMSEA =.05) and explained 25% of the variance in PTSS and 28% of the variance in depression. All predictor variables except support from friends were statistically significant in the expected direction. Specifically, economic stress, childhood abuse, sexual violence, as well as physical and psychological abuse from one´s partner had significant positive associations with PTSS and depression. Having supportive family members and a sense of being part of the community had significant negative associations with symptoms. Conclusions: Results highlight the importance of addressing intimate partner and other forms of interpersonal violence in these settings and hold implications for tailoring interventions for this marginalized population.
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Affiliation(s)
- Jessica E. Lambert
- International Rehabilitation Department, DIGNITY- Danish Institute Against Torture, Copenhagen, Denmark
| | - Christy Denckla
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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The Nairobi Urban Health and Demographic Surveillance of slum dwellers, 2002–2019: Value, processes, and challenges. GLOBAL EPIDEMIOLOGY 2020. [DOI: 10.1016/j.gloepi.2020.100024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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Oni T, Assah F, Erzse A, Foley L, Govia I, Hofman KJ, Lambert EV, Micklesfield LK, Shung-King M, Smith J, Turner-Moss E, Unwin N, Wadende P, Woodcock J, Mbanya JC, Norris SA, Obonyo CO, Tulloch-Reid M, Wareham NJ. The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts. Global Health 2020; 16:100. [PMID: 33076935 PMCID: PMC7570103 DOI: 10.1186/s12992-020-00630-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/07/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. PARTNERSHIP The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders. CONCLUSION We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.
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Affiliation(s)
- Tolu Oni
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Research Initiative for Cities Health and Equity (RICHE), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Felix Assah
- Health of Populations in Transition (HoPiT), Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Agnes Erzse
- SA MRC Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ishtar Govia
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Karen J Hofman
- SA MRC Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Estelle Victoria Lambert
- Health through Physical Activity Lifestyle and Sport Research Centre, University of Cape Town, Cape Town, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Maylene Shung-King
- Research Initiative for Cities Health and Equity (RICHE), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joanne Smith
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nigel Unwin
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Pamela Wadende
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James Woodcock
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Jean Claude Mbanya
- Health of Populations in Transition (HoPiT), Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Marshall Tulloch-Reid
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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Wanjohi MN, Ogada I, Wekesah FM, Khayeka-Wandabwa C, Kimani-Murage EW. Relationship between maternal body composition during pregnancy and infant's birth weight in Nairobi informal settlements, Kenya. BMJ Nutr Prev Health 2020; 3:151-161. [PMID: 33521524 PMCID: PMC7841839 DOI: 10.1136/bmjnph-2019-000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Maternal nutrition depletion during pregnancy compromises fetal programming, and is a cause of adverse birth outcomes. Maternal body composition measurement using direct body composition assessment methods such as the deuterium dilution technique provides better prediction of birth outcomes as compared with commonly used techniques like anthropometry. This study assessed body composition of pregnant mothers in urban informal settlements in Nairobi, Kenya, and established the relationship between maternal body composition and infant birth weight. Methods Deuterium dilution technique was used to determine body composition, including total body water (TBW), fat-free mass (FFM) and fat mass (FM), among 129 pregnant women who were enrolled into the study in their first or second trimester. Descriptive statistics and regression analysis were applied using Stata V.13. Results The mean TBW, FFM and FM were 33.3 L (±4.7), 45.7 kg (±6.5) and 17.01 kg (±7.4), respectively. Both TBW and FFM were significantly related to maternal age and gestation/pregnancy stage during body composition assessment while FM was significantly associated with gestation stage during body composition assessment. TBW and FFM were significantly lower in younger mothers (<20 years) compared with older mothers (≥20 years). The mean birth weight was 3.3 kg±0.42 kg. There was a positive association between infant birth weight and maternal TBW (p=0.031) and FFM (p=0.027), but not FM (p=0.88). Conclusion Non-fat components of the body (TBW and FFM) have a positive association with birth weight. Therefore, interventions to improve optimal maternal feeding practices, to enhance optimal gains in FFM and TBW during pregnancy are recommended, especially among young mothers.
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Affiliation(s)
- Milkah Njeri Wanjohi
- Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | - Irene Ogada
- Department of Human Nutrition, St Francis Xavier University, Antigonish, Nova Scotia, Canada.,Department of Food Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Frederick Murunga Wekesah
- Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, Tianjin, China
| | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya.,Wellcome Trust, London, UK
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25
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Otieno PO, Wambiya EOA, Mohamed SM, Mutua MK, Kibe PM, Mwangi B, Donfouet HPP. Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. BMC Public Health 2020; 20:981. [PMID: 32571277 PMCID: PMC7310125 DOI: 10.1186/s12889-020-09106-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95% confidence intervals were used to interpret the strength of associations. Results The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were three times higher for males than female-headed households (AOR 3.05 [95% CI 1.47–6.37]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥USD 30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ USD 5 (AOR 0.36 [95% CI 0.18–0.74]; p < .05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to those who sought care from public facilities (AOR 6.64 [95% CI 3.67–12.01]; p < .001). Conclusion In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out-of-pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.
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Affiliation(s)
- Peter O Otieno
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Elvis O A Wambiya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Shukri M Mohamed
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Martin Kavao Mutua
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Peter M Kibe
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Bonventure Mwangi
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Hermann Pythagore Pierre Donfouet
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
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Mbae C, Mwangi M, Gitau N, Irungu T, Muendo F, Wakio Z, Wambui R, Kavai S, Onsare R, Wairimu C, Ngetich R, Njeru F, Van Puyvelde S, Clemens J, Dougan G, Kariuki S. Factors associated with occurrence of salmonellosis among children living in Mukuru slum, an urban informal settlement in Kenya. BMC Infect Dis 2020; 20:422. [PMID: 32552753 PMCID: PMC7302364 DOI: 10.1186/s12879-020-05134-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background In Kenya, typhoid fever and invasive non-typhoidal salmonellosis present a huge burden of disease, especially in poor-resource settings where clean water supply and sanitation conditions are inadequate. The epidemiology of both diseases is poorly understood in terms of severity and risk factors. The aim of the study was to determine the disease burden and spatial distribution of salmonellosis, as well as socioeconomic and environmental risk factors for these infections, in a large informal settlement near the city of Nairobi, from 2013 to 2017. Methods Initially, a house-to-house baseline census of 150,000 population in Mukuru informal settlement was carried out and relevant socioeconomic, demographic, and healthcare utilization information was collected using structured questionnaires. Salmonella bacteria were cultured from the blood and faeces of children < 16 years of age who reported at three outpatient facilities with fever alone or fever and diarrhea. Tests of association between specific Salmonella serotypes and risk factors were conducted using Pearson Chi-Square (χ2) test. Results A total of 16,236 children were recruited into the study. The prevalence of bloodstream infections by Non-Typhoidal Salmonella (NTS), consisting of Salmonella Typhimurium/ Enteriditis, was 1.3%; Salmonella Typhi was 1.4%, and this was highest among children < 16 years of age. Occurrence of Salmonella Typhimurium/ Enteriditis was not significantly associated with rearing any domestic animals. Rearing chicken was significantly associated with high prevalence of S. Typhi (2.1%; p = 0.011). The proportion of children infected with Salmonella Typhimurium/ Enteriditis was significantly higher in households that used water pots as water storage containers compared to using water directly from the tap (0.6%). Use of pit latrines and open defecation were significant risk factors for S. Typhi infection (1.6%; p = 0.048). The proportion of Salmonella Typhimurium/ Enteriditis among children eating street food 4 or more times per week was higher compared to 1 to 2 times/week on average (1.1%; p = 0.032). Conclusion Typhoidal and NTS are important causes of illness in children in Mukuru informal settlement, especially among children less than 16 years of age. Improving Water, Sanitation and Hygiene (WASH) including boiling water, breastfeeding, hand washing practices, and avoiding animal contact in domestic settings could contribute to reducing the risk of transmission of Salmonella disease from contaminated environments.
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Affiliation(s)
- Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya.
| | - Moses Mwangi
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Naomi Gitau
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Tabitha Irungu
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Fidelis Muendo
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zilla Wakio
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Ruth Wambui
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Susan Kavai
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Robert Onsare
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Celestine Wairimu
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Ronald Ngetich
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Frida Njeru
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya
| | - Sandra Van Puyvelde
- Department of Medicine, University of Cambridge, Cambridge, UK.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Universiteit Antwerpen, Antwerp, Belgium
| | - John Clemens
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, PO Box 54840-00200, Nairobi, Kenya.,Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
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27
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Winter SC, Obara LM, McMahon S. Intimate partner violence: A key correlate of women's physical and mental health in informal settlements in Nairobi, Kenya. PLoS One 2020; 15:e0230894. [PMID: 32240207 PMCID: PMC7117691 DOI: 10.1371/journal.pone.0230894] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/08/2020] [Indexed: 01/09/2023] Open
Abstract
Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.
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Affiliation(s)
- Samantha C. Winter
- Columbia School of Social Work, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Lena Moraa Obara
- Department of Sociology and Social Work, University of Nairobi, Nairobi, Kenya
| | - Sarah McMahon
- Center on Violence Against Women and Children, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
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McNairy ML, Tymejczyk O, Rivera V, Seo G, Dorélien A, Peck M, Petion J, Walsh K, Bolgrien A, Nash D, Pape J, Fitzgerald DW. High Burden of Non-communicable Diseases among a Young Slum Population in Haiti. J Urban Health 2019; 96:797-812. [PMID: 31218502 PMCID: PMC6904710 DOI: 10.1007/s11524-019-00368-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this study was to characterize the demographics and population health of four slum communities in Port-au-Prince, Haiti, including population density and the burden of communicable and non-communicable diseases. Four urban slums were surveyed using a population-representative design between July and October 2016. A multistage cluster area random sampling process was used to identify households and individuals for the survey. Household surveys included rosters of residents, household characteristics, adult and child deaths in the past year, child health, and healthcare access and utilization. Individual surveys of two randomly sampled adults from each household included sociodemographic data, maternal health, and adult health. Additionally, blood pressure, height, weight, and psychological distress were measured by study staff. Data were weighted for complex survey design and non-response. A total of 525 households and 894 individuals completed the survey (96% household and 90% individual response rate, respectively). The estimated population density was 58,000 persons/km2. Across slums, 55% of all residents were female, and 38% were adolescents and youth 10-24 years. Among adults, 58% were female with median age 29 years (22-38). The most common adult illnesses were severe psychological distress (24%), hypertension (20%), history of physical injury/trauma (10%), asthma (7%), history of cholera (4%), and history of tuberculosis (3%). Ten percent of adults had obesity (BMI > 30 kg/m2), and 7% currently smoked. The most common under-5 diseases during the last 3 months were respiratory and gastrointestinal illnesses (50% and 28%, respectively). One-third of households reported needing medical care for a child in the past year but not being able to access it, largely due to financial constraints. Unique features of these slums are a population structure dominated by adolescents and youth, a high proportion of females, and a high burden of non-communicable diseases including hypertension and psychological distress. Screening, diagnostic, and disease management interventions are urgently needed to protect and promote improved population health outcomes in these slum communities.
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Affiliation(s)
- Margaret L McNairy
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Vanessa Rivera
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Grace Seo
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Audrey Dorélien
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, USA
| | - Mireille Peck
- Haitian Group for the Study of Kaposi Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jacky Petion
- Haitian Group for the Study of Kaposi Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kathleen Walsh
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Anna Bolgrien
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Jean Pape
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Haitian Group for the Study of Kaposi Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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Adams EA, Stoler J, Adams Y. Water insecurity and urban poverty in the Global South: Implications for health and human biology. Am J Hum Biol 2019; 32:e23368. [PMID: 31769124 DOI: 10.1002/ajhb.23368] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Over half of the world's population (4 billion people) experience severe water scarcity at least one month per year, while half a billion people experience severe water scarcity throughout the year. Despite progress from national and global interventions, a staggering proportion of the Global South remains water insecure. Rapid urban growth and associated demographic changes, climate change, and governance failure have also fostered the growth and expansion of urban informal settlements and slums where widespread poverty and environmental hazards exacerbate the impact of water insecurity on health. This article reflects on the interactions between water insecurity and urban poverty in the Global South across four categories of health outcomes: gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness. These examples highlight the mechanisms through which urban poverty exacerbates the adverse health effects of water insecurity. METHODS The four selected health outcomes were chosen a priori to represent two communicable conditions with well-developed literatures, and two noncommunicable conditions with newer literatures that have emerged over the last decade. We conducted a narrative literature review of scholarly and gray literature appearing between January 2000 and April 2019 using several online scholarly databases. RESULTS Gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness all exemplified the relationship between water insecurity and urban poverty through human biological pathways. For each of the four health categories, we identified frontiers for human biology research contributions to the water-poverty-health nexus. CONCLUSIONS We discuss our findings in the context of three crosscutting themes that merit innovative research approaches: stressor interactions and trade-offs, exposure thresholds, and intervention efficacy. We reiterate that the global burden of disease associated with water insecurity cannot be addressed in isolation from efforts to alleviate extreme poverty.
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Affiliation(s)
- Ellis A Adams
- Global Studies Institute and Department of Geosciences, Georgia State University, Atlanta, Georgia
| | - Justin Stoler
- Department of Geography, University of Miami, Coral Gables, Florida
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - Yenupini Adams
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia
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Environmental Correlates of Health-Related Quality of Life among Women Living in Informal Settlements in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203948. [PMID: 31627277 PMCID: PMC6843694 DOI: 10.3390/ijerph16203948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
Informal settlements (slums)—defined as residential areas lacking durable housing; sufficient living and public spaces; access to basic infrastructure, water, sanitation, and other services; and secure tenancy—are presumed to be poor health environments. Research in Kenya suggests that residents of these settlements have the worst health outcomes of any population, yet there is a paucity of research focused on the health and well-being of these residents. Even less attention is given to the role played by environment in health in these settings. The present study addresses these gaps by examining potential environmental correlates, specifically access to water and sanitation, of health-related quality of life (HRQOL) among 552 women in Mathare slum in Nairobi, Kenya. A Kiswahili version of the 36-Item Short Form Health Survey (SF-36) measured HRQOL. Results suggested that access to a toilet at all times was associated with every subscale of the mental health and general well-being domains of the SF-36. Primary water source was also associated with women’s HRQOL. Despite increasing efforts to expand sanitation and water access in informal settlements, more attention should be given to whether the interventions being introduced, which likely affect women’s psychosocial health, are appropriate for all residents, including women.
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Briskin EA, Casanovas-Massana A, Ryff KR, Morales-Estrada S, Hamond C, Perez-Rodriguez NM, Benavidez KM, Weinberger DM, Castro-Arellano I, Wunder EA, Sharp TM, Rivera-Garcia B, Ko AI. Seroprevalence, Risk Factors, and Rodent Reservoirs of Leptospirosis in an Urban Community of Puerto Rico, 2015. J Infect Dis 2019; 220:1489-1497. [PMID: 31342075 PMCID: PMC6761939 DOI: 10.1093/infdis/jiz339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The burden of leptospirosis in Puerto Rico remains unclear due to underreporting. METHODS A cross-sectional survey and rodent trapping was performed in a community within San Juan, Puerto Rico to determine the seroprevalence and risk factors for Leptospira infection. The microscopic agglutination test was used to detect anti-Leptospira antibodies as a marker of previous infection. We evaluated Leptospira carriage by quantitative polymerase chain reaction among rodents trapped at the community site. RESULTS Of 202 study participants, 55 (27.2%) had Leptospira agglutinating antibodies. Among the 55 seropositive individuals, antibodies were directed most frequently against serogroups Icterohaemorrhagiae (22.0%) and Autumnalis (10.6%). Of 18 captured rodents, 11 (61.1%) carried pathogenic Leptospira (Leptospira borgpetersenii, 7 and Leptospira interrogans, 2). Four participants showed their highest titer against an isolate obtained from a rodent (serogroup Ballum). Increasing household distance to the canal that runs through the community was associated with decreased risk of infection (odds ratio = 0.934 per 10-meter increase; 95% confidence interval, .952-.992). CONCLUSIONS There are high levels of Leptospira exposure in an urban setting in Puerto Rico, for which rodents may be an important reservoir for transmission. Our findings indicate that prevention should focus on mitigating risk posed by infrastructure deficiencies such as the canal.
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Affiliation(s)
- Emily A Briskin
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Kyle R Ryff
- Office of Epidemiology, Puerto Rico Department of Health, San Juan Puerto Rico
| | | | - Camila Hamond
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Nicole M Perez-Rodriguez
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | | | - Elsio A Wunder
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
- Centro de Pesquisas Gonçalo Moniz, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Tyler M Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
- Centro de Pesquisas Gonçalo Moniz, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
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Salinas DA, Fouts HN, Neitzel CL, Bates-Fredi DR. Young Children’s Social Networks in an Informal Urban Settlement in Kenya: Examining Network Characteristics Among Kamba, Kikuyu, Luo, and Maasai Children. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2019. [DOI: 10.1177/0022022119840443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children’s social networks comprise a variety of social partners who interact with the child in unique ways and contribute distinctly to her social and emotional development. This study examines the structure of children’s social networks from four different ethnic groups (Kamba, Kikuyu, Luo, and Maasai) residing in an informal urban settlement in Kenya. Twenty boys and 24 girls ( M = 40 months) were observed on three different weekdays for 2 hr each day, to assess children’s experiences across daylight hours. Children’s social networks predominantly consisted of nonrelative children and nonrelative adults. However, larger social networks did not necessarily mean more highly involved members. Peers were observed to be in close proximity and to engage in play and conversation with the focal children more often than did adult social partners. The findings have implications for intervention programs that focus predominantly on nuclear family members, as they may overlook important roles that other social network members play in children’s lives. The low occurrence of play between adults and children in this study is consistent with studies in other non-Western contexts, where play is generally not considered part of parents’ role nor a fundamental characteristic of parent–child interactions.
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Affiliation(s)
| | | | - Carin L. Neitzel
- The University of Tennessee, Knoxville, USA
- Black Hills State University, Spearfish, SD, USA
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Dianati K, Zimmermann N, Milner J, Muindi K, Ezeh A, Chege M, Mberu B, Kyobutungi C, Fletcher H, Wilkinson P, Davies M. Household air pollution in Nairobi's slums: A long-term policy evaluation using participatory system dynamics. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 660:1108-1134. [PMID: 30743908 PMCID: PMC6854458 DOI: 10.1016/j.scitotenv.2018.12.430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/30/2018] [Accepted: 12/28/2018] [Indexed: 05/03/2023]
Abstract
58% of Nairobi's population live in informal settlements in extremely poor conditions. Household air pollution is one of the leading causes of premature death and disease in these settlements. Regulatory frameworks and government budgets for household air pollution do not exist and humanitarian organisations remain largely inattentive and inactive on this issue. The purpose of this paper is to evaluate the effectiveness of potential indoor-air related policies, as identified together with various stakeholders, in lowering household air pollution in Nairobi's slums. Applying a novel approach in this context, we used participatory system dynamics within a series of stakeholder workshops in Nairobi, to map and model the complex dynamics surrounding household air pollution and draw up possible policy options. Workshop participants included community members, local and national policy-makers, representatives from parastatals, NGOs and academics. Simulation modelling demonstrates that under business-as-usual, the current trend of slowly improving indoor air quality will soon come to a halt. If we aim to continue to substantially reduce household PM2.5 levels, a drastic acceleration in the uptake of clean stoves is needed. We identified the potentially high impact of redirecting investment towards household air quality monitoring and health impact assessment studies, therefore raising the public's and the government's awareness and concern about this issue and its health consequences. Such investments, due to their self-reinforcing nature, can entail high returns on investment, but are likely to give 'worse-before-better' results due to the time lags involved. We also discuss the usefulness of the participatory process within similar multi-stakeholder contexts. With important implications for such settings this work advances our understanding of the efficacy of high-level policy options for reducing household air pollution. It makes a case for the usefulness of participatory system dynamics for such complex, multi-stakeholder, environmental issues.
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Affiliation(s)
| | | | - J Milner
- London School of Hygiene and Tropical Medicine, UK
| | - K Muindi
- African Population and Health Research Center, Kenya
| | - A Ezeh
- African Population and Health Research Center, Kenya
| | - M Chege
- African Population and Health Research Center, Kenya
| | - B Mberu
- African Population and Health Research Center, Kenya
| | - C Kyobutungi
- African Population and Health Research Center, Kenya
| | | | - P Wilkinson
- London School of Hygiene and Tropical Medicine, UK
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Al-Shahethi AH, Zaki RA, Al-Serouri AWA, Bulgiba A. Maternal, prenatal and traditional practice factors associated with perinatal mortality in Yemen. Women Birth 2019; 32:e204-e215. [PMID: 30030021 DOI: 10.1016/j.wombi.2018.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Perinatal mortality remains a major international problem responsible for nearly six million stillbirths and neonatal deaths. OBJECTIVES To estimate the perinatal mortality rate in Sana'a, Yemen and to identify risk factors for perinatal deaths. METHODS A community-based prospective cohort study was carried out between 2015 and 2016. Nine-hundred and eighty pregnant women were identified and followed up to 7 days following birth. A multi-stage cluster sampling was used to select participants from community households', residing in the five districts of the Sana'a City, Yemen. RESULTS Total of 952 pregnant women were tracked up to 7 days after giving birth. The perinatal mortality rate, the stillbirth rate and the early neonatal mortality rate, were 89.3 per 1000, 46.2 per 1000 and 45.2 per 1000, respectively. In multivariable analysis older age (35+ years) of mothers at birth (Relative Risk=2.83), teenage mothers' age at first pregnancy (<18 years) (Relative Risk=1.57), primipara mothers (Relative Risk=1.90), multi-nuclear family (Relative Risk=1.74), mud house (Relative Risk=2.02), mothers who underwent female genital mutilation (Relative Risk=2.92) and mothers who chewed khat (Relative Risk=1.60) were factors associated with increased risk of perinatal death, whereas a positive mother's tetanus vaccination status (Relative Risk=0.49) were significant protective factors against perinatal deaths. CONCLUSION Rates of perinatal mortality were higher in Sana'a City compared to perinatal mortality at the national level estimated by World Health Organization. It is imperative there be sustainable interventions in order to improve the country's maternal and newborn health.
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Affiliation(s)
- Ahmed H Al-Shahethi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rafdzah Ahmad Zaki
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Clark S, Madhavan S, Kabiru C. Kin support and child health: Investigating two approaches in an African slum. SOCIAL SCIENCE RESEARCH 2018; 76:105-119. [PMID: 30268272 PMCID: PMC6170012 DOI: 10.1016/j.ssresearch.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 06/30/2018] [Accepted: 08/01/2018] [Indexed: 06/01/2023]
Abstract
Extensive research from sub-Saharan Africa shows that mothers frequently rely on help from other family members to ensure their children's health and well-being. Yet, there is considerable debate about the relative importance of support from grandmothers versus fathers. Using an innovative survey instrument to interview 462 unmarried mothers in a slum area of Nairobi, Kenya, we provide insight into this debate by showing that a status versus transfers approach to measuring kin support asks subtly different questions and yields different results. A status approach reflects an evolutionary perspective that argues that maternal grandmothers have a greater incentive than non-residential fathers to provide material and practical support for young children. In contrast, a transfers approach is consistent with social support theories whereby the social capital provided by fathers may be more beneficial to children's health than that afforded by grandmothers. Demonstrating that different approaches to measuring kin support matter highlights the need for kin research that crosses disciplinary boundaries and encourages the development of more nuanced family policies designed to protect children's health in Africa.
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Affiliation(s)
- Shelley Clark
- McGill University, Peterson Hall, 3460 McTavish, Montreal, QC, H3A 0E6, Canada.
| | - Sangeetha Madhavan
- Department of African American Studies, University of Maryland, 1119 Taliaferro Hall, College Park, MD, 20742, USA; Department of Sociology, University of Maryland, 1119 Taliaferro Hall, College Park, MD, 20742, USA.
| | - Caroline Kabiru
- African Population and Health Research Center, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
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Groot HE, Muthuri SK. Comparison of domains of self-reported physical activity between Kenyan adult urban-slum dwellers and national estimates. Glob Health Action 2018; 10:1342350. [PMID: 28718712 PMCID: PMC5533120 DOI: 10.1080/16549716.2017.1342350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) - largely the result of modifiable behavioral risks such as physical inactivity that gradually develop into physiological risks - are a main cause of morbidity and mortality worldwide. In Kenya, a nationally representative STEPwise survey of risk factors for NCDs established that 10.8% of Kenyans accumulated low levels of total physical activity. OBJECTIVES The goal of our analyses was to compare domains of self-reported physical activity in two Nairobi slums to national estimates. METHODS Levels and time of self-reported activity in three domains (work, transport, and recreation), collected as part of a SCALE-UP study conducted in Korogocho and Viwandani slums in Nairobi, were compared to STEPwise findings. RESULTS The samples included a total of 10,128 participants (5,628 slum, 4,500 national). Only 7.1% and 4.0% of slum dwellers reported low levels of work and transport physical activity, respectively, but 95.9% reported low levels of recreation-related activity. Slum residents reported higher mean daily minutes of total activity than the national estimate (499 minutes versus 291 minutes), however, both samples spent similar proportions of total activity on work (79.0% slum, 78.3% national), transport (20.4% slum, 18.1% national), and recreation (0.6% slum, 3.6% national) activities. CONCLUSIONS While the total amount of time spent in different domains of self-reported activity differs between urban slum residents and the national Kenyan population, proportions of time in each of the three domains are similar. It is important that such differences or similarities be considered when addressing NCD risk factors in these populations.
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Affiliation(s)
- Hilde E Groot
- a Departments of Population Dynamics and Reproductive Health , African Population and Health Research Center , Nairobi , Kenya.,b University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Stella K Muthuri
- a Departments of Population Dynamics and Reproductive Health , African Population and Health Research Center , Nairobi , Kenya
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Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya. ATMOSPHERE 2018. [DOI: 10.3390/atmos9090351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Exposure to air pollution is associated with adverse health outcomes. However, the health burden related to ambient outdoor air pollution in sub-Saharan Africa remains unclear. This study examined the relationship between exposure to outdoor air pollution and child health in urban slums of Nairobi, Kenya. We conducted a semi-ecological study among children under 5 years of age from two slum areas and exposure measurements of particulate matter (PM2.5) at the village level were aligned to data from a retrospective cohort study design. We used logistic and Poisson regression models to ascertain the associations between PM2.5 exposure level and child morbidity and mortality. Compared to those in low-pollution areas (PM2.5 < 25 µg/m3), children in high-pollution areas (PM2.5 ≥ 25 µg/m3) were at significantly higher risk for morbidity in general (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.11–1.41) and, specifically, cough (OR = 1.38, 95% CI: 1.20–1.48). Exposure to high levels of pollution was associated with a high child mortality rate from all causes (IRR = 1.22, 95% CI: 1.08–1.39) and respiratory causes (IRR = 1.12, 95% CI: 0.88–1.42). The findings indicate that there are associated adverse health outcomes with air pollution in urban slums. Further research on air pollution health impact assessments in similar urban areas is required.
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Harada H, Fujimori Y, Gomi R, Ahsan MN, Fujii S, Sakai A, Matsuda T. Pathotyping of Escherichia coli isolated from community toilet wastewater and stored drinking water in a slum in Bangladesh. Lett Appl Microbiol 2018; 66:542-548. [PMID: 29574855 DOI: 10.1111/lam.12878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022]
Abstract
This study investigated the occurrence of Escherichia coli pathotypes in sanitary wastewater and drinking water in a Bangladeshi urban slum and the potential associations between these sources. We examined 621 E. coli isolates from sanitary wastewater and stored drinking water by multiplex PCR and dual-index sequencing, classifying them into eight pathotypes based on 14 virulence genes and additionally evaluating the possession of the human-specific E. coli genetic biomarker H8. The proportions of pathogenic E. coli were significantly different (P < 0·001) between wastewater (18·6%) and drinking water (1·7%). StIb-positive enterotoxigenic E. coli (ETEC) were predominant in wastewater, indicating that people in the site carried ETEC. In contrast, no ETEC was present in drinking water and the proportion of H8-positive isolates was significantly smaller (7·8%) than that in wastewater (16·3%) (P = 0·001). Our findings indicate that sanitary wastewater from the slum was heavily contaminated with pathogenic E. coli, posing a great health risk. Furthermore, E. coli contamination of drinking water could be derived from not only human but also other sources. SIGNIFICANCE AND IMPACT OF THE STUDY Sanitary wastewater from an urban slum was heavily contaminated with pathogenic Escherichia coli. It is worth noting a great health risk of accidental exposure to pathogenically contaminated wastewater improperly discharged in and around urban slums. The distinct difference in pathotypes between wastewater and drinking water and the significantly smaller positive proportion of the human-specific E. coli genetic biomarker (H8) in drinking water indicate that drinking water contamination could be derived from not only human but also other sources. This highlights that pathotyping in association with the H8 marker provides an indication of pathogen contamination sources of environmental transmission media.
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Affiliation(s)
- H Harada
- Graduate School of Global Environmental Studies, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Y Fujimori
- Graduate School of Global Environmental Studies, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - R Gomi
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Nishikyo-ku, Kyoto, Japan
| | - Md N Ahsan
- Life Science School, Khulna University, Khulna, Bangladesh
| | - S Fujii
- Graduate School of Global Environmental Studies, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - A Sakai
- University of Marketing and Distribution Sciences, Nishi-ku, Kobe, Japan
| | - T Matsuda
- Research Center for Environmental Quality Management, Kyoto University, Otsu, Shiga, Japan
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Casanovas-Massana A, Costa F, Riediger IN, Cunha M, de Oliveira D, Mota DC, Sousa E, Querino VA, Nery N, Reis MG, Wunder EA, Diggle PJ, Ko AI. Spatial and temporal dynamics of pathogenic Leptospira in surface waters from the urban slum environment. WATER RESEARCH 2018; 130:176-184. [PMID: 29220718 PMCID: PMC5767135 DOI: 10.1016/j.watres.2017.11.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 05/09/2023]
Abstract
Leptospirosis has emerged as an important urban health problem as slum settlements have expanded worldwide. Yet the dynamics of the environmentally transmitted Leptospira pathogen has not been well characterized in these settings. We used a stratified dense sampling scheme to study the dynamics of Leptospira abundance in surface waters from a Brazilian urban slum community. We collected surface water samples during the dry, intermediate and rainy seasons within a seven-month period and quantified pathogenic Leptospira by quantitative PCR (qPCR). We used logistic and linear mixed models to identify factors that explained variation for the presence and concentration of Leptospira DNA. Among 335 sewage and 250 standing water samples, Leptospira DNA were detected in 36% and 34%, respectively. Among the 236 samples with positive results geometric mean Leptospira concentrations were 152 GEq/mL. The probability of finding Leptospira DNA was higher in sewage samples collected during the rainy season when increased leptospirosis incidence occurred, than during the dry season (47.2% vs 12.5%, respectively, p = 0.0002). There was a marked spatial and temporal heterogeneity in Leptospira DNA distribution, for which type of water, elevation, and time of day that samples were collected, in addition to season, were significant predictors. Together, these findings indicate that Leptospira are ubiquitous in the slum environment and that the water-related risk to which inhabitants are exposed is low. Seasonal increases in Leptospira presence may explain the timing of leptospirosis outbreaks. Effective prevention will need to consider the spatial and temporal dynamics of pathogenic Leptospira in surface waters to reduce the burden of the disease.
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Affiliation(s)
- Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, USA
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, USA; Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Universitário Canela, Salvador, Bahia, Brazil
| | - Irina N Riediger
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil; Laboratório Central do Estado do Paraná, Curitiba, Paraná, Brazil, Rua Sebastiana Santana Fraga, 1001, Guatupê, São José dos Pinhais, Paraná, Brazil
| | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, Brazil
| | - Daiana de Oliveira
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Diogenes C Mota
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Erica Sousa
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Vladimir A Querino
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Nivisson Nery
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Mitermayer G Reis
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, USA; Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil
| | - Elsio A Wunder
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, USA
| | - Peter J Diggle
- Faculty of Health and Medicine, University of Lancaster, Lancaster LA1 4YG, United Kingdom
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, USA; Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador, Bahia, Brazil.
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Shawar YR, Crane LG. Generating global political priority for urban health: the role of the urban health epistemic community. Health Policy Plan 2017; 32:1161-1173. [PMID: 28582532 PMCID: PMC5886225 DOI: 10.1093/heapol/czx065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/15/2022] Open
Abstract
Over the past decade there has been much discussion of the challenges posed by rapid urbanization in the developing world; yet the health of the urban poor, and especially those residing in low- and middle-income countries, continues to receive little political priority in most developing countries and at the global level. This research applies social science scholarship and a public policy analytical framework to assess the factors that have challenged efforts to make health in urban poor settings a priority. We conducted 19 semi-structured phone interviews with key urban health proponents and experts representing agencies that shape opinions and manage resources in global health. We also conducted a literature review, which included published scholarly literature and reports from organizations involved in urban health provision and advocacy. Utilizing a process-tracing method, we triangulated among these sources of data to create a historical narrative and analyse the factors that shape the global level of attention to and resources for urban health. The urban health agenda continues to be challenged by six factors, three of which concern the political context or characteristics of the issue: long-standing competition with the dominant development agenda that is rural health oriented; limited data and measurement tools that can effectively gauge the extent of the problem; and lack of evidence on how to best to address the issue. The other three factors are directly under the control of the urban health community: the community's ineffective governance; little common understanding among its members of the problem and how to address it; and an unconvincing framing of the issue to the public. The study offers suggestions as to what advocates can do to secure greater attention and resources in order to help address the health needs of the urban poor.
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Affiliation(s)
- Yusra Ribhi Shawar
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA and
| | - Lani G Crane
- Department of Global Health, Save the Children, Washington, DC, USA
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Snyder RE, Rajan JV, Costa F, Lima HCAV, Calcagno JI, Couto RD, Riley LW, Reis MG, Ko AI, Ribeiro GS. Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil. Trop Med Infect Dis 2017; 2:E47. [PMID: 30270904 PMCID: PMC6082112 DOI: 10.3390/tropicalmed2030047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 12/13/2022] Open
Abstract
Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities.
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Affiliation(s)
- Robert E Snyder
- Division of Epidemiology, University of California, Berkeley, CA 94720, USA.
| | - Jayant V Rajan
- Department of Medicine, University of California, San Francisco, CA 94143, USA.
| | - Federico Costa
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Helena C A V Lima
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
| | - Juan I Calcagno
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
| | - Ricardo D Couto
- Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
- School of Medicine, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Mitermayer G Reis
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- School of Medicine, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Albert I Ko
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Department of the Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT 06510, USA.
| | - Guilherme S Ribeiro
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
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Kebede Y, Andargie G, Gebeyehu A, Awoke T, Yitayal M, Mekonnen S, Wubshet M, Azmeraw T, Lakew Y, Alemu K. Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007-2013. Popul Health Metr 2017; 15:27. [PMID: 28716042 PMCID: PMC5513201 DOI: 10.1186/s12963-017-0139-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/23/2017] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. METHODS Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. RESULTS Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. CONCLUSION Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.
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Affiliation(s)
- Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Gashaw Andargie
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mamo Wubshet
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Temesgen Azmeraw
- Dabat Health and Demographic Surveillance Site, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yihunie Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
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Ajaero CK, Odimegwu CO, Chisumpa V, Obisie-Nmehielle N. The influence of internal migration on mental health status in South Africa. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2017. [DOI: 10.1080/14623730.2017.1327879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chukwuedozie K. Ajaero
- Department of Geography, University of Nigeria Nsukka, Nsukka, Nigeria
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clifford O. Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vesper Chisumpa
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkechi Obisie-Nmehielle
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Scorgie F, Vearey J, Oliff M, Stadler J, Venables E, Chersich MF, Delany-Moretlwe S. 'Leaving no one behind': reflections on the design of community-based HIV prevention for migrants in Johannesburg's inner-city hostels and informal settlements. BMC Public Health 2017; 17:482. [PMID: 28527472 PMCID: PMC5438852 DOI: 10.1186/s12889-017-4351-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors' experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project. METHODS Formative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey (n = 1458) and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components. RESULTS The project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women (56%) than men (24%). Overwhelmingly, hostel residents were internal migrants from another province, and most felt 'alienated' from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women (70%) regarded their community as unsafe (cf. 47% of men). In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. 'Community health clubs' were established to build residents' capacity to promote health and longer term well-being, and to initiate and sustain change within their communities. CONCLUSIONS To improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival.
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Affiliation(s)
- Fiona Scorgie
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jo Vearey
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
| | - Monique Oliff
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wellsense International, Kilifi, Kenya
| | - Jonathan Stadler
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emilie Venables
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Matthew F. Chersich
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ramirez-Ortiz D, Zolnikov TR. A Qualitative Study on the Interconnected Nature of HIV, Water, and Family. AIDS Behav 2017; 21:803-811. [PMID: 26874847 DOI: 10.1007/s10461-016-1334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.
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Affiliation(s)
- Daisy Ramirez-Ortiz
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
- Kenya Red Cross, Red Cross Road, Bellevue, "South C", Nairobi, Kenya
| | - Tara Rava Zolnikov
- Department of Community Health, National University, San Diego, CA, USA.
- Kenya Red Cross, Red Cross Road, Bellevue, "South C", Nairobi, Kenya.
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Wanjohi M, Griffiths P, Wekesah F, Muriuki P, Muhia N, Musoke RN, Fouts HN, Madise NJ, Kimani-Murage EW. Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya. Int Breastfeed J 2017; 12:5. [PMID: 28096888 PMCID: PMC5225512 DOI: 10.1186/s13006-016-0092-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya's urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. METHODS Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically. RESULTS Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as 'dirty' or 'curdled milk', a curse 'bad omen' associated with breastfeeding while engaging in extra marital affairs, a fear of the 'evil eye' (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers. CONCLUSION Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding. TRIAL REGISTRATION ISRCTN83692672: December 2013 (retrospectively registered).
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Affiliation(s)
- Milka Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Paula Griffiths
- Centers for Global Health and Human Development; Loughborough University, Loughborough, UK
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Peter Muriuki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Nelson Muhia
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Rachel N. Musoke
- Departments of Pediatrics, University of Nairobi, Nairobi, Kenya
| | - Hillary N. Fouts
- Department of Child and Family Studies, University of Tennessee, Knoxville, USA
| | - Nyovani J. Madise
- Center for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK
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Ochako R, Izugbara C, Okal J, Askew I, Temmerman M. Contraceptive method choice among women in slum and non-slum communities in Nairobi, Kenya. BMC WOMENS HEALTH 2016; 16:35. [PMID: 27405374 PMCID: PMC4941019 DOI: 10.1186/s12905-016-0314-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Understanding women's contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women's contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women. METHODS Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15-49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System. Bivariate and multivariate logistic regression were used to explore the association between the outcome variable, contraceptive method choice, and explanatory variables. RESULTS The prevalence of contraceptive method choice was relatively similar across slum and non-slum settlements. 34.3 % of women in slum communities and 28.1 % of women in non-slum communities reported using short-term methods. Slightly more women living in the non-slum settlements reported use of long-term methods, 9.2 %, compared to 3.6 % in slum communities. Older women were less likely to use short-term methods than their younger counterparts but more likely to use long-term methods. Currently married women were more likely than never married women to use short-term and long-term methods. Compared to those with no children, women with three or more children were more likely to report using long term methods. Women working outside the home or those in formal employment also used modern methods of contraception more than those in self-employment or unemployed. CONCLUSION Use of short-term and long-term methods is generally low among women living in slum and non-slum contexts in Nairobi. Investments in increasing women's access to various contraceptive options are urgently needed to help increase contraceptive prevalence rate. Thus, interventions that focus on more disadvantaged segments of the population will accelerate contraceptive uptake and improve maternal and child health in Kenya.
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Affiliation(s)
- Rhoune Ochako
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | | | - Ian Askew
- World Health Organization, Geneva, Switzerland
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Egondi T, Muindi K, Kyobutungi C, Gatari M, Rocklöv J. Measuring exposure levels of inhalable airborne particles (PM2.5) in two socially deprived areas of Nairobi, Kenya. ENVIRONMENTAL RESEARCH 2016; 148:500-506. [PMID: 27152713 DOI: 10.1016/j.envres.2016.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Ambient air pollution is a growing global health concern tightly connected to the rapid global urbanization. Health impacts from outdoor air pollution exposure amounts to high burdens of deaths and disease worldwide. However, the lack of systematic collection of air pollution and health data in many low-and middle-income countries remains a challenge for epidemiological studies in the local environment. This study aimed to provide a description of the particulate matter (PM2.5) concentration in the poorest urban residential areas of Nairobi, Kenya. METHODS Real-time measurements of (PM2.5) were conducted in two urban informal settlements of Nairobi City, Kenya"s Capital, from February 2013 to October 2013. The measurements were conducted using DustTrak II 8532 hand-held samplers at a height of about 1.5m above ground level with a resolution of 1-min logging. Sampling took place from early morning to evenings according to a fixed route of measurement within areas including fixed geographical checkpoints. RESULTS The study period average concentration of PM2.5 was 166μg/m(3) in the Korogocho area and 67μg/m(3) in the Viwandani area. The PM2.5 levels in both areas reached bimodal daily peaks in the morning and evening. The average peak value of morning concentration in Korogocho was 214μg/m(3), and 164μg/m(3) in the evening and in Viwandani was 76μg/m(3) and 82μg/m(3) respectively. The daily mid-day average low observed during was 146μg/m(3) in Korogocho and 59μg/m(3) in Viwandani. CONCLUSION The results show that residents in both slums are continuously exposed to PM2.5 levels exceeding hazardous levels according to World Health Organization guidelines. The study showed a marked disparity between the two slum areas situated only 7km apart indicating the local situation and sources to be very important for exposure to PM2.5.
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Affiliation(s)
- Thaddaeus Egondi
- African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden.
| | - Kanyiva Muindi
- African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden.
| | - Catherine Kyobutungi
- African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Michael Gatari
- Institute of Nuclear Science and Technology, College of Architecture & Engineering, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden.
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Wilunda B, Ng N, Stewart Williams J. Health and ageing in Nairobi's informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study. BMC Public Health 2015; 15:1231. [PMID: 26652252 PMCID: PMC4676180 DOI: 10.1186/s12889-015-2556-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much of the focus on population ageing has been in high-income counties. Relatively less attention is given to the world's poorest region, Sub-Saharan Africa (SSA) where children and adolescents still comprise a high proportion of the population. Yet the number of adults aged 60-plus in SSA is already twice that in northern Europe. In addition, SSA is experiencing massive rural to urban migration with consequent expansion of informal urban settlements, or slums, whose health problems are usually unrecognised and not addressed. This study aims to improve understanding of functional health and well-being in older adult slum-dwellers in Nairobi (Kenya). METHODS The study sample comprised men and women, aged 50 years and over, living in Korogocho and Viwandani, Nairobi, Kenya (n = 1,878). Data from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) and the WHO Study on global AGEing and adult health (SAGE Wave 1) were analysed. The prevalence of poor self-reported quality of life (QoL) and difficulties in domain-specific function is estimated by age and sex. Logistic regression investigates associations between difficulties in the domains of function and poor QoL, adjusting for age, sex and socio-demographic factors. Statistical significance is set at P<0.05. RESULTS Women reported poorer QoL and greater functional difficulties than men in all domains except self-care. In the multivariable logistic regression the odds of poor QoL among respondents with problems or difficulties in relation to affect (OR = 7.0; 95%CI = 3.0-16.0), pain/discomfort (OR = 3.6; 95%CI = 2.3-5.8), cognition (OR = 1.8; 95 %CI = 1.2-2.9) and mobility (OR = 1.8; 95%CI = 1.1-2.8) were statistically significant. CONCLUSIONS The findings underscore differences in the domains of functional health that encapsulate women and men's capacities to perform regular activities and the impact of poor functioning on QoL. Investing in the health and QoL of older people in SSA will be crucial in helping the region to realise key development goals and in opening opportunities for improved health outcomes and sustainable economic development.
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Affiliation(s)
- Boniface Wilunda
- United Nations Office at Nairobi (UNON), UN Gigiri Office Complex, Block X, P.O Box 30218-00100, Nairobi, Kenya.
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden. .,Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden.
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.
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van de Vijver S, Oti S, Oduor C, Ezeh A, Lange J, Agyemang C, Kyobutungi C. Challenges of health programmes in slums. Lancet 2015; 386:2114-2116. [PMID: 26452707 DOI: 10.1016/s0140-6736(15)00385-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.
| | - Samuel Oti
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
| | - Clement Oduor
- African Population and Health Research Center, Nairobi, Kenya
| | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Joep Lange
- Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands
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