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Odii A, Arize I, Agwu P, Mbachu C, Onwujekwe O. To What Extent Are Informal Healthcare Providers in Slums Linked to the Formal Health System in Providing Services in Sub-Sahara Africa? A 12-Year Scoping Review. J Urban Health 2024:10.1007/s11524-024-00885-5. [PMID: 38874863 DOI: 10.1007/s11524-024-00885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
The contributions of informal providers to the urban health system and their linkage to the formal health system require more evidence. This paper highlights the collaborations that exist between informal providers and the formal health system and examines how these collaborations have contributed to strengthening urban health systems in sub-Sahara Africa. The study is based on a scoping review of literature that was published from 2011 to 2023 with a focus on slums in sub-Sahara Africa. Electronic search for articles was performed in Google, Google Scholar, PubMed, African Journal Online (AJOL), Directory of Open Access Journals (DOAJ), ScienceDirect, Web of Science, Hinari, ResearchGate, and yippy.com. Data extraction was done using the WHO health systems building blocks. The review identified 26 publications that referred to collaborations between informal providers and formal health systems in healthcare delivery. The collaboration is manifested through formal health providers registering and standardizing the practice of informal health providers. They also participate in training informal providers and providing free medical commodities for them. Additionally, there were numerous instances of client referrals, either from informal to formal providers or from formal to informal providers. However, the review also indicates that these collaborations are unformalized, unsystematic, and largely undocumented. This undermines the potential contributions of informal providers to the urban health system.
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Affiliation(s)
- Aloysius Odii
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Sociology/Anthropology Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Ifeyinwa Arize
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Social Work Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
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Slekiene J, Swan N, Kalina M. Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa. BMC Public Health 2024; 24:912. [PMID: 38549068 PMCID: PMC10976708 DOI: 10.1186/s12889-024-18396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system. METHODS The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model. RESULTS Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver. CONCLUSIONS Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.
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Affiliation(s)
- Jurgita Slekiene
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Ranas Ltd, Zurich, Switzerland
| | - Nick Swan
- Green Corridors, Durban, South Africa
| | - Marc Kalina
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
- School of Engineering, University of KwaZulu-Natal, Durban, South Africa.
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Jordaan JI, Phillips N, Hoare J. Living through a pandemic: depression and anxiety experienced by youth living with HIV in South Africa. AIDS Care 2024; 36:44-52. [PMID: 38029423 DOI: 10.1080/09540121.2023.2282072] [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] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Youth living with HIV (YLHIV) face significant psychosocial challenges and are at increasedrisk of developing depression and anxiety. This study aims to invesBgate symptoms ofdepression, anxiety and associaBons with psychosocial factors in YLHIV during the first andthird waves of the COVID-19 pandemic. This longitudinal study enrolled 135 YLHIV (ages 12-21) in Cape Town, South Africa. Measures administered telephonically included theCoRonavIruS Health Impact Survey (CRISIS quesBonnaire), Center for Epidemiologic StudiesDepression Scale (CES-D), Beck Anxiety Inventory and Beck Youth Inventory. During the firstwave of COVID-19, 7.5% and 8.0% of YLHIV were depressed (<18 and ≥18 years,respecBvely), and 10% and 4% of parBcipants were anxious (<18 and ≥18 years). During thethird wave, 8.9% and 40.6% of YLHIV were depressed (<18 and ≥18 years), and 13.3% and12.5% (<18 and ≥18 years) were anxious. Depression and anxiety were measured using cutoffscores provided by clinical measures. Symptoms of depression and anxiety in YLHIVescalated over the course of the COVID-19 pandemic. Socio-economic factors, substanceuse, disrupted support and stability concerns were associated with depression and anxiety.These data highlight the increasing need of mental health support and social intervenBonsfor YLHIV in post-pandemic South Africa.
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Affiliation(s)
- Jeannere I Jordaan
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Oyekunle V, Tomita A, Gibbs A. Cluster randomized controlled trial of Stepping Stones and Creating Futures to reduce mental health challenges among young men in informal settlements in KwaZulu-Natal Province, South Africa. Int J Soc Psychiatry 2023; 69:1712-1722. [PMID: 37272405 PMCID: PMC10657496 DOI: 10.1177/00207640231174370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting. AIM This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement. METHODS A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology. RESULTS At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p = .04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p = .03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group. CONCLUSION SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements.
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Affiliation(s)
- Victoria Oyekunle
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Psychology, University of Exeter, UK
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Kubeka Z, Modjadji P. Association of Stunting with Socio-Demographic Factors and Feeding Practices among Children under Two Years in Informal Settlements in Gauteng, South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1280. [PMID: 37628279 PMCID: PMC10453658 DOI: 10.3390/children10081280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Despite improvements in childhood undernutrition through integrated nutritional programs in South Africa, stunting among children remains persistent, and is attributed to poor socio-demographic status. This context has been implicated in disrupting mothers' decisions regarding effective infant feeding, ultimately meaning that children's nutritional demands remain unmet. In view of this, we conducted a cross-sectional study to determine the association between socio-demographic factors and infant and young child feeding (IYCF) practices and stunting among children under two years receiving primary health care in informal settlements in Gauteng, South Africa. A validated questionnaire was used to assess mothers' socio-demographic status and feeding practices using WHO core indicators. Stunting was defined as length-for age z-scores (LAZ) below -2 standard deviation, computed using WHO Anthro software version 3.2.2.1 using age, sex, and anthropometric measurements of children. Univariate and multivariate analyses were stratified by stunting to determine the relationship with socio-demographic, infant, and IYCF factors using STATA 17. The prevalence of stunting was 16% among surveyed children under two years (with a mean age of 8 ± 5 months) living in poor socio-demographic households. Poor feeding practices were characterized by delayed initiation of breastfeeding (58%), sub-optimal exclusive breastfeeding (29%), discontinued breastfeeding (44%), early introduction of solid foods (41%), and low dietary diversity (97%). Significant differences in terms of child's age, monthly household income, and ever being breastfed were observed (Chi square test and univariate analysis). After controlling for potential confounders, stunting was significantly associated with child's age [12-23 months: AOR = 0.35, 95% CI: 0.16-0.76], and monthly household income [ZAR 3000-ZAR 5000: AOR = 0.47, 95% CI: 0.26-0.86]. Despite the few aforementioned socio-demographic and IYCF factors associated with stunting, this study reiterates stunting as the commonest poor nutritional status indicator among children under two years, suggesting the presence of chronic undernutrition in these poverty-stricken informal settlements. A multisectoral approach to address stunting should be context-specific and incorporate tailor-made interventions to promote optimal infant-feeding practices. Conducting future nutrient assessments focusing on children is imperative.
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Affiliation(s)
- Zandile Kubeka
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
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Nejad FN, Ghamari MR, Kamal SHM, Tabatabaee SS. Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents. J Prev Med Public Health 2023; 56:327-337. [PMID: 37551071 PMCID: PMC10415645 DOI: 10.3961/jpmph.23.059] [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] [Received: 02/05/2023] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran. METHODS Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority. RESULTS Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources. CONCLUSIONS Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.
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Affiliation(s)
- Farhad Nosrati Nejad
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Mohammad Reza Ghamari
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad,
Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad,
Iran
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Mokhele T, Mutyambizi C, Manyaapelo T, Ngobeni A, Ndinda C, Hongoro C. Determinants of Deteriorated Self-Perceived Health Status among Informal Settlement Dwellers in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4174. [PMID: 36901185 PMCID: PMC10001468 DOI: 10.3390/ijerph20054174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Self-perceived health (SPH) is a widely used measure of health amongst individuals that indicates an individual's overall subjective perception of their physical or mental health status. As rural to urban migration increases, the health of individuals within informal settlements becomes an increasing concern as these people are at high health and safety risk due to poor housing structures, overcrowding, poor sanitation and lack of services. This paper aimed to explore factors related to deteriorated SPH status among informal settlement dwellers in South Africa. This study used data from the first national representative Informal Settlements Survey in South Africa conducted by the Human Sciences Research Council (HSRC) in 2015. Stratified random sampling was applied to select informal settlements and households to participate in the study. Multivariate logistic regression and multinomial logistic regression analyses were performed to assess factors affecting deteriorated SPH among the informal settlement dwellers in South Africa. Informal settlement dwellers aged 30 to 39 years old (OR = 0.332 95%CI [0.131-0.840], p < 0.05), those with ZAR 5501 and more household income per month (OR = 0.365 95%CI [0.144-0.922], p < 0.05) and those who reported using drugs (OR = 0.069 95%CI [0.020-0.240], p < 0.001) were significantly less likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. Those who reported always running out of food (OR = 3.120 95%CI [1.258-7.737], p < 0.05) and those who reported having suffered from illness or injury in the past month preceding the survey (OR = 3.645 95%CI [2.147-6.186], p < 0.001) were significantly more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. In addition, those who were employed were significantly (OR = 1.830 95%CI [1.001-3.347], p = 0.05) more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than those who were unemployed with neutral SPH as a base category. Overall, the results from this study point to the importance of age, employment, income, lack of food, drug use and injury or illness as key determinants of SPH amongst informal settlement dwellers in South Africa. Given the rapid increasing number of informal settlements in the country, our findings do have implications for better understanding the drivers of deteriorating health in informal settlements. It is therefore recommended that these key factors be incorporated into future planning and policy development aimed at improving the standard of living and health of these vulnerable residents.
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Affiliation(s)
- Tholang Mokhele
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | | | - Thabang Manyaapelo
- Africa Health Research Institute, KwaZulu-Natal, Somkhele 3935, South Africa
| | | | - Catherine Ndinda
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town 8000, South Africa
| | - Charles Hongoro
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Pretoria 0001, South Africa
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Wulandari RD, Laksono AD, Mubasyiroh R, Rachmalina R, Ipa M, Rohmah N. Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective? BMC Public Health 2023; 23:92. [PMID: 36635640 PMCID: PMC9835297 DOI: 10.1186/s12889-023-15017-y] [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: 08/18/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND An urban poor is a vulnerable group that needs government financing support to access health services. Once they are sick, they will fall deeper into poverty. The study aims to analyze the effectiveness of government-run insurance in hospital utilization in urban poor in Indonesia. METHODS The research analyzed the 2018 Indonesian Basic Health Survey data. This cross-sectional survey collected 75,970 participants through stratification and multistage random sampling. Meanwhile, the study employed hospital utilization as an outcome variable and health insurance ownership as an exposure variable. Moreover, the study looked at age, gender, marital status, education, and occupation as control factors. The research employed a binary logistic regression to evaluate the data in the final step. RESULTS The results show that someone with government-run insurance is 4.261 times more likely than the uninsured to utilize the hospital (95% CI 4.238-4.285). Someone with private-run insurance is 4.866 times more likely than the uninsured to use the hospital (95% CI 4.802-4.931). Moreover, someone with government-run and private-run insurance has 11.974 times more likely than the uninsured to utilize the hospital (95% CI 11.752-12.200). CONCLUSION The study concluded that government-run insurance is more effective than the uninsured in improving hospital utilization among the urban poor in Indonesia. Meanwhile, private-run is more effective than government-run and uninsured in improving hospital utilization among the urban poor in Indonesia. Moreover, the most effective is to combine the kind of health insurance ownership (government-run and private-run).
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Affiliation(s)
- Ratna Dwi Wulandari
- grid.440745.60000 0001 0152 762XFaculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Agung Dwi Laksono
- National Research and Innovation Agency, the Republic of Indonesia, Jakarta, Indonesia
| | - Rofingatul Mubasyiroh
- National Research and Innovation Agency, the Republic of Indonesia, Jakarta, Indonesia
| | - Rika Rachmalina
- National Research and Innovation Agency, the Republic of Indonesia, Jakarta, Indonesia
| | - Mara Ipa
- National Research and Innovation Agency, the Republic of Indonesia, Jakarta, Indonesia
| | - Nikmatur Rohmah
- grid.443500.60000 0001 0556 8488Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
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Leung Soo C, Pant Pai N, Bartlett SJ, Esmail A, Dheda K, Bhatnagar S. Socioeconomic factors impact the risk of HIV acquisition in the township population of South Africa: A Bayesian analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001502. [PMID: 36963084 PMCID: PMC10021863 DOI: 10.1371/journal.pgph.0001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023]
Abstract
With a prevalence almost twice as high as the national average, people living in South African townships are particularly impacted by the HIV epidemic. Yet, it remains unclear how socioeconomic factors impact the risk of HIV infection within township populations. Our objective was to estimate the extent to which socioeconomic factors (dwelling situation, education, employment status, and monthly income) explain the risk of HIV in South African township populations, after controlling for behavioural and individual risk factors. Using Bayesian logistic regression, we analysed secondary data from a quasi-randomised trial which recruited participants (N = 3095) from townships located across three subdistricts of Cape Town. We controlled for individual factors (age, sex, marital status, testing history, HIV exposure, comorbidities, and tuberculosis infection) and behavioural factors (unprotected sex, sex with multiple partners, with sex workers, with a partner living with HIV, under the influence of alcohol or drugs), and accounted for the uncertainty due to missing data through multiple imputation. We found that residing in informal dwellings and not having post-secondary education increased the odds of HIV (aOR, 89% CrI: 1.34, 1.07-1.68 and 1.82, 1.29-2.61, respectively), after controlling for subdistrict of residence, individual, and behavioural factors. Additionally, our results suggest different pathways for how socioeconomic status (SES) affect HIV infection in males and female participants: while socioeconomic factors associated with lower SES seem to be associated with a decreased likelihood of having recently sough HIV testing among male participants, they are associated with increased sexual risk taking which, among female participants, increase the risk of HIV. Our analyses demonstrate that social determinants of health are at the root of the HIV epidemic and affect the risk of HIV in multiple ways. These findings stress the need for the deployment of programs that specifically address social determinants of health.
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Affiliation(s)
- Cindy Leung Soo
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sahir Bhatnagar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Mansour A, Bentley R, Baker E, Li A, Martino E, Clair A, Daniel L, Mishra SR, Howard NJ, Phibbs P, Jacobs DE, Beer A, Blakely T, Howden-Chapman P. Housing and health: an updated glossary. J Epidemiol Community Health 2022; 76:833-838. [PMID: 35760516 DOI: 10.1136/jech-2022-219085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/15/2022] [Indexed: 01/10/2023]
Abstract
Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.
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Affiliation(s)
- Adelle Mansour
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Bentley
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emma Baker
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ang Li
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Erika Martino
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amy Clair
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lyrian Daniel
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shiva Raj Mishra
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Phibbs
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, New South Wales, Australia
| | - David E Jacobs
- National Center for Healthy Housing, Columbia, Maryland, USA.,University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrew Beer
- UniSA Business, University of South Australia, Adelaide, South Australia, Australia
| | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippa Howden-Chapman
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
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Influence of Urban Informal Settlements on Trace Element Accumulation in Road Dust and Their Possible Health Implications in Ekurhuleni Metropolitan Municipality, South Africa. TOXICS 2022; 10:toxics10050253. [PMID: 35622666 PMCID: PMC9145476 DOI: 10.3390/toxics10050253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
The study was aimed at assessing the influence of urban informal settlement on trace element accumulation in road dust from the Ekurhuleni Metropolitan Municipality, South Africa, and their possible health implications. The concentration of major and trace elements was determined using the wavelength dispersive XRF method. The major elements in descending order were SiO2 (72.76%), Al2O3 (6.90%), Fe2O3 (3.88%), CaO (2.71%), K2O (1.56%), Na2O (0.99%), MgO (0.94%), MnO (0.57%), TiO2 (0.40%), and P2O5 (0.16%), with SiO2 and P2O5 at above-average shale values. The average mean concentrations of 17 trace elements in decreasing order were Cr (637.4), Ba (625.6), Zn (231.8), Zr (190.2), Sr (120.2), V (69), Rb (66), Cu (61), Ni (49), Pb (30.8), Co (17.4), Y (14.4), Nb (8.6), As (7.2), Sc (5.8), Th (4.58), and U (2.9) mg/kg. Trace elements such as Cr, Cu, Zn, Zr, Ba, and Pb surpassed their average shale values, and only Cr surpassed the South African soil screening values. The assessment of pollution through the geo-accumulation index (Igeo) revealed that road dust was moderately to heavily contaminated by Cr, whereas all other trace elements were categorized as being uncontaminated to moderately contaminated. The contamination factor (CF) exhibited road dust to be very highly contaminated by Cr, moderately contaminated by Zn, Pb, Cu, Zr, and Ba, and lowly contaminated by Co, U, Nb, Ni, As, Y, V, Rb, Sc, Sr, and Th. The pollution load index (PLI) also affirmed that the road dust in this study was very highly polluted by trace elements. Moreover, the results of the enrichment factor (EF) categorized Cr as having a significant degree of enrichment. Zn was elucidated as being minimally enriched, whereas all other trace elements were of natural origin. The results of the non-carcinogenic risk assessment revealed a possibility of non-carcinogenic risks to both children and adults. For the carcinogenic risk, the total CR values in children and adults were above the acceptable limit, signifying a likelihood of carcinogenic risk to the local inhabitants. From the findings of this study, it can be concluded that the levels of trace elements in the road dust of this informal settlement had the possibility to contribute to both non-carcinogenic and carcinogenic risks, and that children were at a higher risk than the adult population.
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Abstract
Informal settlements in developing countries have attracted widespread attention, and existing research is mainly concerned with the causes and evolution of informal settlements. However, few studies have focused on investigating the spatial governance strategies of informal settlements in order to understand the evolution of informal settlements in the context of institutional arrangements. The aim of this research is to develop a framework for the spatial governance of informal settlements to explain their causes. The research finds that informal settlements in China are influenced by an urban–rural dual land system in which the collective land ownership system means that villagers are ambiguous in their approach to land development. During rapid urbanization, villagers have adopted diverse land development strategies based on land rent incentives to attract capital investment and earn profits, which has led to the rapid spread of informal settlements.
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Ali MAS, Yi L. Evaluating the nexus between ongoing and increasing urbanization and carbon emission: a study of ARDL-bound testing approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:27548-27559. [PMID: 34981377 DOI: 10.1007/s11356-021-17858-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/26/2021] [Indexed: 05/27/2023]
Abstract
The growing urbanization has created a substantial economic imbalance between the urban and rural households in the world's emerging economies and put a significant effect on carbon dioxide emissions. Simultaneously, many researchers have grown concerned by the significant consequences of urbanization on carbon emissions. In current research, we make an effort in Pakistan to investigate how urbanization affects the carbon emissions. In order to attain the intended goals of long run and short run investigation, we employed the most appropriate method of auto-regressive distributed lag model for time series data-set, while the vector error correction model, on the other hand, was employed to investigate causation. The estimated findings of the auto-regressive distributed lag model supported the association amongst the model's selected variables. In long and short run, the estimated findings approved that as the level of urbanization rises, so does the carbon emissions. Furthermore, the estimated results of the vector error correction model acknowledged the validity of short run unidirectional causal relationship from urbanization towards carbon emissions and from carbon emission towards energy consumption, as well as in short run, where economic growth one-way Granger generates the carbon emission. To summarize, based on the current findings, that reflects the significance of the underlined factors. The study recommends that government should prioritize the development of energy efficient and environment friendly strategies with respect to fast growing urbanization to control the carbon emission.
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Affiliation(s)
| | - Lan Yi
- International Business School, Shaanxi Normal University, Xi'an, 710119, China.
- Jinhe Center for Economic Research, Xian Jiaotong University, Xian, 710049, China.
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Psaki SR, Pulerwitz J, Zieman B, Hewett PC, Beksinska M. What are we learning about HIV testing in informal settlements in KwaZulu-Natal, South Africa? Results from a randomized controlled trial. PLoS One 2022; 17:e0257033. [PMID: 35259151 PMCID: PMC8903271 DOI: 10.1371/journal.pone.0257033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Recent evidence highlighting high HIV incidence and prevalence in informal settlements suggests that they are environments that foster HIV risk. Given growing urbanization in sub-Saharan Africa, there is a critical need to assess the successes and challenges of implementing HIV testing, prevention and treatment interventions in these contexts. Methods We randomly selected a household-based sample of 1528 adult men (18–35) and women (18–24) living in 18 randomly selected communities in KZN, South Africa. After the baseline interview, communities were randomized to one of three intervention rollout arms in a stepped wedge design. At approximately 8-month intervals, the Asibonisane Community Responses Program (and in particular the implementation of Stepping Stones, a participatory HIV prevention program focused on strengthening relationships and communication) was rolled at by intervention phase. Using data from this evaluation, we describe levels and trends in HIV testing and treatment during follow-up, and we use fixed effects models to estimate the effects of participation in the program on testing. Results Study respondents reported high levels of economic insecurity and mobility, and men report various HIV risk behaviors including about 50% reporting multiple partnerships. About two-thirds of respondents (73% of women, 63% of men) had been tested for HIV in the last six months. Among those living with HIV, treatment levels were high at baseline, and almost universal by endline in 2019. Program participation led to a 17% increase in the probability of testing for women (p<0.05) but had no effect on testing for men due, in part, to the fact that the program did not reach men who were least likely to be tested, including those who had migrated recently, and those who had never been tested at baseline. Conclusions Near universal HIV treatment use demonstrates positive trends in access to some HIV services (including treatment as prevention) in these communities. Stepping Stones had positive effects on HIV testing for women, yet barriers to HIV testing remain, especially for men. Redoubled efforts to reach men with testing are vital for improving HIV outcomes for both men and their partners.
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Affiliation(s)
- Stephanie R. Psaki
- Population Council/Project SOAR, New York, New York, United States of America
- * E-mail:
| | - Julie Pulerwitz
- Population Council/Project SOAR, Washington, DC, United States of America
| | - Brady Zieman
- Population Council/Project SOAR, Blantyre, Malawi
| | - Paul C. Hewett
- Population Council/Project SOAR, Washington, DC, United States of America
| | - Mags Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mkhwanazi S, Gibbs A. Risk factors for generalized anxiety disorder among young women and men in informal settlements in South Africa: A cross-sectional study. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ferreira GRON, de Oliveira IS, Freitas WLS, Lira ALBDC, Reis RK, Gir E, Ramos AMPC, Gonçalves LHT, Botelho EP. Factors associated with low knowledge about sexually transmitted infections in subnormal agglomerate, in the Brazilian Amazon. Prim Health Care Res Dev 2021; 22:e70. [PMID: 34763742 PMCID: PMC8628559 DOI: 10.1017/s1463423621000700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/30/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Populations living in subnormal agglomerates in urban areas are more vulnerable to infections, including sexually transmitted infections (STIs). In these groups, inadequate knowledge about sexually transmitted infections can further increase the risk of contracting STIs. AIM We investigated the factors associated with low knowledge about STIs in a peripheral population in the Brazilian Amazon. METHODS This cross-sectional study was conducted in Belém, in the Amazon region that has a high percentage of subnormal agglomerates in an urban area and a high incidence of STIs. Random sampling was adopted which resulted in a sample of 320 participants. To assess knowledge about STIs, the self-administered Sexually Transmitted Disease Knowledge Questionnaire was used. To assess aspects of vulnerability, a questionnaire was constructed which is linked to individual, social, and programmatic factors. The chi-square test, G test, and ordinal regression analyses were all performed. FINDINGS The sample of this study was composed of 320 participants. The mean age of the participants was 46.09 years. 37.5% (120), 50.6% (162), and 11.9% (38) showed low, medium, and high knowledge, respectively. Multiple analysis revealed that the factors associated with higher chance of having smaller knowledge about sexually transmitted infections were single/separated/divorced/widow(er) marital status (AOR: 1.80, CI: 1.15-2.84, P = 0.01); income equal to or less than one minimum wage (1.98, CI: 1.21-3.17, P = 0.00); equal to or over than 52 years old (AOR: 1.99, CI: 1.25-3.17, P = 0.00); lack of guidance by a health professional (AOR: 1.59, CI: 1.01-2.51, P = 0.04). Our results show that this community suffer from suboptimal levels of knowledge on STIs, which are linked to individual, social, and programmatic factors. Characterising the risk and vulnerabilities factors allows for carrying out appropriate interventions for populations living in subnormal agglomerates in urban area.
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Affiliation(s)
| | | | | | | | - Renata Karina Reis
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Elucir Gir
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
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Association of Urban Liveability with Cancer Incidence in Iran: A Nationwide Ecological Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Urban liveability is a multidimensional concept associated with many domains of human health. Objectives: This study aimed at investigating the association between urban liveability and cancer incidence in Iran. Methods: The data of provincial-level urban liveability were obtained from reliable sources. The data of cancer incidence were inquired from the population-based cancer registry of the Iranian Ministry of Health and Medical Education in 2016. Urban liveability scores were determined in all provinces of Iran by utilizing the Global Liveable City Index (GLCI) method. Negative binomial Poisson regression was used to examine the relationship between urban liveability and cancer incidence. Results: Provinces with a higher urban liveability had a higher likelihood of cancer incidence. Higher economic score was significantly associated with higher incidence in colorectal (IRR = 1.49, P = 0.005), liver (IRR = 1.48, P = 0.002), leukemia (IRR = 1.39, P = 0.005), lung (IRR = 1.39, P = 0.039), breast (IRR = 1.38, P = 0.011), and prostate cancers (IRR = 2.11, P < 0.001). Also, provinces with higher environmental friendliness and sustainability had significantly more stomach (IRR = 1.53, P = 0.004), colorectal (1.79, P < 0.001), lung (IRR = 1.43, P = 0.014), and prostate (IRR = 1.50, P = 0.032) cancer incidence. Provinces with higher political governance had significantly more breast cancer (IRR = 1.34, P = 0.002) and leukemia (IRR = 1.30, P = 0.016) incidence rates. Conclusions: Along with the development of urban liveability, the incidence of cancers is increasing in Iran. Cancer control strategies should be implemented especially in settings with higher urbanization.
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Haywood LK, Kapwata T, Oelofse S, Breetzke G, Wright CY. Waste Disposal Practices in Low-Income Settlements of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158176. [PMID: 34360468 PMCID: PMC8346154 DOI: 10.3390/ijerph18158176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
Domestic solid waste is rapidly increasing due to accelerated population growth and urbanization. Improper waste disposal poses potential health risks and environmental concerns. Here, we investigated waste disposal practices in relation to household/dwelling characteristics in South African low-income communities. Data for 2014 to 2019 from a community-orientated primary care program were analyzed using logistic regression. Families who reported living in a shack were more likely to dump waste in the street. Households who reported using non-electric sources of fuel for heating/cooking, those who lacked proper sanitation, and those who did not have access to piped water inside the dwelling were more likely to dispose of waste by dumping it in the street/in the yard or burying it. Families living in low-income settlements are at risk of solid waste exposure and this situation is exacerbated by poor access to piped water, proper sanitation, and electricity.
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Affiliation(s)
- Lorren Kirsty Haywood
- Smart Places, Council of Scientific and Industrial Research (CSIR), Pretoria 0001, South Africa;
- Correspondence:
| | - Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa;
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, P.O. Box 524, Auckland Park 2006, South Africa
| | - Suzan Oelofse
- Smart Places, Council of Scientific and Industrial Research (CSIR), Pretoria 0001, South Africa;
- Unit for Environmental Science and Management, North West University, Pothchefstroom 2502, South Africa
| | - Gregory Breetzke
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa; (G.B.); (C.Y.W.)
| | - Caradee Yael Wright
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa; (G.B.); (C.Y.W.)
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
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Nejad FN, Ghamari MR, Mohaqeqi Kamal SH, Tabatabaee SS, Ganjali R. The Most Important Social Determinants of Slum Dwellers' Health: A Scoping Review. J Prev Med Public Health 2021; 54:265-274. [PMID: 34370940 PMCID: PMC8357537 DOI: 10.3961/jpmph.21.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants. Methods This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness. Results Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers. Conclusions This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.
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Affiliation(s)
- Farhad Nosrati Nejad
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Reza Ghamari
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raheleh Ganjali
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Evaluating the Relationship between Park Features and Ecotherapeutic Environment: A Comparative Study of Two Parks in Istanbul, Beylikdüzü. SUSTAINABILITY 2021. [DOI: 10.3390/su13094600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The impacts of problems related to dense, unplanned, and irregular urbanization on the natural environment, urban areas, and humankind have been discussed in many disciplines for decades. Because of the circular relationship between humans and their environment, human health and psychology have become both agents and patients in interactions with nature. The field of ecopsychology investigates within this reciprocal context the relationship between human psychology and ecological issues and the roles of human psychology and society in environmental problems based on deteriorated nature–human relationships in urbanized areas. This approach has given rise to ecotherapy, which takes a systemic approach to repairing this disturbed nature–human relationship. This study aims to uncover the relationship between the physical attributes of urban green areas and their potential for providing ecotherapy service to users, first by determining the characteristics of ecotherapeutic urban space and urban green areas given in studies in the ecopsychology and ecotherapy literature, and then by conducting a case study in two urban parks from the Beylikdüzü District of the Istanbul Metropolitan Area. The impacts of these parks’ changing physical characteristics on user experiences are determined through a comparison of their physical attributes and the user experiences related to their ecotherapy services.
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Upfold NS, Luke GA, Knox C. Occurrence of Human Enteric Viruses in Water Sources and Shellfish: A Focus on Africa. FOOD AND ENVIRONMENTAL VIROLOGY 2021; 13:1-31. [PMID: 33501612 PMCID: PMC7837882 DOI: 10.1007/s12560-020-09456-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/16/2020] [Indexed: 05/02/2023]
Abstract
Enteric viruses are a diverse group of human pathogens which are primarily transmitted by the faecal-oral route and are a major cause of non-bacterial diarrhoeal disease in both developed and developing countries. Because they are shed in high numbers by infected individuals and can persist for a long time in the environment, they pose a serious threat to human health globally. Enteric viruses end up in the environment mainly through discharge or leakage of raw or inadequately treated sewage into water sources such as springs, rivers, dams, or marine estuaries. Human exposure then follows when contaminated water is used for drinking, cooking, or recreation and, importantly, when filter-feeding bivalve shellfish are consumed. The human health hazard posed by enteric viruses is particularly serious in Africa where rapid urbanisation in a relatively short period of time has led to the expansion of informal settlements with poor sanitation and failing or non-existent wastewater treatment infrastructure, and where rural communities with limited or no access to municipal water are dependent on nearby open water sources for their subsistence. The role of sewage-contaminated water and bivalve shellfish as vehicles for transmission of enteric viruses is well documented but, to our knowledge, has not been comprehensively reviewed in the African context. Here we provide an overview of enteric viruses and then review the growing body of research where these viruses have been detected in association with sewage-contaminated water or food in several African countries. These studies highlight the need for more research into the prevalence, molecular epidemiology and circulation of these viruses in Africa, as well as for development and application of innovative wastewater treatment approaches to reduce environmental pollution and its impact on human health on the continent.
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Affiliation(s)
- Nicole S Upfold
- Department of Biochemistry and Microbiology, Rhodes University, Grahamstown, 6140, South Africa
| | - Garry A Luke
- Centre for Biomolecular Sciences, School of Biology, Biomolecular Sciences Building, University of St Andrews, North Haugh, St Andrews, Scotland, KY16 9ST, UK
| | - Caroline Knox
- Department of Biochemistry and Microbiology, Rhodes University, Grahamstown, 6140, South Africa.
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Leder K, Openshaw JJ, Allotey P, Ansariadi A, Barker SF, Burge K, Clasen TF, Chown SL, Duffy GA, Faber PA, Fleming G, Forbes AB, French M, Greening C, Henry R, Higginson E, Johnston DW, Lappan R, Lin A, Luby SP, McCarthy D, O'Toole JE, Ramirez-Lovering D, Reidpath DD, Simpson JA, Sinharoy SS, Sweeney R, Taruc RR, Tela A, Turagabeci AR, Wardani J, Wong T, Brown R. Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji. BMJ Open 2021; 11:e042850. [PMID: 33419917 PMCID: PMC7798802 DOI: 10.1136/bmjopen-2020-042850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries. METHODS AND ANALYSIS RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being. ETHICS Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University. TRIAL REGISTRATION NUMBER ACTRN12618000633280; Pre-results.
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Affiliation(s)
- Karin Leder
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J Openshaw
- Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford, California, USA
| | - Pascale Allotey
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Ansariadi Ansariadi
- Public Health Faculty, Hasanuddin University, Makassar, Sulawesi Selatan, Indonesia
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kerrie Burge
- CRC for Water Sensitive Cities, Monash University, Melbourne, Victoria, Australia
| | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Steven L Chown
- School of Biological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Grant A Duffy
- School of Biological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peter A Faber
- School of Biological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Genie Fleming
- School of Biological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew French
- Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Chris Greening
- Department of Microbiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rebekah Henry
- Civil Engineering, Monash University, Melbourne, Victoria, Australia
| | - Ellen Higginson
- Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - David W Johnston
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Rachael Lappan
- Department of Microbiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Audrie Lin
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford, California, USA
| | - David McCarthy
- Civil Engineering, Monash University, Melbourne, Victoria, Australia
| | - Joanne E O'Toole
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Daniel D Reidpath
- Monash University - Malaysia Campus, Bandar Sunway, Selangor, Malaysia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Ruzka R Taruc
- Public Health Faculty, Hasanuddin University, Makassar, Sulawesi Selatan, Indonesia
| | - Autiko Tela
- School of Public Health and Primary Care, Fiji National University, College of Medicine, Nursing and Health Sciences, Tamavua Campus, Suva, Rewa, Fiji
| | - Amelia R Turagabeci
- School of Public Health and Primary Care, Fiji National University, College of Medicine, Nursing and Health Sciences, Tamavua Campus, Suva, Rewa, Fiji
| | - Jane Wardani
- Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Tony Wong
- CRC for Water Sensitive Cities, Monash University, Melbourne, Victoria, Australia
| | - Rebekah Brown
- Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
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Glover RE, van Schalkwyk MCI, Akl EA, Kristjannson E, Lotfi T, Petkovic J, Petticrew MP, Pottie K, Tugwell P, Welch V. A framework for identifying and mitigating the equity harms of COVID-19 policy interventions. J Clin Epidemiol 2020; 128:35-48. [PMID: 32526461 PMCID: PMC7280094 DOI: 10.1016/j.jclinepi.2020.06.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global pandemic. Governments have implemented combinations of "lockdown" measures of various stringencies, including school and workplace closures, cancellations of public events, and restrictions on internal and external movements. These policy interventions are an attempt to shield high-risk individuals and to prevent overwhelming countries' healthcare systems, or, colloquially, "flatten the curve." However, these policy interventions may come with physical and psychological health harms, group and social harms, and opportunity costs. These policies may particularly affect vulnerable populations and not only exacerbate pre-existing inequities but also generate new ones. METHODS We developed a conceptual framework to identify and categorize adverse effects of COVID-19 lockdown measures. We based our framework on Lorenc and Oliver's framework for the adverse effects of public health interventions and the PROGRESS-Plus equity framework. To test its application, we purposively sampled COVID-19 policy examples from around the world and evaluated them for the potential physical, psychological, and social harms, as well as opportunity costs, in each of the PROGRESS-Plus equity domains: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, and disability). RESULTS We found examples of inequitably distributed adverse effects for each COVID-19 lockdown policy example, stratified by a low- or middle-income country and high-income country, in every PROGRESS-Plus equity domain. We identified the known policy interventions intended to mitigate some of these adverse effects. The same harms (anxiety, depression, food insecurity, loneliness, stigma, violence) appear to be repeated across many groups and are exacerbated by several COVID-19 policy interventions. CONCLUSION Our conceptual framework highlights the fact that COVID-19 policy interventions can generate or exacerbate interactive and multiplicative equity harms. Applying this framework can help in three ways: (1) identifying the areas where a policy intervention may generate inequitable adverse effects; (2) mitigating the policy and practice interventions by facilitating the systematic examination of relevant evidence; and (3) planning for lifting COVID-19 lockdowns and policy interventions around the world.
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Affiliation(s)
- Rebecca E Glover
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH.
| | - May C I van Schalkwyk
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Elie A Akl
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Elizabeth Kristjannson
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | | | - Mark P Petticrew
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Kevin Pottie
- Department of Family Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
| | - Peter Tugwell
- Department of Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario L8S 4L8, Canada
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
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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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25
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Matzopoulos R, Bloch K, Lloyd S, Berens C, Bowman B, Myers J, Thompson ML. Urban upgrading and levels of interpersonal violence in Cape Town, South Africa: The violence prevention through urban upgrading programme. Soc Sci Med 2020; 255:112978. [PMID: 32330747 DOI: 10.1016/j.socscimed.2020.112978] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 11/15/2022]
Abstract
Violence Prevention through Urban Upgrading applies second generation crime prevention through environmental design, which includes built environment interventions alongside social programmes and community participation initiatives in Khayelitsha, one of South Africa's poorest and most violent suburbs. We conducted a retrospective population-based study using survey data from 3625 geo-located households collected between 2013 and 2015 and mapped alcohol outlets to assess the association between the intervention and reported experience of violence. The analysis used generalised linear models to estimate and compare selfreported experience of violence adjusting for known confounders, which included area and household deprivation as well as alcohol outlet density. Living in close proximity to the upgraded urban infrastructure was associated with a 34% reduced exposure to interpersonal violence after adjusting for confounders. This association was consistent across age and gender. Access to additional social programmes alongside the urban upgrading intervention was not associated with further reduction in risk. The association between urban-upgrading and reduced exposure to interpersonal violence supports its inclusion among interventions in national and local crime prevention policies to address social and structural environments.
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Affiliation(s)
- Richard Matzopoulos
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Kim Bloch
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sam Lloyd
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Institute of Science, Technology and Policy and Center for Security Studies, ETH Zürich, Switzerland
| | | | - Brett Bowman
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonny Myers
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary Lou Thompson
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, USA
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