Indonesia – Water from street vendors and child mortality/morbidity

From: Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia, International Journal of Hygiene and Environmental Health, Article in Press.

Richard D. Sembaa, et al.

In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days.

Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001).

Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20–1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29–1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums.

IIED – Pro-poor adaptation to climate change in urban centres

Towards pro-poor adaptation to climate change in the urban centres of low- and middle-income countries, November 2008. (pdf, 22KB) by Caroline Moser, David Satterthwaite. IIED.

This paper outlines a framework for adaptation to climate change for urban areas in low- and middle-income nations that is pro-poor and that enhances the capacity of low-income households and community organizations to contribute to such adaptation. It begins by describing how urban centres in low and middle income countries concentrate a large proportion of those most at risk from the effects of climate change as people‘s lives, assets, environmental quality and future prosperity are threatened by the increasing risk of storms, flooding, landslides, heatwaves and drought that climate change is likely to bring. It also points to the weaknesses in the local institutions with responsibility for addressing this and the very large deficiencies in the infrastructure and services needed for protection. It also discusses the lack of attention given to supporting adaptation in urban areas by scientists, governments and international agencies, and considers why this is so.

Kenya – Refuse dumps and cholera infection in Kumasi

Spatial dependency of V. cholera prevalence on open space refuse dumps in Kumasi, Ghana: a spatial statistical modelling. Author: Frank B Osei and Alfred A Duker. International Journal of Health Geographics 2008, 7:62.

Cholera has persisted in Ghana since its introduction in the early 70’s. From 1999 to 2005, the Ghana Ministry of Health officially reported a total of 26,924 cases and 620 deaths to the WHO.

Etiological studies suggest that the natural habitat of V. cholera is the aquatic environment.

Its ability to survive within and outside the aquatic environment makes cholera a complex health problem to manage. Once the disease is introduced in a population, several environmental factors may lead to prolonged transmission and secondary cases.

An important environmental factor that predisposes individuals to cholera infection is sanitation. In this study, we exploit the importance of two main spatial measures of sanitation in cholera transmission in an urban city, Kumasi.

These are proximity and density of refuse dumps within a community.

Results: A spatial statistical modelling carried out to determine the spatial dependency of cholera prevalence on refuse dumps show that, there is a direct spatial relationship between cholera prevalence and density of refuse dumps, and an inverse spatial relationship between cholera prevalence and distance to refuse dumps. A spatial scan statistics also identified four significant spatial clusters of cholera; a primary cluster with greater than expected cholera prevalence, and three secondary clusters with lower than expected cholera prevalence.

A GIS based buffer analysis and a quantitative assessment of distance discrimination of the buffer zones around refuse dumps show that the optimum spatial discrimination of cholera occurs at 500m from refuse dumps. This indicates that the minimum distance within which refuse dumps should not be sited within community centres is 500m.

Conclusion: The results suggest that proximity and density of open space refuse dumps play a contributory role in cholera infection in Kumasi.

Source – 7th Space Interactive

Bangladesh – Hygiene classes help poor women break taboos

In sharp contrast to her questioner, who tip-toes around the delicate subject, Akhi Sultana belts out a full-throated response that is audible to everyone in a room full of strangers.

“Before, when I had my period, I could not change my rags or wash properly,” the 16-year-old says, referring to the strips of old saris that poor Bangladeshi women use to manage menstruation because they cannot afford tampons or sanitary pads. “I always felt shaky and afraid because there was no privacy in the latrines and no water nearby to wash with,” Ms Sultana says. “Now there is a water pump adjacent to the latrine and it is private.”

She lives in the Zakirer slum in the Bangladeshi capital Dhaka, one of dozens of cramped settlements where a third of the city’s 10m people reside. The pump and latrine she refers to were installed thanks to Water­Aid, the charity the Financial Times is supporting this year in its seasonal appeal. But equally significant – in a society where women are often treated as second or third-class citizens – is the way she is talking: forthright, matter-of-fact, unabashed.

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Kenya – Nairobi metropolitan development strategy launched

President Mwai Kibaki Monday launched the Nairobi Metro 2030 Strategy and directed relevant Government organs to speedily expedite the requisite legal and institutional reforms that will facilitate the success of the strategy.

Speaking during the launch at Kenyatta International Conference Centre -KICC-, President Kibaki said his Government is putting in place strategies aimed at transforming the city of Nairobi and other major towns into vibrant centres of economic activity for the benefit of wananchi.

“Towards this end, we are according priority to urban development, and specifically Metropolitan development, as one of the driving forces that will propel our country into the status of a middle income rapidly industrializing country,” President Kibaki said.

He said the Government, under vision 2030, programmed to create and develop metropolitan regions across the country, namely Nairobi, Mombasa, Kisumu-Kakamega, Nakuru-Eldoret, Wajir-Garissa-Mandera, and Kitui-Mwingi-Meru.

The President emphasized that the identification of the metropolitan region is strategic as it is intended to play a pivotal role in the realisation of the growth targets envisaged under VISION 2030.

Said the President:” Some of these targets include promotion of social equity and inclusiveness and making our cities yield more in terms of their productive potential.”

President Kibaki pointed out that the Government’s decision to begin the implementation of the urban development strategy with the Nairobi Metropolitan region is based on the fact that the capital city is the country’s main gateway to the rest of the world.

The Head of State expressed confidence that the Nairobi Metro 2030 strategy will guide the transformation of the Nairobi Metro region into a world class metropolis and also inform decisions on a wide range of urban issues including transportation, infrastructure, housing

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South Africa – Urban health survey

Our way of living is killing us gradually – December 11, 2008

Many South Africans lead sedentary lifestyles, have poor and unhealthy diets and are overweight or obese, leading to all kinds of preventable but fatal conditions.

The latest South African Health Review warns that South Africans, especially poor people in urban areas, are at high risk of chronic non-communicable diseases linked to preventable risk factors such as high blood pressure, high cholesterol, obesity, physical inactivity, unhealthy diet, smoking and drinking. These factors lead to various chronic disease processes – heart attacks, tobacco- and nutrition-induced cancers and obstructive lung diseases – that culminate in high death rates.

A South African study conducted in 2000 identified heart disease, stroke, high blood pressure and diabetes as causing 65 000 deaths per year, suggesting that the prevention of these diseases should receive priority attention.

The authors of the review also expressed concern that these high-risk patients were not being identified at primary healthcare level. “Routine screening for risk factors in all individuals in the health services is poor,” they wrote. In 2003, national data showed that only 18% of men and 22% of women had controlled hypertension.

In 2000, the prevalence of diabetes among adults older than 30 was estimated to be about 5,5%. A study to identify environmental risk factors for noncommunicable diseases in urban townships showed that there was a shortage of healthy, low-fat food and fresh fruit and vegetables. Another study reported that although many black women were overweight or obese, few perceived themselves as such.

“The belief that thinness is associated with personal problems and sickness, especially HIV/Aids, seems to be a barrier to maintaining normal body weight in some individuals,” it said. Young people were found to have bad habits.

A national survey found that youngsters frequently consumed fast foods (38,8%), cakes and biscuits (47,4%), cooldrinks and sweets (52%) at least four days a week. The review also found that the nutritional status of South Africans had deteriorated since 1994.

Severe vitamin A deficiency was recorded in about 15% of children – despite the legislated fortification of bread, flour and maize meal and the national high-dose vitamin A supplementation programme. High levels of zinc deficiency were also recorded.

The authors cited an example from Finland – which had the highest death rate from cardiovascular disease due to heavy smoking, high-fat diet and low vegetable intake – where a community-based intervention reduced cancer and heart disease mortality by at least 56%. The intervention led to policies banning tobacco advertising and the introduction of low-fat and vegetableoil products

Source – The Star

South Africa – Buckets kicked as Khayelitsha waits to flush

After waiting for years for access to flushing toilets, residents of the BM Section informal settlement in Khayelitsha have finally had 280 of them installed by the city.

About 5 000 residents, who have until now been using bucket toilets, will benefit from the new flushing toilets.

The city plans to install the next 140 toilets by next March.

A resident of the area, Nokuzola Nedala, said she was very happy that she now had access to a flushing toilet.

The ward councillor for the area, Nosakhele Jelele, said the community was delighted to have the flushing toilets available to them.

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China’s next 30 years: Building the world’s biggest cities

SHANGHAI (AFP) — China’s past 30 years of reforms planted seeds that will in the coming decades produce future coastal megacities, an urban population of one billion and possibly the world’s biggest economy.

What the next 30 years of reforms have in store may be unclear but experts agree with widespread pollution problems and a tidal wave of migration set to hit China’s cities, urbanisation will be the future’s biggest challenge.

“The next 30 years are going to be a critical timetable for addressing all the needs of a large population and how China manages cities,” said James Canton, author of “The Extreme Future”.

By 2025 China’s urban population is expected to rise to 926 million from 572 million in 2005 — an increase equal to the entire current population of the United States, according to management consultants McKinsey & Company. By 2030 that number will increase to a billion.

Over the next two decades China will build 20,000 to 50,000 new skyscrapers — the equivalent of ten New York cities, according to McKinsey.

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Indonesia – Health survey paints mixed picture

JAKARTA, 9 December 2008 (IRIN) – Stroke is the leading cause of death among adults in Indonesia, according to a Health Ministry survey.

The Basic Health Research also revealed that non-communicable diseases have replaced infectious diseases as the leading cause of death in all age groups.

…

Dengue haemorrhagic fever is the main cause of death among children between five and 15 in urban areas, at 30.4 percent, while diarrhoea is the greatest killer among the same age group in rural areas, at 11.3 percent.

The prevalence of dengue is 0.6 percent nationally but in some provinces it is higher: 2.5 percent in East Nusa Tenggara, 2 percent in West Papua, 1.2 percent in Bengkulu and 1.2 percent in Jakarta.

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Nepal – Water tariff hike will hurt the urban poor

KATHMANDU, Dec 9 – Water Tariff Fixation Commission is likely to hike water tariff by 10 to 30 per cent this week, even as the Kathmandu Valley continues to face a perennial shortage of water. Kathmandu Upatyaka Khanepani Limited (KUKL), the public-private partnership utility responsible for the distribution of piped water in the Valley, had proposed hikes in water tariff last week.

…

“The proposed hike does injustice to the urban poor. This will force them to pay three times more tariff than the rich or those who have private taps,” chief executive director of NGO Forum for Urban Water and Sanitation, Prakash Amatya, said.

“If the proposed tariff takes effect, the community tap users will have to pay Rs 205.80 for consuming 10,000 litres of water. This includes sewarage charge.

On the other hand, private tap owners will have to pay only Rs. 82.50 for consuming 10,000 litres. Urban poor’s right to water will be in jeopardy if the commission gives a go-ahead to the proposed water tariff hike,” he said.

Earlier, a KUKL official claimed the proposed hike tariff was in line with recommendation of Asian Development Bank (ADB), the main donor for Melamchi Water Supply project. This time, however, no one was available for comment on the proposed water tariff hike.

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