1
|
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 Glob 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Baker KK, Simiyu S, Busienei P, Gutema FD, Okoth B, Agira J, Amondi CS, Ziraba A, Kapanka AG, Osinuga A, Ouma C, Sewell DK, Gaire S, Tumwebaze IK, Mberu B. Protocol for the PATHOME study: a cohort study on urban societal development and the ecology of enteric disease transmission among infants, domestic animals and the environment. BMJ Open 2023; 13:e076067. [PMID: 38000826 PMCID: PMC10680014 DOI: 10.1136/bmjopen-2023-076067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Global morbidity from enteric infections and diarrhoea remains high in children in low-income and middle-income countries, despite significant investment over recent decades in health systems and water and sanitation infrastructure. Other types of societal development may be required to reduce disease burden. Ecological research on the influence of household and neighbourhood societal development on pathogen transmission dynamics between humans, animals and the environment could identify more effective strategies for preventing enteric infections. METHODS AND ANALYSIS The 'enteric pathome'-that is, the communities of viral, bacterial and parasitic pathogens transmitted from human and animal faeces through the environment is taxonomically complex in high burden settings. This integrated cohort-exposure assessment study leverages natural socioeconomic spectrums of development to study how pathome complexity is influenced by household and neighbourhood infrastructure and hygiene conditions. We are enrolling under 12-month-old children in low-income and middle-income neighbourhoods of two Kenyan cities (Nairobi and Kisumu) into a 'short-cohort' study involving repeat testing of child faeces for enteric pathogens. A mid-study exposure assessment documenting infrastructural, behavioural, spatial, climate, environmental and zoonotic factors characterises pathogen exposure pathways in household and neighbourhood settings. These data will be used to inform and validate statistical and agent-based models (ABM) that identify individual or combined intervention strategies for reducing multipathogen transmission between humans, animals and environment in urban Kenya. ETHICS AND DISSEMINATION The protocols for human subjects' research were approved by Institutional Review Boards at the University of Iowa (ID-202004606) and AMREF Health Africa (ID-ESRC P887/2020), and a national permit was obtained from the Kenya National Commission for Science Technology and Innovation (ID# P/21/8441). The study was registered on Clinicaltrials.gov (Identifier: NCT05322655) and is in pre-results stage. Protocols for research on animals were approved by the University of Iowa Animal Care and Use Committee (ID 0042302).
Collapse
Affiliation(s)
- Kelly K Baker
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sheillah Simiyu
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Phylis Busienei
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Fanta D Gutema
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bonphace Okoth
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - John Agira
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Christine S Amondi
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Abdhalah Ziraba
- Division of Health and Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | - Alexis G Kapanka
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Abisola Osinuga
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Daniel K Sewell
- Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sabin Gaire
- Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Innocent K Tumwebaze
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
3
|
Karuga R, Kabaria C, Chumo I, Okoth L, Njoroge I, Otiso L, Muturi N, Karki J, Dean L, Tolhurst R, Steege R, Ozano K, Theobald S, Mberu B. Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches. Front Public Health 2023; 11:1175326. [PMID: 38074741 PMCID: PMC10701261 DOI: 10.3389/fpubh.2023.1175326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.
Collapse
Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Caroline Kabaria
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ivy Chumo
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Linet Okoth
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Inviolata Njoroge
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Nelly Muturi
- Airbel Impact Lab, International Rescue Committee, Nairobi, Kenya
| | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rosie Steege
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kim Ozano
- The SCL Agency, Wales, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
Chumo I, Kabaria C, Mberu B. Social inclusion of persons with disability in employment: what would it take to socially support employed persons with disability in the labor market? Front Rehabil Sci 2023; 4:1125129. [PMID: 37456796 PMCID: PMC10349392 DOI: 10.3389/fresc.2023.1125129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Introduction One of the major challenges that persons with disabilities (PWDs) are facing globally is unemployment. The challenge is attributed to systems that are not built with inclusivity in mind by employers. As such, the work of inclusion is not inviting PWDs to do more but to make a difference through social support. Most research on inclusion in the employment of PWDs in low-income settings has been concentrated upon the labor "supply" side, and to the best of our knowledge, no specific studies moved toward inclusion in employment issues from the employers' perspective in informal settlements. Notably, our research question is: "what would it take to socially support employed PWD in informal settlements building from the perspectives of employers." Methods This paper used data from in-depth interviews with 38 service providers in the education, health, water, sanitation, and solid waste management sectors and two sub-county officials in two informal settlements in Nairobi, Kenya. The service providers were employers or entrepreneurs who had hired PWDs in their workspaces and the sub-county officials that had vast experiences with employed PWDs. Data from transcripts were analyzed by the research team using content analysis. Results The social support offered to employed PWDs included listening to them with a concern; identifying their strengths and obstacles; planning for them based on their qualities, knowledge, and experience and linking them with existing opportunities; creating specific opportunities and facilitating their access to opportunities; gradual withdrawal of support by support group; and, lastly, compromise by employers with PWD inclusion strategies. Study participants described how misdirected and inadequate resources, dissatisfaction and unhappiness, and conflicts at the workplace associated with non-inclusion were constraints to social support. Employment matters affecting PWDs are complex and require multi-pronged context-specific social support approaches. Essential to the functioning of an inclusive workplace for PWDs were communication, coordination, sharing of the workload, and supporting individual PWD. Conclusion Inclusion of PWDs in the labor market is about generating a supportive workplace where people are valued and appreciated without judgement for what they can contribute. Notably, in the absence of jobs for everyone and high unemployment rates among every segment of the population, there is a need for an awareness creation, mobilization, and sensitization of employers and investors around the competencies of PWDs and their need to socially support on an impartial basis. On the other hand, employment centers could establish stations in low-income areas to advise and support PWDs on career opportunities that are disability-friendly and partner with employers to avail information about the capabilities of PWDs. Conversely, the government should provide some tax-related benefits to employers to upsurge employer incentives for hiring PWDs and empower employers on benefits and positive culture of employing PWDs. At all times, employers should be hands-on and involve diverse stakeholders to implement current policies and frameworks in different work contexts across the country and beyond.
Collapse
|
5
|
Muindi K, Iddi S, Gitau H, Mberu B. Housing and health outcomes: evidence on child morbidities from six Sub-Saharan African countries. BMC Pediatr 2023; 23:219. [PMID: 37147616 PMCID: PMC10163804 DOI: 10.1186/s12887-023-03992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The connection between healthy housing status and health is well established. The quality of housing plays a significant role in infectious and non-communicable as well as vector-borne diseases. The global burden of disease attributable to housing is considerable with millions of deaths arising from diarrheal and respiratory diseases annually. In sub-Saharan Africa (SSA), the quality of housing remains poor although improvements have been documented. There is a general dearth of comparative analysis across several countries in the sub-region. We assess in this study, the association between healthy housing and child morbidity across six countries in SSA. METHODS We use the Demographic and Health Survey (DHS) data for six countries where the most recent survey collected health outcome data on child diarrhoea, acute respiratory illness, and fever. The total sample size of 91,096 is used in the analysis (representing 15, 044 for Burkina Faso, 11, 732 for Cameroon, 5, 884 for Ghana, 20, 964 for Kenya, 33, 924 for Nigeria, and 3,548 for South Africa). The key exposure variable is healthy housing status. We control for various factors associated with the three childhood health outcomes. These include quality housing status, residency (rural/urban), age of the head of the household, mother's education, mother's BMI status, marital status, mother's age, and religious status. Others include the child's gender, age, whether the child is from multiple or single births, and breastfeeding status. Inferential analysis using survey-weighted logistic regression is employed. RESULTS Our findings indicate that housing is an important determinant of the three outcomes investigated. Compared to unhealthier housing, healthy housing status was found to be associated with reduced odds of diarrhoea in Cameroon [Healthiest: aOR = 0.48, 95% CI, (0.32,0.71), healthier: aOR = 0.50, 95% CI,(0.35,0.70), Healthy: aOR = 0.60, 95% CI, (0.44,0.83), Unhealthy: aOR = 0.60, 95% CI, (0.44,0.81)], Kenya [Healthiest: aOR = 0.68, 95% CI, (0.52,0.87), Healtheir: aOR = 0.79, 95% CI, (0.63,0.98), Healthy: aOR = 0.76, 95% CI, (0.62,0.91)], South Africa[Healthy: aOR = 0.41, 95% CI, (0.18, 0.97)], and Nigeria [Healthiest: aOR = 0.48, 95% CI,(0.37,0.62), Healthier: aOR = 0.61, 95% CI,(0.50,0.74), Healthy: aOR = 0.71, 95%CI, (0.59,0.86), Unhealthy: aOR = 0.78, 95% CI, (0.67,0.91)], and reduced odds of Acute Respiratory Infection in Cameroon [Healthy: aOR = 0.72, 95% CI,(0.54,0.96)], Kenya [Healthiest: aOR = 0.66, 95% CI, (0.54,0.81), Healthier: aOR = 0.81, 95% CI, (0.69,0.95)], and Nigeria [Healthiest: aOR = 0.69, 95% CI, (0.56,0.85), Healthier: aOR = 0.72, 95% CI, (0.60,0.87), Healthy: aOR = 0.78, 95% CI, (0.66,0.92), Unhealthy: aOR = 0.80, 95% CI, (0.69,0.93)] while it was associated with increased odds in Burkina Faso [Healthiest: aOR = 2.45, 95% CI, (1.39,4.34), Healthy: aOR = 1.55, 95% CI, (1.09,2.20)] and South Africa [Healthy: aOR = 2.36 95% CI, (1.31, 4.25)]. In addition, healthy housing was significantly associated with reduced odds of fever among children in all countries except South Africa [Healthiest: aOR = 2.09, 95% CI, (1.02, 4.29)] where children living in the healthiest homes had more than double the odds of having fever. In addition, household-level factors such as the age of the household head, and place of residence were associated with the outcomes. Child-level factors such as breastfeeding status, age, and sex, and maternal-level factors such as education, age, marital status, body mass index (BMI), and religion were also associated with the outcomes. CONCLUSIONS The dissimilarity of findings across similar covariates and the multiple relations between healthy housing and under 5 morbidity patterns show unequivocally the heterogeneity that exists across African countries and the need to account for different contexts in efforts to seek an understanding of the role of healthy housing in child morbidity and general health outcomes.
Collapse
Affiliation(s)
- Kanyiva Muindi
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.
| | - Samuel Iddi
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.
- Department of Statistics and Actuarial Science, University of Ghana, Legon, Accra, Ghana.
| | - Hellen Gitau
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
- Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Chumo I, Kabaria C, Shankland A, Igonya E, Mberu B. Complementarity of formal and informal actors and their networks in support of vulnerable populations in informal settlements: Governance diaries approach. Front Public Health 2023; 10:1043602. [PMID: 36777785 PMCID: PMC9911518 DOI: 10.3389/fpubh.2022.1043602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Beyond several interests and speculations on the relationship between formal and informal actors and their networks in support of vulnerable populations, most studies do not conclusively establish whether the two types of support are substitutes or complements. While informal care and formal care may be substitutes in general, they are complements among the vulnerable groups. Despite how some studies have described complementarity, further insights on the synergy between formal and informal actors and networks are needed to pinpoint how to maximize policy and interventions to alleviate the challenges facing vulnerable groups in informal settlements. Methods We conducted an ethnography using governance diaries with 24 participants in Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved conducting bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used framework analysis approach. Findings Informal actors identified include family, neighbors, friends, community groups and community members, and their direct networks. Formal actors on the other hand included government institutions, individuals and authorities that make policies and rules and their desired and possible networks. Both the formal and informal actors and their networks had complementary roles that were beneficial to the vulnerable populations living and working in informal settlements. The complementarities between formal and informal actors and networks in supporting vulnerable groups were portrayed in roles and responsibilities to the vulnerable groups; rules, regulations and governance in supporting vulnerable groups; knowledge, skills and dynamic workforces among formal and informal actors and their networks; information flow on health and wellbeing to the vulnerable populations; transition of actors in supporting vulnerable groups; availability, access and involvement of formal and informal actors and networks to support vulnerable groups. The complementarities allowed for maximum support of the vulnerable populations than otherwise. Conclusion We conclude that informal social support is needed regardless of the availability of formal social support. Moreover, a combination of formal and informal actors and related networks are essential to support vulnerable persons. Formal actors should establish, support, or maintain the informal actors and related networks through goodwill and sundry incentives as a vital dimension of building with local community structures and enhancing inclusion, participation and ownership of policy and program interventions by marginalized and vulnerable groups.
Collapse
Affiliation(s)
- Ivy Chumo
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Caroline Kabaria
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Alex Shankland
- Institute of Development Studies (IDS), Brighton, United Kingdom
| | - Emmy Igonya
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| |
Collapse
|
7
|
Chumo I, Kabaria C, Elsey H, Ozano K, Phillips-Howard PA, Mberu B. Co-creation and self-evaluation: An accountability mechanism process in water, sanitation and hygiene services delivery in childcare centres in Nairobi's informal settlements. Front Public Health 2023; 10:1035284. [PMID: 36711348 PMCID: PMC9877527 DOI: 10.3389/fpubh.2022.1035284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Background Accountability strategies are expected to enhance access to water, sanitation and hygiene (WASH) service delivery in low-and middle-income countries (LMIC). Conventional formal social accountability mechanisms (SAMs) for WASH service delivery have been inadequate to meet the needs of residents in informal settlements in LMICs. This has prompted growing interest in alternative informal SAMs (iSAMs) in Nairobi's informal settlements. To date, iSAMs have shown a limited effect, often due to implementation failures and poor contextual fit. In childcare centers in Nairobi's informal settlements, co-creation of the iSAMs process, where parents, childcare managers, researchers and other WASH stakeholders, contribute to the design and implementation of iSAMs, is an approach with the potential to meet urgent WASH needs. However, to our knowledge, no study has documented (1) co-creating iSAMs processes for WASH service delivery in childcare centers and (2) self-evaluation of the co-creation process in the informal settlements. Methods We used a qualitative approach where we collected data through workshops and focus group discussions to document and inform (a) co-creation processes of SAMs for WASH service delivery in childcare centers and (b) self-evaluation of the co-creation process. We used a framework approach for data analysis informed by Coleman's framework. Results Study participants co-created an iSAM process that entailed: definition; action and sharing information; judging and assessing; and learning and adapting iSAMs. The four steps were considered to increase the capability to meet WASH needs in childcare centers. We also documented a self-evaluation appraisal of the iSAM process. Study participants described that the co-creation process could improve understanding, inclusion, ownership and performance in WASH service delivery. Negative appraisals described included financial, structural, social and time constraints. Conclusion We conclude that the co-creation process could address contextual barriers which are often overlooked, as it allows understanding of issues through the 'eyes' of people who experience service delivery issues. Further, we conclude that sustainable and equitable WASH service delivery in childcare centers in informal settlements needs research that goes beyond raising awareness to fully engage and co-create to ensure that novel solutions are developed at an appropriate scale to meet specific needs. We recommend that actors should incorporate co-creation in identification of feasible structures for WASH service delivery in childcare centers and other contexts.
Collapse
Affiliation(s)
- Ivy Chumo
- Urbanization and Wellbeing Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya,*Correspondence: Ivy Chumo ✉
| | - Caroline Kabaria
- Urbanization and Wellbeing Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Helen Elsey
- Hull York Medical School, University of York, York, United Kingdom
| | - Kim Ozano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Institute of Public Health, Liverpool, United Kingdom
| | - Penelope A. Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Institute of Public Health, Liverpool, United Kingdom
| | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| |
Collapse
|
8
|
Chumo I, Kabaria C, Oduor C, Amondi C, Njeri A, Mberu B. Community advisory committee as a facilitator of health and wellbeing: A qualitative study in informal settlements in Nairobi, Kenya. Front Public Health 2023; 10:1047133. [PMID: 36699924 PMCID: PMC9868729 DOI: 10.3389/fpubh.2022.1047133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction A range of community engagement initiatives to advance health and wellbeing are currently taking place in informal settlements in low and middle income countries (LMICs), including community and stakeholder meetings, use of radio, film, TV programs and other information, education and communication materials (IECs) organized by different stakeholders. While these initiatives tend to focus on unidirectional flow of information to communities, the need to incorporate initiatives focusing on bi or multi-directional flow of information have been identified. Despite the extensive body of literature on community engagement, the role of Community Advisory Committees (CACs) in advancing health and wellbeing in informal settlements is still a puzzle, occasioned by considerable ambiguity. A community advisory committee is a dedicated group of volunteers to support health and wellbeing needs of their community using a community approach. Researchers and project implementers work in partnership with CACs to successfully implement their activities within the target community. Methods In this paper, using in-depth interviews, we document the roles of CACs in advancing health and wellbeing in Korogocho and Viwandani informal settlements in Nairobi, Kenya. Results Study participants described the role of CAC in advancing health and wellbeing through education and awareness creation, advisory roles in research and implementation goals, protecting community interests and acting as gatekeepers and collaborators to community partners. Identified barriers to achieving CAC roles include lack of finance and other field resources, being labeled as organization staff and low involvement by some upcoming and emerging local leaders on issues which involve the CAC constituents. Enablers of CACs in their roles include possession of appropriate skills and values by members; involvement of the community in the selection of members, regular consultative and advisory meetings, representativeness in the composition of CAC membership and knowledge about the community. Conclusion We conclude that CACs play key roles in advancing health and wellbeing in informal settlements and that existing CACs mechanisms and operations need to be given due consideration by researchers, project implementers and local authorities right from project conceptualization. CACs need recognition beyond consultations and placations during research and project implementation to a veritable social structure for community's social viability and survival as well as partners in development for inclusive urbanization process. While CACs have contributed in advancing health and wellbeing in informal settlements, there is need for a long-term strategy to optimize their impact and reduce puzzles around their roles.
Collapse
|
9
|
de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
Collapse
Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
10
|
Chumo I, Kabaria C, Phillips-Howard PA, Simiyu S, Elsey H, Mberu B. Mapping social accountability actors and networks and their roles in water, sanitation and hygiene (WASH) in childcare centres within Nairobi’s informal settlements: A governance diaries approach. PLoS One 2022; 17:e0275491. [PMCID: PMC9665391 DOI: 10.1371/journal.pone.0275491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Despite many institutions gaining access to improved water sanitation and hygiene (WASH) services, childcare centres in informal settlements have low access and poor condition of WASH services. It is imperative to understand how existing actors and social networks operate in the WASH sector in childcare centres in Nairobi’s informal settlements. Objective To empirically map and understand how different actors within informal settlements influence the provision of adequate and quality water, sanitation and hygiene services within childcare centres in Nairobi’s informal settlements. Methods This was a qualitative study. We conducted an ethnographic study using governance diaries with 24 participants from Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved conducting bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used a framework analysis which is partly deductive, informed by the governance framework and stakeholder framework. Results Social accountability actors were individuals or groups involved in WASH service provision in childcare centres. The actors included both key actors (actors who are primary to meeting the day-to-day WASH service needs of children) and non-key actors (actors operating in the WASH sector but not always present for day-to-day provision in childcare centres). The key actors were unanimously identified as childcare centre owners/teachers and parents/guardians as they had a more direct role in the provision of WASH services in childcare centres. The actors had direct, possible or desired networks, with the direct networks portrayed more by the parents and childcare centre owners, whose roles included acting as a voice and responding to the WASH service needs of children as it relates to access and quality. Centre owners had more power/authority over WASH services for children in childcare centres than the parents. Key actors derived power by their discretion depending on whether a decision was beneficial to children or not. Lastly, the interest of key actors were diverse ranging from income generation, access to WASH services by children, compliance with government regulations, and promotion of child health, to the prevention of the spread of diseases. Conclusion Our study highlights that parents and childcare owners play an important role in WASH service provision. While service providers and other players may be statutorily given primary responsibilities for WASH provision, and more visible in official standing, among study participants they are not seen as primary actors but secondary players with ancillary responsibilities. We conclude that WASH service provision in child care centres may be realised when key actors have a voice and work within networks to demand WASH services from desired networks including the government. We also conclude that developing more direct networks and converting desired and potential networks into direct networks in WASH service provision is critical for the success of WASH service delivery. Lastly, actors in WASH services in childcare centres may need to collaborate in identifying potential avenues for strengthening existing networks that enhance access and quality of WASH services in childcare centres.
Collapse
Affiliation(s)
- Ivy Chumo
- African Population and Health Research Center (APHRC), Nairobi, Kenya
- * E-mail:
| | - Caroline Kabaria
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Sheillah Simiyu
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Helen Elsey
- University of York and Hull York Medical School, York, United Kingdom
| | - Blessing Mberu
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| |
Collapse
|
11
|
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] [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: 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.
Collapse
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
| |
Collapse
|
12
|
Davies M, Belesova K, Crane M, Hale J, Haines A, Hutchinson E, Kiesewetter G, Mberu B, Mohajeri N, Michie S, Milner J, Moore G, Osrin D, Pineo H, Pluchinotta I, Prasad A, Salvia G, Symonds P, Taylor J, Turcu C, Tsoulou I, Zimmermann N, Wilkinson P. The CUSSH programme: supporting cities' transformational change towards health and sustainability. Wellcome Open Res 2022; 6:100. [PMID: 35028422 PMCID: PMC8686329 DOI: 10.12688/wellcomeopenres.16678.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the
Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st Century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.
Collapse
Affiliation(s)
- Michael Davies
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | | | - Melanie Crane
- Sydney School of Public Health, University of Sydney, Camperdown, Australia
| | - Joanna Hale
- Centre for Behaviour Change, University College London, London, UK
| | - Andy Haines
- Dept of Public Health, Environments and Society, Dept of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Hutchinson
- Dept of Public Health, Environments and Society, Dept of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregor Kiesewetter
- International Institute for Applied Systems Analysis (IIASA), Air Quality & Greenhouse Gases (AIR), Luxemburg, Austria
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Nahid Mohajeri
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - James Milner
- Dept of Public Health, Environments and Society, Dept of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gemma Moore
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | - Helen Pineo
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Irene Pluchinotta
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Aarathi Prasad
- Institute for Global Health, University College London, London, UK
| | - Giuseppe Salvia
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Phil Symonds
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | | | - Catalina Turcu
- Bartlett School of Planning, University College London, London, UK
| | - Ioanna Tsoulou
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Nici Zimmermann
- Bartlett School of Environment, Energy and Resources, University College London, Institute for Environmental Design and Engineering, London, UK
| | - Paul Wilkinson
- Dept of Public Health, Environments and Society, Dept of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
13
|
Simiyu S, Chumo I, Mberu B. Fecal Sludge Management in Low Income Settlements: Case Study of Nakuru, Kenya. Front Public Health 2021; 9:750309. [PMID: 34708018 PMCID: PMC8542775 DOI: 10.3389/fpubh.2021.750309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In order to meet the sustainable development goals targets of sanitation, countries aim to increase access to safely managed sanitation services for its citizens. Safely managed sanitation services refers to improved sanitation technologies that are not shared with other households and where excreta is treated and disposed; or stored, transported and treated off-site. In most Sub-Saharan Africa (SSA) countries, on-site sanitation facilities such as latrines and septic tanks are common, with low-income urban settlements mainly using pit latrines. However, little is documented about the management of sludge from these facilities, especially in low income settlements in secondary and emerging cities. This lack of data is a major hindrance to public health, development and planning efforts by governments and planning agencies. This study specifically assesses practices and challenges along the sanitation value chain related to containment, emptying, transportation, treatment and recycling of fecal sludge. Methods: The study was carried out in low income settlements in Nakuru, a secondary city in Kenya. Over half the population in Nakuru live in low income areas and majority of these residents use pit latrines. A case study design was selected for this study and data was collected using qualitative methods. Data was collected through In-depth interviews and Focus Group Discussions using in depth interview guide and focus group discussion guides that had questions on sanitation practices along the value chain, challenges, opportunities available, and recommendations for improvement. Analysis was done through content analysis by reading the transcripts multiple times to gain a sense of the flow of the discussion. Thereafter, coding was done by following emergent issues and thereafter categories were identified which formed the basis for providing a picture of FWM practices in the settlements. Results: On site sanitation facilities are dominant in the settlements, but they are few and are shared by several households. These facilities were unclean, and they filled up at a fast rate because of the high number of users. The latrines were emptied by manual emptiers who used mechanized equipment but complemented with manual emptying using buckets. Sludge was transported to a central collection point using large and small scale means of transportation, before transfer to the treatment site for final treatment and disposal. Various stakeholders are involved in capacity building of emptiers as well as in the transportation, treatment and disposal of fecal sludge in the settlements. Challenges along the stages of the value chain included negative community perceptions and attitudes toward fecal sludge management. Conclusion: The results highlight the need to address the challenges along the chain by involvement of state and non-state actors. Low income areas have high populations and thus contribute huge amounts of fecal sludge. Deliberate efforts to consolidate such data from low income areas will result in availability of data, and informed decision making for stakeholders at national and international levels.
Collapse
Affiliation(s)
- Sheillah Simiyu
- Urbanization and Well-Being Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ivy Chumo
- Urbanization and Well-Being Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- Urbanization and Well-Being Unit, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
14
|
Biermann O, Mwoka M, Ettman CK, Abdalla SM, Shawky S, Ambuko J, Pearson M, Zeinali Z, Galea S, Mberu B, Valladares LM. Data, Social Determinants, and Better Decision-making for Health: the 3-D Commission. J Urban Health 2021; 98:4-14. [PMID: 34414512 PMCID: PMC8376119 DOI: 10.1007/s11524-021-00556-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
More than a decade after the World Health Organization Commission on the Social Determinants of Health (SDoH), it is becoming widely accepted that social and economic factors, including but not limited to education, energy, income, race, ethnicity, and housing, are important drivers of health in populations. Despite this understanding, in most contexts, social determinants are not central to local, national, or global decision-making. Greater clarity in conceptualizing social determinants, and more specificity in measuring them, can move us forward towards better incorporating social determinants in decision-making for health. In this paper, first, we summarize the evolution of the social framing of health. Second, we describe how the social determinants are conceptualized and contextualized differently at the global, national, and local levels. With this, we seek to demonstrate the importance of analyzing and understanding SDoH relative to the contexts in which they are experienced. Third, we problematize the gap in data across contexts on different dimensions of social determinants and describe data that could be curated to better understand the influence of social determinants at the local and national levels. Fourth, we describe the necessity of using data to understand social determinants and inform decision-making to improve health. Our overall goal is to provide a path for our collective understanding of the foundational causes of health, facilitated by advances in data access and quality, and realized through improved decision-making.
Collapse
Affiliation(s)
- Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Catherine K. Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Sherine Shawky
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- The Social Research Center, The American University in Cairo, Cairo, Egypt
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- OECD, Paris, France
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- African Population and Health Research Center, Nairobi, Kenya
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
| |
Collapse
|
15
|
Mwoka M, Biermann O, Ettman CK, Abdalla SM, Ambuko J, Pearson M, Rashid SF, Zeinali Z, Galea S, Valladares LM, Mberu B. Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission. J Urban Health 2021; 98:15-30. [PMID: 34480327 PMCID: PMC8415197 DOI: 10.1007/s11524-021-00557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/31/2022]
Abstract
Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.
Collapse
Affiliation(s)
- Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Olivia Biermann
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Catherine K Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA. .,Department of Epidemiology, Boston University School of Public Health, Boston, USA.
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,OECD, Paris, France
| | - Sabina Faiz Rashid
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Brac James P Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
16
|
Moore G, Michie S, Anderson J, Belesova K, Crane M, Deloly C, Dimitroulopoulou S, Gitau H, Hale J, Lloyd SJ, Mberu B, Muindi K, Niu Y, Pineo H, Pluchinotta I, Prasad A, Roue-Le Gall A, Shrubsole C, Turcu C, Tsoulou I, Wilkinson P, Zhou K, Zimmermann N, Davies M, Osrin D. Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health. Wellcome Open Res 2021; 6:35. [PMID: 34095507 PMCID: PMC8156501 DOI: 10.12688/wellcomeopenres.16542.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 03/28/2024] Open
Abstract
Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to "work" in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an 'action model'), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a 'change model'). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be 'about', and the inherent unpredictability of complex initiatives.
Collapse
Affiliation(s)
- Gemma Moore
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, WC1E 7HB, UK
| | | | - Kristine Belesova
- Centre on Climate Change and Planetary Health and Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Melanie Crane
- Sydney School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Clément Deloly
- Department of Environmental and occupational Health, EHESP, Rennes, 35000, France
| | - Sani Dimitroulopoulou
- Air Quality and Public Health, Environmental Hazards and Emergencies Dept, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK
| | - Hellen Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Joanna Hale
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Simon J. Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, 08003, Spain
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Kanyiva Muindi
- African Population and Health Research Center, Nairobi, Kenya
| | - Yanlin Niu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Helen Pineo
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Irene Pluchinotta
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Aarathi Prasad
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Anne Roue-Le Gall
- Department of Environmental and occupational Health, EHESP, Rennes, 35000, France
| | - Clive Shrubsole
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Catalina Turcu
- Bartlett School of Planning, University College London, London, 1WC 0NN, UK
| | - Ioanna Tsoulou
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Paul Wilkinson
- Centre on Climate Change and Planetary Health and Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Ke Zhou
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Nici Zimmermann
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Michael Davies
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - David Osrin
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| |
Collapse
|
17
|
Moore G, Michie S, Anderson J, Belesova K, Crane M, Deloly C, Dimitroulopoulou S, Gitau H, Hale J, Lloyd SJ, Mberu B, Muindi K, Niu Y, Pineo H, Pluchinotta I, Prasad A, Roue-Le Gall A, Shrubsole C, Turcu C, Tsoulou I, Wilkinson P, Zhou K, Zimmermann N, Davies M, Osrin D. Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health. Wellcome Open Res 2021; 6:35. [PMID: 34095507 PMCID: PMC8156501 DOI: 10.12688/wellcomeopenres.16542.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.
Collapse
Affiliation(s)
- Gemma Moore
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, WC1E 7HB, UK
| | | | - Kristine Belesova
- Centre on Climate Change and Planetary Health and Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Melanie Crane
- Sydney School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Clément Deloly
- Department of Environmental and occupational Health, EHESP, Rennes, 35000, France
| | - Sani Dimitroulopoulou
- Air Quality and Public Health, Environmental Hazards and Emergencies Dept, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK
| | - Hellen Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Joanna Hale
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Simon J Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, 08003, Spain
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Kanyiva Muindi
- African Population and Health Research Center, Nairobi, Kenya
| | - Yanlin Niu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Helen Pineo
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Irene Pluchinotta
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Aarathi Prasad
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Anne Roue-Le Gall
- Department of Environmental and occupational Health, EHESP, Rennes, 35000, France
| | - Clive Shrubsole
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Catalina Turcu
- Bartlett School of Planning, University College London, London, 1WC 0NN, UK
| | - Ioanna Tsoulou
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Paul Wilkinson
- Centre on Climate Change and Planetary Health and Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Ke Zhou
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Nici Zimmermann
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - Michael Davies
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, WC1H 0NN, UK
| | - David Osrin
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| |
Collapse
|
18
|
Dianati K, Schäfer L, Milner J, Gómez-Sanabria A, Gitau H, Hale J, Langmaack H, Kiesewetter G, Muindi K, Mberu B, Zimmermann N, Michie S, Wilkinson P, Davies M. A system dynamics-based scenario analysis of residential solid waste management in Kisumu, Kenya. Sci Total Environ 2021; 777:146200. [PMCID: PMC8155395 DOI: 10.1016/j.scitotenv.2021.146200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 05/25/2023]
Abstract
The problem of solid waste management presents an issue of increasing importance in many low-income settings, including the progressively urbanised context of Kenya. Kisumu County is one such setting with an estimated 500 t of waste generated per day and with less than half of it regularly collected. The open burning and natural decay of solid waste is an important source of greenhouse gas (GHG) emissions and atmospheric pollutants with adverse health consequences. In this paper, we use system dynamics modelling to investigate the expected impact on GHG and PM2.5 emissions of (i) a waste-to-biogas initiative and (ii) a regulatory ban on the open burning of waste in landfill. We use life tables to estimate the impact on mortality of the reduction in PM2.5 exposure. Our results indicate that combining these two interventions can generate over 1.1 million tonnes of cumulative savings in GHG emissions by 2035, of which the largest contribution (42%) results from the biogas produced replacing unclean fuels in household cooking. Combining the two interventions is expected to reduce PM2.5 emissions from the waste and residential sectors by over 30% compared to our baseline scenario by 2035, resulting in at least around 1150 cumulative life years saved over 2021–2035. The contribution and novelty of this study lies in the quantification of a potential waste-to-biogas scenario and its environmental and health impact in Kisumu for the first time. We present a system dynamics study of solid waste management in Kisumu, Kenya. Scenarios involve a waste-to-biogas initiative and a ban on open burning in landfill. Combined scenario generates 1.1m tonnes cumulative GHG savings by 2035. Largest contribution (42%) is from biogas substituting traditional cooking fuels. Combined scenario may save 1,150 cumulative life years by 2035, plus ~220 more p.a.
Collapse
Key Words
- ad, anaerobic digestion
- bc, black carbon
- co, carbon monoxide
- cop, conference of the parties
- doc, degradable organic carbon
- eu, european union
- gbd, global burden of disease
- ghg, greenhouse gas
- gwp, global warming potential
- hdi, human development index
- ics, improved cookstove
- ihd, ischaemic heart disease
- ipcc, intergovernmental panel on climate change
- kiswamp, kisumu integrated solid waste management plan
- knbs, kenyan national bureau of statistics
- lca, life cycle assessment
- lpg, liquefied petroleum gas
- lri, lower respiratory infections
- mj, megajoule
- msw, municipal solid waste
- mswm, municipal solid waste management
- mw, megawatt
- pm, particulate matter
- sd, system dynamics
- sdg, sustainable development goals
- ssa, sub-saharan africa
- swm, solid waste management
- who, world health organization
- wte, waste-to-energy
- municipal solid waste management
- system dynamics
- greenhouse gas emissions
- ghg accounting
- health impact assessment
- kisumu
Collapse
Affiliation(s)
- K. Dianati
- Institute for Environmental Design and Engineering (IEDE), Bartlett, UCL, UK
| | | | - J. Milner
- London School of Hygiene and Tropical Medicine (LSHTM), UK
| | - A. Gómez-Sanabria
- International Institute for Applied Systems Analysis (IIASA), Austria
| | - H. Gitau
- African Population and Health Research Centre (APHRC), Kenya
| | - J. Hale
- UCL Centre for Behaviour Change (CBC), UK
| | | | - G. Kiesewetter
- International Institute for Applied Systems Analysis (IIASA), Austria
| | - K. Muindi
- African Population and Health Research Centre (APHRC), Kenya
| | - B. Mberu
- African Population and Health Research Centre (APHRC), Kenya
| | - N. Zimmermann
- Institute for Environmental Design and Engineering (IEDE), Bartlett, UCL, UK
| | - S. Michie
- UCL Centre for Behaviour Change (CBC), UK
| | - P. Wilkinson
- London School of Hygiene and Tropical Medicine (LSHTM), UK
| | - M. Davies
- Institute for Environmental Design and Engineering (IEDE), Bartlett, UCL, UK
| |
Collapse
|
19
|
Teixeira de Siqueira-Filha N, Li J, Kibuchi E, Quayyum Z, Phillips-Howard P, Awal A, Mithu MIH, Manzoor F, Karuga R, Saidu S, Smith J, Sai V, Garimella S, Chumo I, Mberu B, Tolhurst R, Mazumdar S, Rao V, Farnaz N, Alam W, Elsey H. Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents. BMJ Open 2021; 11:e045441. [PMID: 34244254 PMCID: PMC8273471 DOI: 10.1136/bmjopen-2020-045441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2022] Open
Abstract
INTRODUCTION People living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents. METHODS AND ANALYSIS This scoping review adopts the framework suggested by Arksey and O'Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported. ETHICS AND DISSEMINATION Ethical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.
Collapse
Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Zahidul Quayyum
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Abdul Awal
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Farzana Manzoor
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | | | | | - Varun Sai
- The George Institute for Global Health India, New Delhi, India
| | | | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Rachel Tolhurst
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sumit Mazumdar
- Centre for Health Economics, University of York, York, UK
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Center, Mumbai, India
| | - Nadia Farnaz
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Wafa Alam
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
20
|
Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, Contay Y, Conteh A, Dean L, Dobson S, Edstrom J, Elsey H, Farnaz N, Garimella S, Gray L, Gupte J, Hawkins K, Hollihead B, Josyula KL, Kabaria C, Karuga R, Kimani J, Leyland AH, Te Lintelo D, Mansaray B, MacCarthy J, MacGregor H, Mberu B, Muturi N, Okoth L, Otiso L, Ozano K, Parray A, Phillips-Howard P, Rao V, Rashid S, Raven J, Refell F, Saidu S, Sobhan S, Saligram PS, Sesay S, Theobald S, Tolhurst R, Tubb P, Waldman L, Wariutu J, Whittaker L, Wurie H. How to prevent and address safeguarding concerns in global health research programmes: practice, process and positionality in marginalised spaces. BMJ Glob Health 2021; 5:bmjgh-2019-002253. [PMID: 32409330 PMCID: PMC7228499 DOI: 10.1136/bmjgh-2019-002253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/12/2022] Open
Abstract
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-income countries (Bangladesh, India, Kenya and Sierra Leone). Our manuscript is divided into three key sections. We start by discussing the importance of safeguarding in global health research and consider how thinking about vulnerability as a relational concept (shaped by unequal power relations and structural violence) can help locate fluid and context specific safeguarding risks within broader social systems. We then discuss the different steps undertaken in ARISE to develop a shared approach to safeguarding: sharing institutional guidelines and practice; facilitating a participatory process to agree a working definition of safeguarding and joint understandings of vulnerabilities, risks and mitigation strategies and share experiences; developing action plans for safeguarding. This is followed by reflection on our key learnings including how safeguarding, ethics and health and safety concerns overlap; the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces; and the importance of reflective practice and critical thinking about power, judgement and positionality and the ownership of the global narrative surrounding safeguarding. We finish by situating our learning within debates on decolonising science and argue for the importance of an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.
Collapse
Affiliation(s)
- Bachera Aktar
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Wafa Alam
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Samiha Ali
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Abdul Awal
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Margaret Bayoh
- Federation of Urban and Rural Poor, Freetown, Sierra Leone
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Yirah Contay
- Federation of Urban and Rural Poor, Freetown, Sierra Leone
| | - Abu Conteh
- Sierra Leone Urban Research Centre, Njala University, Freetown, Sierra Leone
| | - Laura Dean
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Skye Dobson
- Slum Dwellers International, Cape Town, South Africa
| | - Jerker Edstrom
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Helen Elsey
- Health Sciences, University of York, York, UK
| | - Nadia Farnaz
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | | | - Jaideep Gupte
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Kate Hawkins
- Pamoja Communications, Brighton and Hove, United Kingdom
| | - Beth Hollihead
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | | | | | | | - Joseph Kimani
- Slum and Shack Dwellers International Kenya, Nairobi, Kenya
| | | | - Dolf Te Lintelo
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Bintu Mansaray
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Joseph MacCarthy
- Sierra Leone Urban Research Centre, Njala University, Freetown, Sierra Leone
| | - Hayley MacGregor
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Kim Ozano
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Ateeb Parray
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | | | - Sabina Rashid
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | | | - Samuel Saidu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Shafinaz Sobhan
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | - Samira Sesay
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Phil Tubb
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Linda Waldman
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Jane Wariutu
- Slum and Shack Dwellers International Kenya, Nairobi, Kenya
| | - Lana Whittaker
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| |
Collapse
|
21
|
Davies M, Belesova K, Crane M, Hale J, Haines A, Hutchinson E, Kiesewetter G, Mberu B, Mohajeri N, Michie S, Milner J, Moore G, Osrin D, Pineo H, Pluchinotta I, Prasad A, Salvia G, Symonds P, Taylor J, Turcu C, Tsoulou I, Zimmermann N, Wilkinson P. The CUSSH programme: learning how to support cities’ transformational change towards health and sustainability. Wellcome Open Res 2021; 6:100. [DOI: 10.12688/wellcomeopenres.16678.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/20/2022] Open
Abstract
The Complex Urban Systems for Sustainability and Health (CUSSH) project is a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods it will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.
Collapse
|
22
|
Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Correction to: Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2021; 98:309-310. [PMID: 33570740 PMCID: PMC7877315 DOI: 10.1007/s11524-020-00491-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA, USA.
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health, Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas, Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge UK & School of Public Health and Family Medicine, Cambridge, UK.,University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
| |
Collapse
|
23
|
Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, Fayehun O, Griffiths F, Harris B, Kibe P, Lilford RJ, Omigbodun A, Rizvi N, Sartori J, Smith S, Watson SI, Wilson R, Yeboah G, Aujla N, Azam SI, Diggle PJ, Gill P, Iqbal R, Kabaria C, Kisia L, Kyobutungi C, Madan JJ, Mberu B, Mohamed SF, Nazish A, Odubanjo O, Osuh ME, Owoaje E, Oyebode O, Porto de Albuquerque J, Rahman O, Tabani K, Taiwo OJ, Tregonning G, Uthman OA, Yusuf R. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health 2020; 5:e003042. [PMID: 32819917 PMCID: PMC7443197 DOI: 10.1136/bmjgh-2020-003042] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
Collapse
Affiliation(s)
- Syed A K Shifat Ahmed
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
| | - Motunrayo Ajisola
- National Institute for Health Research Project, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Kehkashan Azeem
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Olufunke Fayehun
- Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kibe
- African Population and Health Research Center, Nairobi, Kenya
| | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Simon Smith
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samuel I Watson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ria Wilson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Godwin Yeboah
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Navneet Aujla
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Syed Iqbal Azam
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Peter J Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Lyagamula Kisia
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Jason J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Shukri F Mohamed
- African Population and Health Research Center, Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ahsana Nazish
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Mary E Osuh
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyinlola Oyebode
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Omar Rahman
- University of Liberal Arts Bangladesh, Dhaka, Bangladesh
| | - Komal Tabani
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Olalekan John Taiwo
- Department of Geography, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Grant Tregonning
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
24
|
Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2020; 97:348-357. [PMID: 32333243 PMCID: PMC7182092 DOI: 10.1007/s11524-020-00438-6] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.
Collapse
Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA USA
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology unit, University of Cambridge, UK & School of Public Health and Family Medicine, Cambridge, UK
- University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
| |
Collapse
|
25
|
Dodman D, Adelekan I, Brown D, Leck H, Manda M, Mberu B, Pelling M, Rusca M, Satterthwaite D, Taylor F. A spectrum of methods for a spectrum of risk: Generating evidence to understand and reduce urban risk in sub-Saharan Africa. Area (Oxf) 2019; 51:586-594. [PMID: 31597984 PMCID: PMC6774315 DOI: 10.1111/area.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 05/07/2023]
Abstract
Many African towns and cities face a range of hazards, which can best be described as representing a "spectrum of risk" of events that can cause death, illness or injury, and impoverishment. Yet despite the growing numbers of people living in African urban centres, the extent and relative severity of these different risks is poorly understood. This paper provides a rationale for using a spectrum of methods to address this spectrum of risk, and demonstrates the utility of mixed-methods approaches in planning for resilience. It describes activities undertaken in a wide-ranging multi-country programme of research, which use multiple approaches to gather empirical data on risk, in order to build a stronger evidence base and provide a more solid base for planning and investment. It concludes that methods need to be chosen in regard to social, political economic, biophysical and hydrogeological context, while also recognising the different levels of complexity and institutional capacity in different urban centres. The paper concludes that as well as the importance of taking individual contexts into account, there are underlying methodological principles - based on multidisciplinary expertise and multi-faceted and collaborative research endeavours - that can inform a range of related approaches to understanding urban risk in sub-Saharan Africa and break the cycle of risk accumulation.
Collapse
Affiliation(s)
- David Dodman
- International Institute for Environment and DevelopmentLondonUK
| | | | | | | | | | - Blessing Mberu
- African Population and Health Research CentreNairobiKenya
| | | | - Maria Rusca
- Department of Earth SciencesUppsala UniversityUppsalaSweden
- Centre of Natural Hazards and Disaster ScienceUppsalaSweden
| | | | - Faith Taylor
- Department of GeographyUniversity of PortsmouthPortsmouthUK
| |
Collapse
|
26
|
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. Sci Total Environ 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
27
|
Amugsi DA, Dimbuene ZT, Mberu B, Muthuri S, Ezeh AC. Prevalence and time trends in overweight and obesity among urban women: an analysis of demographic and health surveys data from 24 African countries, 1991 -2014. BMJ Open 2017; 7:e017344. [PMID: 29079606 PMCID: PMC5665233 DOI: 10.1136/bmjopen-2017-017344] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To examine the prevalence and trends in overweight and obesity among non-pregnant urban women in Africa over the past two and a half decades. DESIGN Cross-sectional surveys conducted between 1991 and 2014. SETTINGS Demographic and Health Surveys (DHS), repeated cross-sectional data collected in 24 African countries. PARTICIPANTS Adult non-pregnant women aged 15-49 years. The earlier DHS collected anthropometric data on only those women who had children aged 0-5 years. The main analyses were limited to this subgroup. The participants were classified as overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). RESULTS The prevalence of overweight and obesity among women increased in all the 24 countries. Trends were statistically significant in 17 of the 24 countries in the case of obesity and 13 of the 24 for overweight. In Ghana, overweight almost doubled (p=0.001) while obesity tripled (p=0.001) between 1993 and 2014. Egypt has the highest levels of overweight and obesity at 44% (95% CI 42%, 46.5%) and 39% (95% CI 36.6%, 41.8%), respectively, in 2014 and the trend showed significant increase (p=0.005) from 1995 levels. Also, obesity doubled in Kenya, Benin, Niger, Rwanda, Ivory Coast and Uganda, while tripled in Zambia, Burkina Faso, Mali, Malawi and Tanzania. Ethiopia and Madagascar had the lowest prevalence of both obesity and overweight, with overweight ranging from 7% to 12% and obesity from 1% to 4%. CONCLUSIONS Overweight and obesity are increasing among women of reproductive age in urban Africa, with obesity among this age group having more than doubled or tripled in 12 of the 24 countries. There is an urgent need for deliberate policies and interventions to encourage active lifestyles and healthy eating behaviour to curb this trend in urban Africa.
Collapse
Affiliation(s)
| | - Zacharie T Dimbuene
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Congo
- Statistics Canada, Social Analysis and Modeling Division, Ottawa, Canada
| | - Blessing Mberu
- African Population and Health Research Center, APHRC Campus, Nairobi, Kenya
| | - Stella Muthuri
- African Population and Health Research Center, APHRC Campus, Nairobi, Kenya
| | - Alex C Ezeh
- African Population and Health Research Center, APHRC Campus, Nairobi, Kenya
| |
Collapse
|
28
|
Lilford RJ, Oyebode O, Satterthwaite D, Melendez-Torres GJ, Chen YF, Mberu B, Watson SI, Sartori J, Ndugwa R, Caiaffa W, Haregu T, Capon A, Saith R, Ezeh A. Improving the health and welfare of people who live in slums. Lancet 2017; 389:559-570. [PMID: 27760702 DOI: 10.1016/s0140-6736(16)31848-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health.
Collapse
Affiliation(s)
- Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory, Research and Capacity Development Branch, United Nations Human Settlements Programme, Nairobi, Kenya
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | | | - Ruhi Saith
- Oxford Policy Management, New Delhi, India
| | - Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Ezeh A, Oyebode O, Satterthwaite D, Chen YF, Ndugwa R, Sartori J, Mberu B, Melendez-Torres GJ, Haregu T, Watson SI, Caiaffa W, Capon A, Lilford RJ. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 2017; 389:547-558. [PMID: 27760703 DOI: 10.1016/s0140-6736(16)31650-6] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.
Collapse
Affiliation(s)
- Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory Research and Capacity Development Branch, United Nations Human Settlements Programme, UN Avenue Gigiri, UN Complex, GPO Nairobi, Kenya
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | | | - Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
| |
Collapse
|
30
|
Ziraba AK, Haregu TN, Mberu B. A review and framework for understanding the potential impact of poor solid waste management on health in developing countries. ACTA ACUST UNITED AC 2016; 74:55. [PMID: 28031815 PMCID: PMC5184495 DOI: 10.1186/s13690-016-0166-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The increase in solid waste generated per capita in Africa has not been accompanied by a commensurate growth in the capacity and funding to manage it. It is reported that less than 30% of urban waste in developing countries is collected and disposed appropriately. The implications of poorly managed waste on health are numerous and depend on the nature of the waste, individuals exposed, duration of exposure and availability of interventions for those exposed. OBJECTIVE To present a framework for understanding the linkages between poor solid waste management, exposure and associated adverse health outcomes. The framework will aid understanding of the relationships, interlinkages and identification of the potential points for intervention. METHODS Development of the framework was informed by a review of literature on solid waste management policies, practices and its impact on health in developing countries. A configurative synthesis of literature was applied to develop the framework. Several iterations of the framework were reviewed by experts in the field. Each linkage and outcomes are described in detail as outputs of this study. RESULT The resulting framework identifies groups of people at a heightened risk of exposure and the potential health consequences. Using the iceberg metaphor, the framework illustrates the pathways and potential burden of ill-health related to solid waste that is hidden but rapidly unfolding with our inaction. The existing evidence on the linkage between poor solid waste management and adverse health outcomes calls to action by all stakeholders in understanding, prioritizing, and addressing the issue of solid waste in our midst to ensure that our environment and health are preserved. CONCLUSION A resulting framework developed in this study presents a clearer picture of the linkages between poor solid waste management and could guide research, policy and action.
Collapse
Affiliation(s)
- Abdhalah K Ziraba
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Tilahun Nigatu Haregu
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| |
Collapse
|
31
|
Amugsi DA, Dimbuene ZT, Bakibinga P, Kimani-Murage EW, Haregu TN, Mberu B. Dietary diversity, socioeconomic status and maternal body mass index (BMI): quantile regression analysis of nationally representative data from Ghana, Namibia and Sao Tome and Principe. BMJ Open 2016; 6:e012615. [PMID: 27678544 PMCID: PMC5051549 DOI: 10.1136/bmjopen-2016-012615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To (a) assess the association between dietary diversity (DD) score, socioeconomic status (SES) and maternal body mass index (BMI), and (b) the variation of the effects of DD and SES at different points of the conditional distribution of the BMI. METHODS The study used Demographic and Health Surveys round 5 data sets from Ghana, Namibia and Sao Tome and Principe. The outcome variable for the analysis was maternal BMI. The DD score was computed using 24-hour dietary recall data. Quantile regression (QR) was used to examine the relationship between DD and SES, and maternal BMI, adjusting for other covariates. The QR allows the covariate effects to vary across the entire distribution of maternal BMI. RESULTS Women who consumed an additional unit of DD achieved an increase of 0.245 in BMI for those in the 90th quantile in Ghana. The effect of household wealth increases for individuals across all quantiles of the BMI distribution and in all the 3 countries. A unit change in the household wealth score was associated with an increase of 0.038, 0.052 and 0.065 units increase in BMI for individuals in the 5th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Also, 0.237, 0.301 and 0.174 units increased for those in the 90th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Education had a significant positive effect on maternal BMI across all quantiles in Namibia and negative effect at the 5th, 10th and 90th quantiles in Sao Tome and Principe. CONCLUSIONS There is heterogeneity in the effects of DD and SES on maternal BMI. Studies focusing on the effects of diet and socioeconomic determinants on maternal BMI should examine patterns of effects at different points of the conditional distribution of the BMI and not just the average effect.
Collapse
Affiliation(s)
| | | | | | | | | | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
32
|
Tougher S, Mann AG, Ye Y, Kourgueni IA, Thomson R, Amuasi JH, Ren R, Willey BA, Ansong D, Bruxvoort K, Diap G, Festo C, Johanes B, Kalolella A, Mallam O, Mberu B, Ndiaye S, Nguah SB, Seydou M, Taylor M, Wamukoya M, Arnold F, Hanson K, Goodman C. Improving access to malaria medicine through private-sector subsidies in seven African countries. Health Aff (Millwood) 2016; 33:1576-85. [PMID: 25201662 DOI: 10.1377/hlthaff.2014.0104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.
Collapse
Affiliation(s)
- Sarah Tougher
- Sarah Tougher is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Andrea G Mann
- Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | | | - Yazoume Ye
- Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland
| | - Idrissa A Kourgueni
- Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger
| | - Rebecca Thomson
- Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine
| | - John H Amuasi
- John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana
| | - Ruilin Ren
- Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland
| | - Barbara A Willey
- Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Daniel Ansong
- Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH
| | - Katia Bruxvoort
- Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine
| | - Graciela Diap
- Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland
| | - Charles Festo
- Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania
| | - Boniface Johanes
- Boniface Johanes is a researcher at the Ifakara Health Institute
| | | | - Oumarou Mallam
- Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger
| | - Blessing Mberu
- Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya
| | - Salif Ndiaye
- Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal
| | - Samual Blay Nguah
- Samual Blay Nguah is a researcher at the research and development unit at KATH
| | - Moctar Seydou
- Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger
| | - Mark Taylor
- Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia
| | | | - Fred Arnold
- Fred Arnold is a senior fellow at ICF International in Rockville, Maryland
| | - Kara Hanson
- Kara Hanson is a professor of health systems economics and head of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine
| | - Catherine Goodman
- Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine
| |
Collapse
|
33
|
Ye Y, Arnold F, Noor A, Wamukoya M, Amuasi J, Blay S, Mberu B, Ren R, Kyobutungi C, Wekesah F, Gatakaa H, Toda M, Njogu J, Evance I, O'Connell K, Shewchuk T, Thougher S, Mann A, Willey B, Goodman C, Hanson K. The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention? Malar J 2015; 14:398. [PMID: 26452625 PMCID: PMC4600285 DOI: 10.1186/s12936-015-0904-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background To assess the availability, price and
market share of quality-assured artemisinin-based combination therapy (QAACT) in remote areas (RAs) compared with non-remote areas (nRAs) in Kenya and Ghana at end-line of the Affordable Medicines Facility-malaria (AMFm) intervention. Methods Areas were classified by remoteness using a composite index computed from estimated travel times to three levels of service centres. The index was used to five categories of remoteness, which were then grouped into two categories of remote and non-remote areas. The number of public or private outlets with the potential to sell or distribute anti-malarial medicines, screened in nRAs and RAs, respectively, was 501 and 194 in Ghana and 9980 and 2353 in Kenya. The analysis compares RAs with nRAs in terms of availability, price and market share of QAACT in each country. Results QAACT were similarly available in RAs as nRAs in Ghana and Kenya. In both countries, there was no statistical difference in availability of QAACT with AMFm logo between RAs and nRAs in public health facilities (PHFs), while private-for-profit (PFP) outlets had lower availability in RA than in nRAs (Ghana: 66.0 vs 82.2 %, p < 0.0001; Kenya: 44.9 vs 63.5 %, p = <0.0001. The median price of QAACT with AMFm logo for PFP outlets in RAs (USD1.25 in Ghana and USD0.69 in Kenya) was above the recommended retail price in Ghana (US$0.95) and Kenya (US$0.46), and much higher than in nRAs for both countries. QAACT with AMFm logo represented the majority of QAACT in RAs and nRAs in Kenya and Ghana. In the PFP sector in Ghana, the market share for QAACT with AMFm logo was significantly higher in RAs than in nRAs (75.6 vs 51.4 %, p < 0.0001). In contrast, in similar outlets in Kenya, the market share of QAACT with AMFm logo was significantly lower in RAs than in nRAs (39.4 vs 65.1 %, p < 0.0001). Conclusion The findings indicate the AMFm programme contributed to making QAACT more available in RAs in these two countries. Therefore, the AMFm approach can inform other health interventions aiming at reaching hard-to-reach populations, particularly in the context of universal access to health interventions. However, further examination of the factors accounting for the deep penetration of the AMFm programme into RAs is needed to inform actions to improve the healthcare delivery system, particularly in RAs.
Collapse
Affiliation(s)
- Yazoume Ye
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Fred Arnold
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | | | | | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
| | - Samuel Blay
- Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya.
| | - Ruilin Ren
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | | | | | - Hellen Gatakaa
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Mitsuru Toda
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan.
| | - Julius Njogu
- The ACTwatch project (Population Services International), Nairobi, Kenya.
| | - Illah Evance
- The ACTwatch project (Population Services International), Nairobi, Kenya.
| | - Kathryn O'Connell
- The ACTwatch project (Population Services International), Nairobi, Kenya.
| | - Tanya Shewchuk
- The ACTwatch project (Population Services International), Nairobi, Kenya.
| | - Sarah Thougher
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Andrea Mann
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Barbara Willey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
34
|
Beguy D, Mberu B. Patterns of fertility preferences and contraceptive behaviour over time: change and continuities among the urban poor in Nairobi, Kenya. Cult Health Sex 2015; 17:1074-1089. [PMID: 26057848 DOI: 10.1080/13691058.2015.1038731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The main objective of this paper is to investigate the association between fertility preferences and contraceptive use among 15-49-year-old women living in Korogocho and Viwandani, informal settlements in Nairobi, Kenya. We draw on longitudinal data collected under the Maternal and Child Health project conducted between 2006 and 2010 in the two settlements. There is substantial regularity and stability but also unusual instability in reported fertility preferences over time among women living in these settings. Younger women, aged 15-24 years, are likely to change their preferences over time, passing from limiting to wanting additional children. But women aged 35-49 are likely to change their preferences from desiring more children to limiting their childbearing. The desire to limit childbearing is strongly associated with the use of modern and long-acting contraceptive methods. Findings have major implications for the success of family planning programmes in informal settlements where access to and knowledge about contraception may be limited.
Collapse
Affiliation(s)
- Donatien Beguy
- a African Population and Health Research Center , Nairobi , Kenya
| | | |
Collapse
|
35
|
Mberu B, Wamukoya M, Oti S, Kyobutungi C. Trends in Causes of Adult Deaths among the Urban Poor: Evidence from Nairobi Urban Health and Demographic Surveillance System, 2003-2012. J Urban Health 2015; 92:422-45. [PMID: 25758599 PMCID: PMC4456477 DOI: 10.1007/s11524-015-9943-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
What kills people around the world and how it varies from place to place and over time is critical in mapping the global burden of disease and therefore, a relevant public health question, especially in developing countries. While more than two thirds of deaths worldwide are in developing countries, little is known about the causes of death in these nations. In many instances, vital registration systems are nonexistent or at best rudimentary, and even when deaths are registered, data on the cause of death in particular local contexts, which is an important step toward improving context-specific public health, are lacking. In this paper, we examine the trends in the causes of death among the urban poor in two informal settlements in Nairobi by applying the InterVA-4 software to verbal autopsy data. We examine cause of death data from 2646 verbal autopsies of deaths that occurred in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) between 1 January 2003 and 31 December 2012 among residents aged 15 years and above. The data is entered into the InterVA-4 computer program, which assigns cause of death using probabilistic modeling. The results are presented as annualized trends from 2003 to 2012 and disaggregated by gender and age. Over the 10-year period, the three major causes of death are tuberculosis (TB), injuries, and HIV/AIDS, accounting for 26.9, 20.9, and 17.3% of all deaths, respectively. In 2003, HIV/AIDS was the highest cause of death followed by TB and then injuries. However, by 2012, TB and injuries had overtaken HIV/AIDS as the major causes of death. When this is examined by gender, HIV/AIDS was consistently higher for women than men across all the years generally by a ratio of 2 to 1. In terms of TB, it was more evenly distributed across the years for both males and females. We find that there is significant gender variation in deaths linked to injuries, with male deaths being higher than female deaths by a ratio of about 4 to 1. We also find a fifteen percentage point increase in the incidences of male deaths due to injuries between 2003 and 2012. For women, the corresponding deaths due to injuries remain fairly stable throughout the period. We find cardiovascular diseases as a significant cause of death over the period, with overall mortality increasing steadily from 1.6% in 2003 to 8.1% in 2012, and peaking at 13.7% in 2005 and at 12.0% in 2009. These deaths were consistently higher among women. We identified substantial variations in causes of death by age, with TB, HIV/AIDS, and CVD deaths lowest among younger residents and increasing with age, while injury-related deaths are highest among the youngest adults 15-19 and steadily declined with age. Also, deaths related to neoplasms and respiratory tract infections (RTIs) were prominent among older adults 50 years and above, especially since 2005. Emerging at this stage is evidence that HIV/AIDS, TB, injuries, and cardiovascular disease are linked to approximately 73% of all adult deaths among the urban poor in Nairobi slums of Korogocho and Viwandani in the last 10 years. While mortality related to HIV/AIDS is generally declining, we see an increasing proportion of deaths due to TB, injuries, and cardiovascular diseases. In sum, substantial epidemiological transition is ongoing in this local context, with deaths linked to communicable diseases declining from 66% in 2003 to 53% in 2012, while deaths due to noncommunicable causes experienced a four-fold increase from 5% in 2003 to 21.3% in 2012, together with another two-fold increase in deaths due to external causes (injuries) from 11% in 2003 to 22% in 2012. It is important to also underscore the gender dimensions of the epidemiological transition clearly visible in the mix. Finally, the elevated levels of disadvantage of slum dwellers in our analysis relative to other population subgroups in Kenya continue to demonstrate appreciable deterioration of key urban health and social indicators, highlighting the need for a deliberate strategic focus on the health needs of the urban poor in policy and program efforts toward achieving international goals and national health and development targets.
Collapse
Affiliation(s)
- Blessing Mberu
- African Population and Health Research Center, APHRC Campus, Kirawa Road, off Peponi Road,, 10787-00100,, Nairobi, Kenya,
| | | | | | | |
Collapse
|
36
|
Mberu B, Mumah J, Kabiru C, Brinton J. Bringing sexual and reproductive health in the urban contexts to the forefront of the development agenda: the case for prioritizing the urban poor. Matern Child Health J 2015; 18:1572-7. [PMID: 24352624 PMCID: PMC4152622 DOI: 10.1007/s10995-013-1414-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Estimates suggest that over 90 % of population increase in the least developed countries over the next four decades will occur in urban areas. These increases will be driven both by natural population growth and rural-urban migration. Moreover, despite its status as the world's least urbanized region, the urban population in the sub-Saharan Africa region is projected to increase from under 40 % currently to over 60 % by 2050. Currently, approximately 70 % of all urban residents in the region live in slums or slum-like conditions. Sexual and reproductive health (SRH) risks for the urban poor are severe and include high rates of unwanted pregnancies, sexually transmitted infections, and poor maternal and child health outcomes. However, the links between poverty, urbanization, and reproductive health priorities are still not a major focus in the broader development agenda. Building on theoretical and empirical data, we show that SRH in urban contexts is critical to the development of healthy productive urban populations and, ultimately, the improvement of quality of life. We posit that a strategic focus on the sexual and reproductive health of urban residents will enable developing country governments achieve international goals and national targets by reducing health risks among a large and rapidly growing segment of the population. To that end, we identify key research, policy and program recommendations and strategies required for bringing sexual and reproductive health in urban contexts to the forefront of the development agenda.
Collapse
Affiliation(s)
- Blessing Mberu
- African Population and Health Research Centre, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya,
| | | | | | | |
Collapse
|
37
|
Poyer S, Shewchuk T, Tougher S, Ye Y, Mann AG, Willey BA, Thomson R, Amuasi JH, Ren R, Wamukoya M, Taylor M, Nguah SB, Mberu B, Kalolella A, Juma E, Festo C, Johanes B, Diap G, Bruxvoort K, Ansong D, Hanson K, Arnold F, Goodman C. Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys. Trop Med Int Health 2015; 20:744-56. [DOI: 10.1111/tmi.12491] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Poyer
- Malaria & Child Survival Department; Population Services International; Nairobi Kenya
| | | | - Sarah Tougher
- London School of Hygiene and Tropical Medicine; London UK
| | | | - Andrea G. Mann
- London School of Hygiene and Tropical Medicine; London UK
| | | | - Rebecca Thomson
- London School of Hygiene and Tropical Medicine; London UK
- Ifakara Health Institute; Dar es Salaam Tanzania
| | - John H. Amuasi
- University of Minnesota School of Public Health; Minneapolis MN USA
- Kumasi Center for Collaborative Research in Tropical Medicine; Kumasi Ghana
| | | | | | - Mark Taylor
- London School of Hygiene and Tropical Medicine; London UK
- Department of Public Health; Trnava University; Trnava Slovakia
| | - Samuel Blay Nguah
- Kumasi Center for Collaborative Research in Tropical Medicine; Kumasi Ghana
| | - Blessing Mberu
- African Population and Health Research Center; Nairobi Kenya
| | | | - Elizabeth Juma
- Kenya Medical Research Institute; Centre for Global Health Research; Kisumu Kenya
| | | | | | - Graciela Diap
- Drugs for Neglected Diseases Initiative; Geneva Switzerland
| | - Katia Bruxvoort
- London School of Hygiene and Tropical Medicine; London UK
- Ifakara Health Institute; Dar es Salaam Tanzania
| | - Daniel Ansong
- African Population and Health Research Center; Nairobi Kenya
- Department of Child Health; Kwame Nkrumah University of Science & Technology; Kumasi Ghana
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine; London UK
| | | | | | | |
Collapse
|
38
|
Soura AB, Mberu B, Elungata P, Lankoande B, Millogo R, Beguy D, Compaore Y. Understanding inequities in child vaccination rates among the urban poor: evidence from Nairobi and Ouagadougou health and demographic surveillance systems. J Urban Health 2015; 92:39-54. [PMID: 25316191 PMCID: PMC4338131 DOI: 10.1007/s11524-014-9908-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou's informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services.
Collapse
|
39
|
Beguy D, Elung'ata P, Mberu B, Oduor C, Wamukoya M, Nganyi B, Ezeh A. Health & Demographic Surveillance System Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Int J Epidemiol 2015; 44:462-71. [DOI: 10.1093/ije/dyu251] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Kimani-Murage EW, Schofield L, Wekesah F, Mohamed S, Mberu B, Ettarh R, Egondi T, Kyobutungi C, Ezeh A. Vulnerability to food insecurity in urban slums: experiences from Nairobi, Kenya. J Urban Health 2014; 91:1098-113. [PMID: 25172616 PMCID: PMC4242851 DOI: 10.1007/s11524-014-9894-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.
Collapse
Affiliation(s)
- E W Kimani-Murage
- African Population and Health Research Centre, Nairobi, Kenya, P.O. Box 10787, 00100, Nairobi, Kenya,
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Rossier C, Muindi K, Soura A, Mberu B, Lankoande B, Kabiru C, Millogo R. Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS. Glob Health Action 2014; 7:24351. [PMID: 25014187 PMCID: PMC4093672 DOI: 10.3402/gha.v7.24351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences. Objective By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play. Design We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n=3,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatal care (ANC) use and deliveries at health facilities, controlling for demographic variables. Results ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility. Conclusions These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.
Collapse
Affiliation(s)
- Clémentine Rossier
- Institute of Demographic and Life Course Studies, University of Geneva, Geneva, Switzerland; Institut National d'Etudes Démographiques, Paris, France;
| | - Kanyiva Muindi
- African Population and Health Research Center, Nairobi, Kenya
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Caroline Kabiru
- African Population and Health Research Center, Nairobi, Kenya
| | - Roch Millogo
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| |
Collapse
|
42
|
Willey BA, Tougher S, Ye Y, Mann AG, Thomson R, Kourgueni IA, Amuasi JH, Ren R, Wamukoya M, Rueda ST, Taylor M, Seydou M, Nguah SB, Ndiaye S, Mberu B, Malam O, Kalolella A, Juma E, Johanes B, Festo C, Diap G, Diallo D, Bruxvoort K, Ansong D, Amin A, Adegoke CA, Hanson K, Arnold F, Goodman C. Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention. Malar J 2014; 13:46. [PMID: 24495691 PMCID: PMC3924415 DOI: 10.1186/1475-2875-13-46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. This paper reports private for-profit provider awareness of key features of the AMFm programme, and changes in provider knowledge of appropriate malaria treatment. METHODS This study had a non-experimental design based on nationally representative surveys of outlets stocking anti-malarials before (2009/10) and after (2011) the AMFm roll-out. RESULTS Based on data from over 19,500 outlets, results show that in four of eight settings, where communication campaigns were implemented for 5-9 months, 76%-94% awareness of the AMFm 'green leaf' logo, 57%-74% awareness of the ACT subsidy programme, and 52%-80% awareness of the correct recommended retail price (RRP) of subsidized ACT were recorded. However, in the remaining four settings where communication campaigns were implemented for three months or less, levels were substantially lower. In six of eight settings, increases of at least 10 percentage points in private for-profit providers' knowledge of the correct first-line treatment for uncomplicated malaria were seen; and in three of these the levels of knowledge achieved at endline were over 80%. CONCLUSIONS The results support the interpretation that, in addition to the availability of subsidized ACT, the intensity of communication campaigns may have contributed to the reported levels of AMFm-related awareness and knowledge among private for-profit providers. Future subsidy programmes for anti-malarials or other treatments should similarly include communication activities.
Collapse
Affiliation(s)
- Barbara A Willey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Tougher S, Ye Y, Amuasi JH, Kourgueni IA, Thomson R, Goodman C, Mann AG, Ren R, Willey BA, Adegoke CA, Amin A, Ansong D, Bruxvoort K, Diallo DA, Diap G, Festo C, Johanes B, Juma E, Kalolella A, Malam O, Mberu B, Ndiaye S, Nguah SB, Seydou M, Taylor M, Rueda ST, Wamukoya M, Arnold F, Hanson K. Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Lancet 2012; 380:1916-26. [PMID: 23122217 DOI: 10.1016/s0140-6736(12)61732-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). METHODS We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. FINDINGS In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. INTERPRETATION Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. FUNDING The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Sarah Tougher
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Rapid population growth is a threat to wellbeing in the poorest countries, whereas very low fertility increasingly threatens the future welfare of many developed countries. The mapping of global trends in population growth from 2005-10 shows four distinct patterns. Most of the poorest countries, especially in sub-Saharan Africa, are characterised by rapid growth of more than 2% per year. Moderate annual growth of 1-2% is concentrated in large countries, such as India and Indonesia, and across north Africa and western Latin America. Whereas most advanced-economy countries and large middle-income countries, such as China and Brazil, are characterised by low or no growth (0-1% per year), most of eastern Europe, Japan, and a few western European countries are characterised by population decline. Countries with rapid growth face adverse social, economic, and environmental pressures, whereas those with low or negative growth face rapid population ageing, unsustainable burdens on public pensions and health-care systems, and slow economic growth. Countries with rapid growth should consider the implementation of voluntary family planning programmes as their main policy option to reduce the high unmet need for contraception, unwanted pregnancies, and probirth reproductive norms. In countries with low or negative growth, policies to address ageing and very low fertility are still evolving. Further research into the potential effect of demographic policies on other social systems, social groups, and fertility decisions and trends is therefore recommended.
Collapse
Affiliation(s)
- Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya.
| | | | | |
Collapse
|