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Zambia Demographic and Health Survey 2007
This 511 page DHS report, Zambia Demographic and Health Survey 2007 (pdf, full-text) was just released. Below are excerpts from the sections on Drinking Water and Household Sanitation
P. 22 – 2.4.1 Drinking Water
Increasing access to improved drinking water is one of the Millennium Development Goals that Zambia and other nations worldwide have adopted (United Nations General Assembly, 2001). Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2005). The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.6. They include a piped source within the dwelling or plot, public tap, tube well or borehole, and protected well or spring.1 Lack of ready access to water may limit the quantity of suitable drinking water that is available to a household, even if the water is obtained from an improved source. Water that must be fetched from a source that is not immediately accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is that the burden of fetching water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water.
The table shows that only 41 percent of the households have access to improved sources of water. Households in urban areas are more likely to have access to improved sources of water than those in rural areas (83 percent compared with 19 percent). More than half of the households (56 percent) draw their water from an unimproved source. Almost half of the households in urban areas (49 percent) have water on their premises, while about one in every ten households (8 percent) in rural areas have water on their premises. Overall, 23 percent of the households take 30 or more minutes to obtain water; 8 percent in urban areas compared with 30 percent in the rural areas.
It can also be observed that adult females collect drinking water more often than adult males (66 and 7 percent, respectively). Results also show that both male and female children below age 15 are involved in collecting drinking water. Most of the households (65 percent) do not treat their water, while only 34 percent use an appropriate method to treat their water. Bleach, chlorine or Clorin use and boiling are the most common methods used by households for water treatment (27 and 15 percent, respectively). Treating drinking water with Clorin, a locally produced solution of 0.5% sodium hypochlorite, is promoted throughout Zambia to make the water safer to drink. Table 2.7 shows that 91 percent of Zambians have heard of Clorin. The sources of where Clorin messages are heard differ by urban and rural residence. Forty percent of respondents living in urban areas have heard Clorin messages on the radio, compared with only 17 percent in rural areas. Respondents living in rural areas are informed of Clorin primarily at health facilities (38 percent). Overall, 13 percent of respondents use Clorin, of which 24 percent are in urban areas and 8 percent are in rural areas.
P. 24 – Household Sanitation
Ensuring adequate sanitation facilities is another of the Millennium Development Goals that Zambia shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2004).
Table 2.8 shows that almost four in ten households in Zambia (39 percent) use pit latrines that are open or have no slab: 27 percent in urban areas and 45 percent in rural areas. Flush toilets are mainly found in urban areas and are used by 26 percent of households, compared with 1 percent in rural areas. Overall, 25 percent of households in Zambia have no toilet facilities. This problem is more common in rural areas (37 percent) than in urban areas (2 percent).
State of the World’s Cities 2008/2009 – Harmonious Cities
State of the World’s Cities 2008/2009 – Harmonious Cities. (pdf, 25MB). UN-HABITAT, 2008.
“…….Half of humanity now lives in cities, and within two decades, nearly 60 per cent of the world’s people will be urban dwellers. Urban growth is most rapid in the developing world, where cities gain an average of 5 million residents every month. As cities grow in size and population, harmony among the spatial, social and environmental aspects of a city and between their inhabitants becomes of paramount importance. This harmony hinges on two key pillars: equity and sustainability. “
“……Cities embody some of society’s most pressing challenges, from pollution and disease to unemployment and lack of adequate shelter. But cities are also venues where rapid, dramatic change is not just possible but expected. Thus they present real opportunities for increasing energy efficiency, reducing disparities in development and improving living conditions in general. National and local governments can promote harmonious urbanization by supporting pro-poor, inclusive and equitable urban development and by strengthening urban governance structures and processes. History demonstrates that integrated urban policy can be a solid path towards development.”
The data and analysis contained in this report are intended to improve our understanding of how cities function and what we, as a global community, can do to increase their liveability and unity. In that spirit, I commend this report to policymakers, mayors, citizens’ groups and all those concerned with the welfare of our urbanizing world………..”…. Ban Ki-moon, Secretary-General, United Nations
Contents
Part 1: SPATIAL HARMONY
1.1. The Spatial Distribution of the World’s Cities.
1.2. Urban Growth Patterns
1.3. Which Cities are Growing and Why
1.4. Shrinking Cities.
Part 2: SOCIAL HARMONY
2.1. Why Urban Inequality Matters
2.2. Urban Inequalities: Regional Trends .
2.3. Education, Employment and City Size .
2.4. Slums: The Good, the Bad and the Ugly
2.5. Slum Cities and Cities with Slums. .
Part 3: ENVIRONMENTAL HARMONY
3.1. Urban Environmental Risks and Burdens
3.2. Cities and Climate Change
3.3. Cities at Risk from Rising Sea Levels .
3.4. Energy Consumption in Cities
3.5. Urban Energy Consumption at the Household Level
3.6. Urban Mobility. . 174
Part 4: PLANNING FOR HARMONIOUS CITIES
4.1. Inclusive Urban Planning for Harmonious Urban Development.
4.2. Building Bridges: Social Capital and Urban Harmony
4.3. Unifying the Divided City.
4.4. Addressing Rural-Urban Disparities for Harmonious Regional Development
4.5. Metropolitan Governance: Governing in a City of Cities.
WaterAid – Toilet technology flipbook for urban communities
WaterAid has produced a low cost toilet technology flipbook that lets you find out about the advantages and disadvantages of a range of latrine technologies. The resource is based on the 2004 publication called Low cost toilet options, which was put together by Social Marketing for Urban Sanitation, a research project funded by DFID, to help house owners in low-income urban communities choose an appropriate low-cost toilet. The drawings were produced by WEDC, Water Engineering Development Centre.
The flipbook allows you to mix and match the three toilet components: superstructure, slab and pit or vault. For each correct combination total costs are calculated. Both pit latrine and ecosan models are used. WaterAid plans to plans to update the flipbook.
Link to flipbook: http://www.wateraid.org/uk/what_we_do/sustainable_technologies/7323.asp
Urban Health Bulletin, Jan/Feb 2009
The latest issue of the Urban Health Bulletin is now on the Environmental Health at USAID website at: http://www.ehproject.org/PDF/ehkm/urban_health-jan_feb09.pdf (pdf, 96KB).
This issue contains citations and abstracts of 16 recently published studies plus an introductiuon to the studies by Anthony Kolb, the Urban Health Advisor for USAID.
Below are the titles of the studies in this issue:
Urban Health Analysis
— Estimation of population-based incidence of pregnancy-related illness and mortality (PRIAM) in two districts in West Java, Indonesia.
— Urban health in developing countries: what do we know and where do we go?
— Feasibility of satellite image-based sampling for a health survey among urban townships of Lusaka, Zambia.
— The determinants of exclusive breast feeding in urban slums: a community based study.
— Estimating inequalities in ownership of insecticide treated nets: does the choice of socio-economic status measure matter?
— The health seeking behaviour of elderly population in a poor-urban community of Karachi, Pakistan.
— Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal.
— Patterns of soil-transmitted helminth infection and impact of four-monthly albendazole treatments in preschool children from semi-urban communities in Nigeria: a double-blind placebo-controlled randomised trial.
Urban Environmental Health
— Relationship between intestinal parasitic infection in children and soil contamination in an urban slum.
— The socio-demographic, environmental and reservoir factors associated with leptospirosis in an urban area of north-eastern Brazil.
— Urban sanitation and health in the developing world: reminiscing the nineteenth century industrial nations.
Urban Vector Disease
Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso.
The effects of human movement on the persistence of vector-borne diseases.
HIV/AIDS
— Challenges for Scaling up ART in a Resource-Limited Setting: A Retrospective Study in Kibera, Kenya.
— Alcohol abuse, sexual risk behaviors, and sexually transmitted infections in women in Moshi urban district, northern Tanzania.
— Implementing family-focused HIV care and treatment: the first 2 years’ experience of the mother-to-child transmission-plus program in Abidjan, Côte d’Ivoire.
World Water Forum urges urban action to meet water challenge
ISTANBUL, TURKEY, March 20 (Xinhua) — The ongoing World Water Forum, held in Turkey’s largest city of Istanbul, urged on Friday priority in action of world cities to meet water challenges.
“Mayors and local authorities are the pillars of water governance,” said Loic Fauchon, president of the World Water Council, which convened the forum together with host Turkey.
“Our cities are the battlefield where this struggle will be won or lost,” he said.
More than 250 mayors and local authorities from 43 countries gathered at the forum to ensure power, expertise, money and responsibility to meet the demands for water where human thirst is most intensely concentrated.
According to statistics from the forum, 3.3 billion people live in cities worldwide today, a number which would rise to 5 billion by 2030. Developing countries like India absorb 95 percent of this growth; 300 rural migrants swell Mumbai each day. The strain is severe.
The UN World Water Development Report: Water in a Changing World launched this week said that demographic growth means that water challenges are emphatically urban.
The World Water Forum, the fifth of its kind, has organized a series of debates leading up to endorsement of the Istanbul Water Consensus (IWC), a non-binding agreement to catalyze action on urban water and sanitation issues worldwide.
According to a press release of the Forum, though participation in the Consensus is voluntary, expanding number of cities of all shapes and sizes from every continent have signed it. The first 51signatories include Entebbe, Rotterdam, Vienna, Brisbane, Paris, Buenos Aires, Lausanne, Incheon, Lyon, and Istanbul.
“We no longer have the luxury of remaining indifferent to this problem (to provide water and sanitation),” said Kadir Topbas, Mayor of Istanbul.
“We should turn water into an instrument of peace rather than one of conflict. We want to turn this into an action plan for the work that needs to be conducted after this Forum and to encourage cooperation among cities and countries,” said Topbas.
According to the Forum, those who most lack water are poor, immigrant, landless squatters living in flood-prone valleys or beneath landslide-prone slopes. Job-generating industries may pollute the local water supply of workers. Even previously safe natural water supplies are undermined by the lack of adequate or convenient sanitation services.
The absence of latrines, waste treatment, and drainage systems means storm water can wash human waste into water resources to pollute both rivers and groundwater.
The Forum, the world’s largest water event, kicked off on Monday in Istanbul with the theme of “Bridging Divides for Water” to promote ideas about conserving, managing and supplying water.
Urban malaria annotated bibliography, Jan 2008-Feb 2009
This bibliography contains citations and abstracts to 16 urban malaria studies published from January 2008 through February 2009. Links to author email addresses and full-text are included when available.
1: Acta Trop. 2008 Jan;105(1):81-6.
Marked differences in the prevalence of chloroquine resistance between urban and rural communities in Burkina Faso.
Meissner PE, Mandi G, Mockenhaupt FP, Witte S, Coulibaly B, Mansmann U, Frey C, Merkle H, Burhenne J, Walter-Sack I, Müller O.
Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University, Heidelberg, Germany. peter.meissner@urz.uni-heidelberg.de
BACKGROUND: Chloroquine (CQ) resistance has reached high levels in Africa in recent years. Little is known about variations of resistance between urban and rural areas. OBJECTIVES: To compare the rates of in vivo resistance to CQ and the prevalences of the main molecular marker for CQ resistance among young children
from urban and rural areas in Burkina Faso. METHODS: The current analysis used the frame of a randomized controlled trial (ISRCTN27290841) on the combination CQ-methylene blue (MB) (n=177) compared to CQ alone (n=45) in young children with uncomplicated malaria. We examined clinical and parasitological failure rates as well as the prevalence of the Plasmodium falciparum chloroquine resistance transporter gene (pfcrt) T76 mutation. RESULTS: Clinical and parasitological failure rates of CQ-MB differed significantly between urban (70%) and rural areas (29%, p<0.0001). Likewise, CQ failure rates were higher in the urban setting. Matching this pattern, pfcrt T76 was more frequently seen among parasite strains from urban areas (81%) when compared to rural ones (64%, p=0.01). In the presence of parasites exhibiting pfcrt T76, the odds of overall clinical failure were increased to 2.6-fold ([1.33, 5.16], p(LR)=0.005). CQ was detected at baseline in 21% and 2% of children from the urban and the rural study area, respectively (p(Chi)=0.002). CONCLUSION: Even within circumscribed geographical areas, CQ efficacy can vary dramatically. The differences in the prevalence of pfcrt T76 and in CQ failure rates are probably explained by a higher drug pressure in the urban area compared to the rural study area. This finding has important implications for national malaria policies.
2: Am J Trop Med Hyg. 2009 Mar;80(3):487-91.
How much malaria occurs in urban Luanda, Angola? A health facility-based assessment.
Thwing JI, Mihigo J, Fernandes AP, Saute F, Ferreira C, Fortes F, de Oliveira AM, Newman RD.
Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
jthwing@cdc.gov
We conducted a health facility-based survey of patients with fever during malaria transmission season to determine the proportion with laboratory-confirmed malaria in Luanda, Angola. We enrolled 864 patients at 30 facilities; each underwent a blood film for malaria and a questionnaire. Only 3.6% had a positive blood film. When stratified by distance of the facility to city center ( or = 15 km), the proportions were 1.5% (9/615) and 8.8% (22/249), respectively (P < 0.0001). Of patients traveling outside Luanda in the preceding 3 months, 6.8% (6/88) had malaria, compared with 3.2% (26/776) not traveling (P = 0.13). Children < 5 years of age were less likely to have malaria (2.4%; 12/510) than children ages 5-14 (8.7%; 9/104) and adults (4.0%; 10/250) (P = 0.03). The prevalence of laboratory-confirmed malaria in febrile patients in Luanda is very low, but increases with distance from the urban center. Prevention and treatment should be focused in surrounding rural areas.
3: Bull Soc Pathol Exot. 2008 Apr;101(2):124-7.
Self-medication in the treatment of acute malaria: study based on users of private health drug stores in Ouagadougou, Burkina Faso.
Ouédraogo LT, Somé IT, Diarra M, Guissou IP.
Département de santé publique, UFR/SDS, Université de Ouagadougou, BP 5705 Ouagadougou 01, Burkina Faso. laurent_tikar@yahoo.fr
In order to contribute to the national debate on the change of protocol of the simple forms of malaria treatment in Burkina Faso, we conducted a transversal descriptive study among 397 private pharmacies users in Ouagadougou. The aims of the study were: – making an inventory of the antimalarials and signs which led to self-medication; – identifying the factors favouring self-treatment and the reasons why these antimalarials have been bought; – making an inventory of the misuses of antimalarial drugs by individuals practicing self-medication; – checking the knowledge base in individuals practicing self-medication in relation to resistance to antimalarials. We noticed that chloroquine (39.3%), sulfadoxine-pyrimethamin (24.4%), arthemisinin and its by products (15.1%) were the three main molecules which account for antimalarial self-treatment However the use of these molecules was inappropriate regarding the dosage (41.3%) as well as the rate of intake (40.7%). Self-medication was motivated by the common signs of malaria and the way in which this parasitosis has become an every day feature in people’s minds. The choice of the molecule, the knowledge of the directions for use and the rate of intake were significantly linked to the level of education (p < 0.001). Self-medication being one of the major causes of resistance development, it is necessary together with local pharmacies retailers, to organize information campaigns on the correct use of molecules of the new antimalarial therapeutic scheme which will be adopted.
4: East Mediterr Health J. 2008 Jan-Feb;14(1):206-15.
Malaria control in an urban area: a success story from Khartoum, 1995-2004.
Elkhalifa SM, Mustafan IO, Wais M, Malik EM.
State Malaria Control Programme, Khartoum State, Khartoum, Sudan.
Khartoum is an urban area with low malaria transmission. Early control efforts were successful in reducing the risk but malaria has resurged in recent years. In 2002, the Government of Sudan, with support of the World Health Organization, embarked on an initiative aimed at freeing Khartoum of malaria. The initiative’s prevention strategy has focused on larval control interventions. The results indicate a significant reduction in malaria prevalence, confirmed and clinically diagnosed malaria cases among outpatient attendance and the number of malaria-associated deaths. It is proposed information be collected on parity rates and that a sub-sample of the adult mosquito collections be subjected to ELISA or PCR for identification of malaria parasite infections in mosquitoes in areas showing active foci.
5: Ecotoxicol Environ Saf. 2008 May;70(1):147-53.
Heavy metals in mosquito larval habitats in urban Kisumu and Malindi, Kenya, and their impact.
Mireji PO, Keating J, Hassanali A, Mbogo CM, Nyambaka H, Kahindi S, Beier JC.
Department of Biochemistry, Kenyatta University, P.O. Box 43844, Nairobi 00100, Kenya.
mireji@gmail.com
Concentrations and distribution of cadmium, chromium, copper, iron, lead, manganese and zinc in mosquito larval habitats in urban Kisumu and Malindi, Kenya and their effect on the presence of Anopheles gambiae, Aedes aegypti, Culex quinquefasciatus and Anopheles funestus larvae were investigated. Manganese and iron were the most prevalent heavy metals in water of larval habitats in urbanKisumu and Malindi, respectively. Iron was the most prevalent heavy metal in bottom sediments in larval habitats in both cities. The highest concentrations of all heavy metals, except cadmium and iron, were recorded in the poorly planned-well drained stratum in the two cities. All heavy metals were more concentrated in human-made than in natural larval habitats. Copper was positively associated with the presence of Ae. aegypti, and lead was associated with the presence of An. gambiae and Ae. aegypti in urban Kisumu. Absence of significant correlation between the other metals and mosquito species in both cities, despite relatively high concentrations, suggest that the local larval populations, including key malaria vectors have adapted to the detected levels of these metals.
6: Int J Hyg Environ Health. 2008 Oct;211(5-6):591-605.
Lead poisoning associated with malaria in children of urban areas of Nigeria.
Nriagu J, Afeiche M, Linder A, Arowolo T, Ana G, Sridhar MK, Oloruntoba EO, Obi E, Ebenebe JC, Orisakwe OE, Adesina A.
Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA. jnriagu@umich.edu
The principal objectives of this study are to (a) investigate the prevalence of elevated blood lead levels (EBLLs) in children of three major cities of Nigeria with different levels of industrial pollution; (b) identify the environmental, social and behavioral risk factors for the EBLLs in the children; and (c) explore the association between malaria (endemic in the study areas) and EBLLs in the pediatric population. The study involved 653 children aged 2-9 years (average, 3.7 years). The mean blood lead level (BLL) for the children was 8.9+/-4.8microg/dL, the median value was 7.8microg/dL, and the range was 1-52microg/dL. About 25% of the children had BLL greater than 10microg/dL. There were important differences in BLLs across the three cities, with the average value in Ibadan (9.9+/-5.2microg/dL) and Nnewi (8.3+/-3.5microg/dL) being higher than that in Port Harcourt (4.7+/-2.2micro/dL). Significant positive associations were found between BLL and a child’s town of residence (p<0.001), age of the child (p=0.004), length of time the child played outside (p<0.001), presence of pets in a child’s home (p=0.023), but negatively with educational level of caregiver (p<0.001). This study is one of the first to find a significant negative association between BLL and malaria in a pediatric population, and this association remained significant after controlling for confounding diseases and symptoms. The shared environmental and socio-demographic risks factors for lead exposure and Plasmodium (most common malaria parasites) infection in urban areas of Nigeria are discussed along with possible ways that lead exposure may influence the host response to infection with malarial parasites.
7: J Am Mosq Control Assoc. 2008 Sep;24(3):410-4.
Field evaluation of a previously untested strain of biolarvicide (Bacillus thuringiensis israelensis H14) for mosquito control in an urban area of Orissa, India.
Sharma SK, Upadhyay AK, Haque MA, Raghavendra K, Dash AP. National Institute of Malaria Research, Field Station, Sector-5, Rourkela-769 002, Orissa, India.
A previously untested strain of Bacillus thuringiensis israelensis (Bti) serotype H14 (ID No. VCRC B17) has been evaluated under field conditions in an urban area of Rourkela city, India for its impact on the larval density of different mosquito species in a variety of habitats. The persistence of the biolarvicide used in an aqueous solution varied in different habitats. The lowest field application rate of 0.5 ml/m2 remained effective for about 10-12 days and provided 80-100% reduction in larval abundance of anopheline species, including Anopheles culicifacies breeding in unpolluted water bodies. However, in stagnant polluted waters in drains and cesspools supporting culicine breeding, the biocide at the same rate persists for 5-6 days only. An application rate of 1 ml/m2 to stagnant drains and cesspools, resulted in 84-100% reduction in the larval population of Culex quinquefasciatus over a period of 2 wk. Based on the field observations, an operational dose of 0.5 ml/m2 at fortnightly intervals is suggested for clean water sources supporting anopheline breeding. However, to control breeding of culicine mosquitoes in stagnant and polluted waters, an operational dose of 1 ml/m2 at fortnightly intervals is required. The study showed that Bti serotype H14 (VCRC B17) is a suitable biolarvicide that can be used against different mosquitoes in different types of urban habitats.
8: J Infect Dis. 2008 Sep 15;198(6):920-7.
Plasmodium falciparum and helminth coinfection in a semi urban population of pregnant women in Uganda.
Hillier SD, Booth M, Muhangi L, Nkurunziza P, Khihembo M, Kakande M, Sewankambo M, Kizindo R, Kizza M, Muwanga M, Elliott AM.
The University of Birmingham Medical School, Birmingham, United Kingdom. sdhillier@doctors.org.uk
BACKGROUND: Helminth infections and malaria are widespread in the tropics. Recent studies suggest helminth infections may increase susceptibility to Plasmodium falciparum infection. If confirmed, this increased susceptibility could be particularly important during pregnancy-induced immunosuppression. OBJECTIVE: To evaluate the geographical distribution of P. falciparum-helminth coinfection and the associations between P. falciparum infection and infection with various parasite species in pregnant women in Entebbe, Uganda. METHODS: A cross-sectional study was conducted at baseline during a trial of antihelminthic drugs during pregnancy. Helminth and P. falciparum infections were quantified in 2,507 asymptomatic women. Subjects’ socioeconomic and demographic characteristics and geographical details were recorded. RESULTS: Hookworm and Mansonella perstans infections were associated with P. falciparum infection, but the effect of hookworm infection was seen only in the absence of M. perstans infection. The odds ratio [OR] for P. falciparum infection, adjusted for age, tribe, socioeconomic status, HIV infection status, and location was as follows: for individuals infected with hookworm but not M. perstans, 1.53 (95% confidence interval [CI], 1.09-2.14); for individuals infected with M. perstans but not hookworm, 2.33 (95% CI, 1.47-3.69); for individuals infected with both hookworm and M. perstans, 1.85 (CI, 1.24-2.76). No association was observed between infection with Schistosoma mansoni, Trichuris, or Strongyloides species and P. falciparum infection. CONCLUSIONS: Hookworm-P. falciparum coinfection and M. perstans-P. falciparum coinfection among pregnant women in Entebbe is more common than would be expected by chance. Further studies are needed to elucidate the mechanism of this association. A helminth-induced increase in susceptibility to P. falciparum could have important consequences for pregnancy outcome and
responses to P. falciparum infection in infancy.
9: Malar J. 2009 Jan 13;8:13.
Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-8-13.pdf
Baragatti M, Fournet F, Henry MC, Assi S, Ouedraogo H, Rogier C, Salem G.
Parasite Biology and Epidemiology Research Dept, UMR- URMITE, IMTSSA, Parc du Pharo, Marseille-Armées, France. baragattimeili@hotmail.com
BACKGROUND: Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas. METHODS: The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas. RESULTS: Overall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou. CONCLUSION: Malaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network. Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.
10: Malar J. 2009 Jan 5;8:2.
Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-8-2.pdf
Dodoo AN, Fogg C, Asiimwe A, Nartey ET, Kodua A, Tenkorang O, Ofori-Adjei D.
Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, P,O, Box KB 4236, Accra, Ghana. alexooo@yahoo.com
BACKGROUND: Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT) is widespread in Africa. To expand knowledge of safety profiles of ACT, pharmacovigilance activities are included in the implementation process of therapy changes. Ghana implemented first-line therapy of artesunate-amodiaquine in 2005. Drug utilization data is an important component of determining drug safety, and this paper describes how anti-malarials were prescribed within a prospective pharmacovigilance study in Ghana following anti-malarial treatment policy change. METHODS: Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics. RESULTS: The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574) of patients, although 33% (n = 936) of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age >5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1-9). Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177). CONCLUSION: This study shows that though first-line therapy recommendations may change, clinical practice may still be affected by factors other than the decision or ability to diagnose malaria. Age, diagnostic confirmation and suspected concurrent conditions lead to benefit:risk assessments for individual patients by clinicians as to which anti-malarial treatment to prescribe. This has implications for adherence to policy changes aiming to implement effective use of ACT. These results should inform education of health professionals and rational drug use policies to reduce poly-pharmacy, and also suggest a potential positive impact of increased access to testing for malaria both within health facilities and in homes.
11: Malar J. 2008 Oct 27;7:218.
Human population, urban settlement patterns and their impact on Plasmodium falciparum malaria endemicity.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-218.pdf
Tatem AJ, Guerra CA, Kabaria CW, Noor AM, Hay SI.
Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK. andy.tatem@zoo.ox.ac.uk
BACKGROUND: The efficient allocation of financial resources for malaria control and the optimal distribution of appropriate interventions require accurate information on the geographic distribution of malaria risk and of the human populations it affects. Low population densities in rural areas and high population densities in urban areas can influence malaria transmission substantially. Here, the Malaria Atlas Project (MAP) global database of Plasmodium falciparum parasite rate (PfPR) surveys, medical intelligence and contemporary population surfaces are utilized to explore these relationships and other issues involved in combining malaria risk maps with those of human population distribution in order to define populations at risk more accurately. METHODS: First, an existing population surface was examined to determine if it was sufficiently detailed to be used reliably as a mask to identify areas of very low and very high population density as malaria free regions. Second, the potential of international travel and health guidelines (ITHGs) for identifying malaria free cities was examined. Third, the differences in PfPR values between surveys conducted in author-defined rural and urban areas were examined. Fourth, the ability of various global urban extent maps to reliably discriminate these author-based classifications of urban and rural in the PfPR database was investigated. Finally, the urban map that most accurately replicated the author-based classifications was analysed to examine the effects of urban classifications on PfPR values across the entire MAP database. RESULTS: Masks of zero population density excluded many non-zero PfPR surveys, indicating that the population surface was not detailed enough to define areas of zero transmission resulting from low population densities. In contrast, the ITHGs enabled the identification and mapping of 53 malaria free urban areas within endemic countries. Comparison of PfPR survey results showed significant differences between author-defined ‘urban’ and ‘rural’ designations in Africa, but not for the remainder of the malaria endemic world. The Global Rural Urban Mapping Project (GRUMP) urban extent mask proved most accurate for mapping these author-defined rural and urban locations, and further sub-divisions of urban extents into urban and peri-urban classes enabled the effects of high population densities on malaria transmission to be mapped and quantified. CONCLUSION: The availability of detailed, contemporary census and urban extent data for the construction of coherent and accurate global spatial population databases is often poor. These known sources of uncertainty in population surfaces and urban maps have the potential to be incorporated into future malaria burden estimates. Currently, insufficient spatial information exists globally to identify areas accurately where population density is low enough to impact upon transmission. Medical intelligence does however exist to reliably identify malaria free cities. Moreover, in Africa, urban areas that have a significant effect on malaria transmission can be mapped.
12: Malar J. 2008 Sep 16;7:178.
Malaria transmission in Dakar: a two-year survey.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-178.pdf
Pagès F, Texier G, Pradines B, Gadiaga L, Machault V, Jarjaval F, Penhoat K, Berger F, Trape JF, Rogier C, Sokhna C.
Unité d’Entomologie Médicale, Institut de Médecine Tropicale du Service de Santé des Armées, Marseille, France. frederic_pages@yahoo.com
BACKGROUND: According to entomological studies conducted over the past 30 years, there was low malaria transmission in suburb of Dakar but little evidence of it in the downtown area. However; there was some evidence of local transmission based on reports of malaria among permanent residents. An entomological
evaluation of malaria transmission was conducted from May 2005 to October 2006 in two areas of Dakar. METHODS: Mosquitoes were sampled by human landing collection during 34 nights in seven places in Bel-air area (238 person-nights) and during 24 nights in five places in Ouakam area (120 person-nights). Mosquitoes were identified morphologically and by molecular methods. The Plasmodium falciparum circumsporozoïte indexes were measured by ELISA, and the entomological inoculation rates (EIR) were calculated for both areas. Molecular assessments of pyrethroid knock down resistance (Kdr) and of insensitive acetylcholinesterase resistance were conducted. RESULTS: From May 2005 to October 2006, 4,117 and 797 Anopheles gambiae s.l. respectively were caught in Bel-air and Ouakam. Three members of the complex were present: Anopheles arabiensis (> 98%), Anopheles melas (< 1%) and An. gambiae s.s. molecular form M (< 1%). Infected mosquitoes were caught only during the wintering period between September and November in both places. In 2005 and 2006, annual EIRs were 9,5 and 4, respectively, in Bel-air and 3 and 3, respectively, in Ouakam. The proportion of host-seeking An. gambiae s.l. captured indoors were 17% and 51% in Bel air and Ouakam, respectively. Ace 1 mutations were not identified in both members of the An. gambiae complex. Kdr mutation frequency in An. arabiensis was 12% in Bel-air and 9% in Ouakam. CONCLUSION: Malaria is transmitted in Dakar downtown area. Infected mosquitoes were caught in two subsequent years during the wintering period in two distant quarters of Dakar. These data agree with clinical data from a Senegalese military Hospital of Dakar (Hospital Principal) where most malaria cases occurred between October and December. It was the first detection of An. melas in Dakar.
13: Malar J. 2008 Aug 4;7:151.
Impact of urban agriculture on malaria vectors in Accra, Ghana.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-151.pdf
Klinkenberg E, McCall P, Wilson MD, Amerasinghe FP, Donnelly MJ.
International Water Management Institute (IWMI), West Africa Office, Ghana.
klinkenberge@kncvtbc.nl
To investigate the impact of urban agriculture on malaria transmission risk in urban Accra larval and adult stage mosquito surveys, were performed. Local transmission was implicated as Anopheles spp. were found breeding and infected Anopheles mosquitoes were found resting in houses in the study sites. The predominant Anopheles species was Anopheles gambiae s.s.. The relative proportion of molecular forms within a subset of specimens was 86% S-form and 14% M-form. Anopheles spp. and Culex quinquefasciatus outdoor biting rates were respectively three and four times higher in areas around agricultural sites (UA) than in areas far from agriculture (U). The annual Entomological Inoculation Rate (EIR), the number of infectious bites received per individual per year, was 19.2 and 6.6 in UA and U sites, respectively. Breeding sites were highly transitory in nature, which poses a challenge for larval control in this setting. The data also suggest that the epidemiological importance of urban agricultural areas may be the provision of resting sites for adults rather than an increased number of larval habitats. Host-seeking activity peaked between 2-3 am, indicating that insecticide-treated bednets should be an effective control method.
14: Malar J. 2008 Feb 29;7:39.
A census-weighted, spatially-stratified household sampling strategy for urban malaria epidemiology.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-39.pdf
Siri JG, Lindblade KA, Rosen DH, Onyango B, Vulule JM, Slutsker L, Wilson ML.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. jsiri@umich.edu
BACKGROUND: Urban malaria is likely to become increasingly important as a consequence of the growing proportion of Africans living in cities. A novel sampling strategy was developed for urban areas to generate a sample simultaneously representative of population and inhabited environments. Such a strategy should facilitate analysis of important epidemiological relationships in this ecological context. METHODS: Census maps and summary data for Kisumu, Kenya, were used to create a pseudo-sampling frame using the geographic coordinates of census-sampled structures. For every enumeration area (EA) designated as urban by the census (n = 535), a sample of structures equal to one-tenth the number of households was selected. In EAs designated as rural (n = 32), a geographically random sample totalling one-tenth the number of households was selected from a grid of points at 100 m intervals. The selected samples were cross-referenced to a geographic information system, and coordinates transferred to handheld global
positioning units. Interviewers found the closest eligible household to the sampling point and interviewed the caregiver of a child aged < 10 years. The demographics of the selected sample were compared with results from the Kenya Demographic and Health Survey to assess sample validity. Results were also compared among urban and rural EAs. RESULTS: 4,336 interviews were completed in 473 of the 567 study area EAs from June 2002 through February 2003. EAs without completed interviews were randomly distributed, and non-response was approximately 2%. Mean distance from the assigned sampling point to the completed interview was 74.6 m, and was significantly less in urban than rural EAs, even when controlling for number of households. The selected sample had significantly more children and females of childbearing age than the general population, and fewer older individuals. CONCLUSION: This method selected a sample that was simultaneously population-representative and inclusive of important environmental variation. The use of a pseudo-sampling frame and pre-programmed handheld GPS units is more efficient and may yield a more complete sample than traditional methods, and is less expensive than complete population enumeration.
15: Malar J. 2008 Feb 25;7:34.
Quantitative urban classification for malaria epidemiology in sub-Saharan Africa.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-34.pdf
Siri JG, Lindblade KA, Rosen DH, Onyango B, Vulule J, Slutsker L, Wilson ML.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. jsiri@umich.edu
BACKGROUND: Although sub-Saharan Africa (SSA) is rapidly urbanizing, the terms used to classify urban ecotypes are poorly defined in the context of malaria epidemiology. Lack of clear definitions may cause misclassification error, which likely decreases the accuracy of continent-wide estimates of malaria burden, limits the generalizability of urban malaria studies, and makes identification of high-risk areas for targeted interventions within cities more difficult. Accordingly, clustering techniques were applied to a set of urbanization- and malaria-related variables in Kisumu, Kenya, to produce a quantitative classification of the urban environment for malaria research. METHODS: Seven variables with a known or expected relationship with malaria in the context of urbanization were identified and measured at the census enumeration area (EA) level, using three sources: a) the results of a citywide knowledge, attitudes and practices (KAP) survey; b) a high-resolution multispectral satellite image; and c) national census data. Principal components analysis (PCA) was used to identify three factors explaining higher proportions of the combined variance than the original variables. A k-means clustering algorithm was applied to the EA-level factor scores to assign EAs to one of three categories: “urban,” “peri-urban,” or “semi-rural.” The results were compared with classifications derived from two other approaches: a) administrative designation of urban/rural by the census or b) population density thresholds. RESULTS: Urban zones resulting from the clustering algorithm were more geographically coherent than those delineated by population density. Clustering distributed population more evenly among zones than either of the other methods and more accurately predicted variation in other variables related to urbanization, but not used for classification. CONCLUSION: Effective urban malaria epidemiology and control would benefit from quantitative methods to identify and characterize urban areas. Cluster analysis techniques were used to classify Kisumu, Kenya, into levels of urbanization in a repeatable and unbiased manner, an approach that should permit more relevant comparisons among and within urban areas. To the extent that these divisions predict meaningful intra-urban differences in malaria epidemiology, they should inform targeted urban malaria interventions in cities across SSA.
16: Malar J. 2008 Jan 25;7:20.
A tool box for operational mosquito larval control: preliminary results and early lessons from the Urban Malaria Control Programme in Dar es Salaam, Tanzania.
Full-text: http://www.malariajournal.com/content/pdf/1475-2875-7-20.pdf
Fillinger U, Kannady K, William G, Vanek MJ, Dongus S, Nyika D, Geissbühler Y, Chaki PP, Govella NJ, Mathenge EM, Singer BH, Mshinda H, Lindsay SW, Tanner M, Mtasiwa D, de Castro MC, Killeen GF.
Durham University, School of Biological and Biomedical Sciences, South Road, Durham DH13LE, UK. ulrike.fillinger@durham.ac.uk
BACKGROUND: As the population of Africa rapidly urbanizes, large populations could be protected from malaria by controlling aquatic stages of mosquitoes if cost-effective and scalable implementation systems can be designed. METHODS: A recently initiated Urban Malaria Control Programme in Dar es Salaam delegates responsibility for routine mosquito control and surveillance to modestly-paid community members, known as Community-Owned Resource Persons (CORPs). New vector surveillance, larviciding and management systems were designed and evaluated in 15 city wards to allow timely collection, interpretation and reaction to entomologic monitoring data using practical procedures that rely on minimal technology. After one year of baseline data collection, operational larviciding with Bacillus thuringiensis var. israelensis commenced in March 2006 in three selected wards. RESULTS: The procedures and staff management systems described greatly improved standards of larval surveillance relative to that reported at the outset of this programme. In the first year of the programme, over 65,000 potential Anopheles habitats were surveyed by 90 CORPs on a weekly basis. Reaction times to vector surveillance at observations were one day, week and month at ward, municipal and city levels, respectively. One year of community-based larviciding reduced transmission by the primary malaria vector, Anopheles gambiae s.l., by 31% (95% C.I. = 21.6-37.6%; p = 0.04). CONCLUSION: This novel management, monitoring and evaluation system for implementing routine larviciding of malaria vectors in African cities has shown considerable potential for sustained, rapidly responsive, data-driven and affordable application. Nevertheless, the true programmatic value of larviciding in urban Africa can only be established through longer-term programmes which are stably financed and allow the operational teams and management infrastructures to mature by learning from experience.
India – Thane-Mulund dumping ground breeds diseases
The Dumping ground between Thane and Mulund has been giving out bad odour, as the open space receives 300 metric tonnes of waste everyday. Although the issue has been raised on several occasions by both residents and political parties, nothing has been done so far. This has become a problem, as the dumping ground is an excellent breeding ground. According to medical experts, the continuous dumping could result in around 40 diseases.
The major diseases amongst these 40 include leptospirosis, food poisoning, cholera, dysentery and diarrhea. Other diseases include histoplasmosis (breathing problem), worms and loose motions. Physicians also point out that the air released from the dumping ground is toxic.
“At the time of decomposition of the waste, many gases like methane, carbon monoxide, carbon dioxide and ammonia are released into the air. The microorganisms manage to decompose the bacteria and release the oxygen into the air through anaerobic respiration. The gases released are harmful to human life and are also responsible for the stench in the area,” says Shyam Moghe, assistant manager of the Pest Control of India.
Physician Nisha Ahmed, points out that the waste attracts small animals, who contact diseases like leptospirosis and food poisoning, as these animals are sometimes consumed by humans. “Flies and mosquitoes that are present at dumping grounds are the carriers of several air and water borne diseases like cholera, dysentery and diarrhea,” she explains.
With the monsoons approaching in the next three months, the civic authorities need to get their act together before the list of diseases increases.
Inexpensive flooring change improves child health in urban slums
BERKELEY — Replacing dirt floors with cement in the homes of urban slums makes for more comfortable living – but more importantly, it significantly improves children’s health by interrupting the transmission of intestinal parasites and boosts youngsters’ cognitive abilities, according to a new study conducted for the University of California, Berkeley’s Center of Evaluation for Global Action (CEGA).
Professor Paul Gertler, the Li Ka Shing Professor of Economics in the Haas School of Business and the School of Public Health at UC Berkeley, led the investigation. The study, detailed in the article, “Housing, Health and Happiness,” in the February American Economic Journal: Economic Policy, concludes that replacing dirt floors with cement appears to be at least as effective for health as nutritional supplements and as helpful for brain development as early childhood development programs.
Not only are young children better off when their homes have concrete rather than dirt floors, but the study also found that their mothers are less depressed, less stressed and happier.
“The reasons adults are happier may have to do with the fact that they are living in a better environment and that their children are healthier,” says the report. “These results also indicate that housing has a significant effect on welfare, which would not be captured by standard monetary indicators such as income, consumption or assets, or by the types of health outcomes used in this study.”
The CEGA researchers note that inadequate housing poses serious health risks around the globe for 600 million urban residents, almost half of them living in slums. These problems also contribute to the deaths of 3 million children every year from parasitic infections associated with diarrhea, malnutrition and micronutrient deficiencies such as anemia, a widespread problem that slows cognitive development.
The economists say their findings offer an important direction for the cost-effective allocation of public resources by countries seeking to upgrade slums and improve housing for the poor.
They tracked a Mexican government program, “Piso Firme” or “firm floor,” that sought to improve living standards and health in high-density, low-income communities by offering homeowners with dirt floors up to 538 square feet of concrete flooring. The program cost the government about $150 per home. The owners prepared and laid the new flooring themselves, or with volunteer help.
By 2005, the program had covered more than 34,000 homes in 650 neighborhoods and 200 suburban communities. It expanded into other Mexican states starting in late 2003 and installed cement floors in about 300,000 of the 3 million homes indentified in the country’ s 2000 census as having dirt floors.
Researchers collected information about children’s incidences of diarrhea, results of fecal samples, blood tests for anemia, and height and weight data to reveal stunting of growth, and also assessed the youngsters’ communication and language abilities. They compared the statistics for youths under the age of 6 both in the Coahuilan city of Torreón, where Piso Firme was enacted, and in the cities of Gómez Palacios and Lerdo in the same urban area but located on Coahuila’s border with state of Durango, where Piso Firme was still not fully under way in 2005.
Additional data came from a cross-sectional household survey conducted with the Mexican National Institute of Public Health in spring 2005, the 2000 Mexican census, vital statistics mortality files and national household surveys taken from 1994 to 2000.
Homeowners in Torreón reported a nearly 20 percent reduction in the presence of parasites, and when compared to their neighbors, their children under the age of 6 showed the following improvements:
– Almost 13 percent fewer episodes of diarrhea
– A 20 percent reduction in incidences of anemia
– Higher scores of 30 percent on language and communication skills for toddlers ages 12 to 30 months
– Scores 9 percent higher on vocabulary tests for youths ages 36 to 71 months
The researchers caution that the dirt-to-cement strategy probably would not have the same results in rural areas without access to safe water supplies.
The research team included Gertler, who is the director of UC Berkeley’s Institute for Business and Economics Research and recently served as the chief economist of the World Bank’s Human Development Network; Rocío Titiunik, a UC Berkeley graduate student in agricultural and resource economics; Sebastián Martinez, a World Bank economist who earned his Ph.D. in economics at UC Berkeley; Sebastian Galiani, an associate professor of economics at Washington University in St. Louis; and Matias Cattaneo, an associate professor of economics at the University of Michigan who also earned his Ph.D. at UC Berkeley.
Long-Term Exposure to Urban Air Pollution (Ozone) Increases Risk of Lung Disease
Scientists Find Long-Term Exposure to Ozone Increases Risk of Lung Disease
Scientists have found that long-term exposure to urban air pollution known as ozone increases the risk of death from lung disease, and that the risk is greatest in large metropolitan areas.
According to a large US study, researchers conclude that the risk of dying from lung disease associated with ozone exposure is three times higher in large cities compared to smaller urban areas, where pollution concentrations are lower.
Ozone is a form of air pollution, commonly known as smog, which is produced by the interaction of tailpipe and factory emissions and sunlight.
Michael Jerrett of the University of California at Berkeley led the study.
Jerrett says short term studies have been done suggesting a link between ozone and lung diseases but the latest study is different both in size and scope.
“What we found was that for the very first time, we were able to determine an association between ozone levels and premature mortality from respiratory causes,” Jerrett said.
Researchers looked at the health impacts of ground level ozone on almost 450,000 people living in 96 large and small cities in the United States between 1977 and 2000. They found approximately 10,000 people died of some form of respiratory illness, with the greatest number of deaths occurring in large urban areas where smog levels are highest.
Jerrett says ozone is a lung irritant that causes asthma, chronic obstructive pulmonary disease and pneumonia which over time can lead to death. He says researchers found that ozone contributes to lung disease regardless of age, gender or smoking status.
Ghana’s waste challenges: Veep hints at plastic ban
Vice President John Dramani Mahama has indicated that a ban on the use of non-degradable plastics could be on the cards for consideration as part of measures to stem Ghana’s increasing waste management difficulties.
In brief remarks to the first ever National Environmental Sanitation Forum underway at the Accra International Conference Centre, John Mahama said the nation is drowning in plastics and it is high time a decision is taken on what to do with the menace.
The forum under the theme, ‘Cleanliness is next to Godliness’ is part of the Government of Ghana’s Hundred Days’ Sanitation and Ghana Going Green Agenda, and will rise this afternoon with a communiqué and a blueprint on dealing with the sanitation challenges across the country.
The Vice President told the forum that banning plastics in the country may not be the best option and expressed the hope that the situation does not come to that, but he stressed that if the country failed to come out with an effective programme to deal with the danger, then the safety of the populace would have to take precedence and a ban imposed on the use of plastic bags
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