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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: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Turagabeci AR, Nakamura K, Kizuki M, Takano T. Family structure and health, how companionship acts as a buffer against ill health. Health Qual Life Outcomes 2007; 5:61. [PMID: 18036211 PMCID: PMC2234394 DOI: 10.1186/1477-7525-5-61] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 11/23/2007] [Indexed: 11/23/2022] Open
Abstract
Background Health and well-being are the result of synergistic interactions among a variety of determinants. Family structure and composition are social determinants that may also affect health behaviours and outcomes. This study was performed to examine the associations between family structure and health and to determine the protective effects of support mechanisms to improve quality of health outcome. Methods Six hundred people, selected by multistage sampling to obtain a representative population of men and women aged 20–60 living in communities in Japan, were included in this study. Data regarding subjective views of one's own health, family structure, lifestyle and social support were collected through structured face-to-face interviews on home visits. Systolic and diastolic blood pressures, height and weight were measured by trained examiners. The associations between family structure and health after controlling for demographics, lifestyle and social support were examined using logistic and linear regression analyses. Results Subjects living alone were significantly more likely to be in ill health, as determined using the General Health Questionnaire, in comparison to those in extended families (OR = 3.14). Subjects living alone or as couples were significantly more likely to suffer from severe hypertension in comparison to those living in extended families (OR = 8.25, OR = 4.90). These associations remained after controlling for the influence of lifestyle. Subjects living only with spouse or in nuclear family had higher probabilities of mental ill health in the absence than in the presence of people showing concern for their well-being. Conclusion The results of this study infers that a support mechanism consisting of companionship and the presence of family or other people concerned for one's well being acts as a buffer against deleterious influence of living in small family that will lead to improved quality of health outcome.
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Affiliation(s)
- Amelia R Turagabeci
- International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
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