Urban Health Bulletin – July 2010

The July 2010 issue of the Urban Health Bulletin contains citations and abstracts of recently published studies. Entries are arranged alphabetically by journal title.

1. AIDS. 2010 Jul;24 Suppl 2:S39-44.

Violence, abuse, alcohol and drug use, and sexual behaviors in street children of Greater Cairo and Alexandria, Egypt.

Nada KH, Suliman el DA. Population Council, West Asia and North Africa Regional Office, Maadi, Cario, Egypt.

OBJECTIVES: To measure the prevalence of HIV/AIDS risk behaviors and related factors in a large, probability-based sample of boys and girls aged 12-17 years living on the streets of Egypt’s largest urban centers of Greater Cairo and Alexandria.

METHODS: Time-location sampling (TLS) was used to recruit a cross-sectional sample of street children. Procedures entailed using key informants and field observation to create a sampling frame of locations at predetermined time intervals of the day, where street children congregate in the two cities, selecting a random sample of time-locations from the complete list, and intercepting children in the selected time- locations to assess eligibility and conduct interviews. Interviews gathered basic demographic information, life
events on the street (including violence, abuse, forced sex), sexual and drug use behaviors, and HIV/AIDS knowledge.

RESULTS: A total of 857 street children were enrolled in the two cities, with an age, sex, and time-location composition matching the sampling frame. The majority of these children had faced harassment or abuse (93%) typically by police and other street children, had used drugs (62%), and, among the older adolescents, were sexually active (67%). Among the sexually active 15-17-year-olds, most reported multiple partners (54%) and never using condoms (52%). Most girls (53% in Greater Cairo and 90% in Alexandria) had experienced sexual abuse. The majority of street children experienced more than one of these risks. Overlaps with populations at highest risk for HIV were substantial, namely men who have sex with men, commercial sex workers, and injection drug users.

CONCLUSION: Our study using a randomized TLS approach produced a rigorous, diverse, probability-based sample of street children and documented very high levels of multiple concurrent risks. Our findings strongly advocate for multiple services including those addressing HIV and STI prevention and care, substance use, shelters, and sensitization of authorities to the plight of street children in Egypt.

2. Am J Clin Nutr. 2010 Jul;92(1):170-6

Iron-fortified milk and noodle consumption is associated with lower risk of anemia among children aged 6-59 mo in Indonesia.

Semba RD, Moench-Pfanner R, Sun K, de Pee S, Akhter N, Rah JH, Campbell AA, Badham J, Bloem MW, Kraemer K.

Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rdsemba@jhmi.edu

BACKGROUND: Anemia is common among children in developing countries and is associated with decreased cognitive and physical development. Iron-fortified foods may decrease child anemia.

OBJECTIVE: The objective was to describe the association between iron-fortified milk and iron-fortified noodle consumption and anemia in children aged 6-59 mo.

DESIGN: Consumption of fortified milk and fortified noodles and child anemia were assessed in 81,885 families from rural and 26,653 families from urban slum areas in Indonesia.

RESULTS: The proportions of children who received fortified milk and noodles were 30.1% and 22.6%, respectively, in rural families and 40.1% and 48.9%, respectively, in urban families. The prevalence of anemia among children from rural families was 55.9% and from urban families was 60.8%. Children from rural and urban families were less likely to be anemic if they received fortified milk [odds ratio (OR): 0.76; 95% CI: 0.72, 0.80 (P < 0.0001) and OR: 0.79; 95% CI: 0.74, 0.86 (P < 0.0001), respectively] but not fortified noodles [OR: 0.98; 95% CI: 0.93, 1.09 (P = 0.56) and OR: 0.95; 95% CI: 0.88, 1.02 (P = 0.16), respectively] in multiple logistic regression models with adjustment for potential confounders. In rural families, the odds of anemia were lower when the child who consumed fortified milk also consumed fortified noodles or when the child who consumed fortified noodles also consumed fortified milk.

CONCLUSIONS: In Indonesia, consumption of fortified milk and noodles was associated with decreased odds of child anemia. Iron-fortified milk and noodles may be a strategy that could be applied more widely as an intervention to decrease child anemia.

3 – Asia Pac J Public Health. 2010 Jul;22(3 Suppl):254S-261S.

Urban environment and health: food security.

Galal O, Corroon M, Tirado C. Center for Global and Immigrant Health, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA. ogalal@ucla.edu

The authors examine the impact of urbanization on food security and human health in the Middle East. Within urban-population disparities in food security represent one of the most dramatic indicators of economic and health disparities. These disparities are reflected in a double burden of health outcomes: increasing levels of chronic disease as well as growing numbers of undernourished among the urban poor. These require further comprehensive solutions.

Some of the factors leading to food insecurity are an overdependence on purchased food commodities, lack of sufficient livelihoods, rapid reductions in peripheral agricultural land, and adverse impacts of climate change. The Food and Agriculture Organization of the United Nations (FAO) Food Security Framework is used to examine and compare 2 cities in the Middle East: Amman, Jordan, and Manama, Bahrain.

4. Glob Public Health. 2010 Jul 13:1-13.

Discourses of illegality and exclusion: When water access matters.

Mudege NN, Zulu EM. African Population and Health Research Center, Shelter Afrique Center, Nairobi, Kenya.

This paper examines the politics and the underlying discourses of water provisioning and how residents of Korogocho and Viwandani slum settlements in Nairobi city cope with challenges relating to water access. We use qualitative data from 36 focus group discussions conducted in the two slums to unravel discourses regarding water provisioning in the rapidly growing slum settlements in African cities.

Results show that the problems concerning water provisioning within Nairobi slums are less about water scarcity and more about unequal distribution and the marginalisation of slum areas in development plans. Poor water management, lack of equity-based policies and programmes, and other slum-specific features such as land-tenure systems and insecurity exacerbate water-supply problems within slum areas.

It is hard to see how water supply in these communities can improve without the direct and active involvement of the government in infrastructural development and oversight of the water-supply actors. Innovative public-private partnerships in water provision and the harnessing of existing community efforts to improve the water supply would go a long way towards improving the water supply to the rapidly growing urban poor population in Africa.

5. Int J Infect Dis. 2010 Jul 16.

The effect of Helicobacter pylori infection on growth velocity in young children from poor urban communities in Ecuador.

Egorov AI, Sempértegui F, Estrella B, Egas J, Naumova EN, Griffiths JK. US Environmental Protection Agency, National Center for Environmental Assessment, 26 W. Martin Luther King Drive, MS A110, Cincinnati, OH 45268, USA; Tufts School of Medicine, Department of Public Health and Family Medicine, Boston, Massachusetts, USA.

OBJECTIVE: To characterize the potential effects of Helicobacter infections on growth velocity in low socioeconomic status young children in a developing country.

METHODS: Children were recruited in poor suburbs of Quito, Ecuador. Normally nourished, mildly and substantially malnourished children (defined using weight-for-age Z-scores at recruitment) formed equal strata. Six height and weight measurements were collected during one year. Enrollment and exit serum samples were analyzed for anti-Helicobacter IgG and exit non-diarrheal feces tested for Helicobacter antigen.

RESULTS: Among 124 participants (enrollment age 19+/-9 months), 76 (61%) excreted fecal antigen at exit (were infected). Of these, 44 were seropositive at least once (chronic infections) and 32 tested seronegative both times (new or acute phase infections). The adjusted linear growth velocity during follow-up in children with new infections was reduced by 9.7 (3.8, 15.6) mm/year compared to uninfected controls and 6.4 (0.0, 12.9) mm/year compared to children with chronic infections. The effects of Helicobacter infections on ponderal growth were not significant.

CONCLUSION: These results suggest that linear growth velocity is reduced in young children during the initial phase of Helicobacter infection.

6. Indian J Pediatr. 2010 Jul;77(7):759-62.

Human touch to detect hypothermia in neonates in Indian slum dwellings.

Agarwal S, Sethi V, Srivastava K, Jha P, Baqui AH. Urban Health Resource Center, New Delhi, India. siddharth@uhrc.in

OBJECTIVE: To assess the validity of human touch (HT) method to measure hypothermia compared against axillary digital thermometry (ADT) and study association of hypothermia with poor suckle and underweight status in newborns and environmental temperature in 11 slums of Indore city, India.

METHODS: Field supervisors of slum-based health volunteers measured body temperature of 152 newborns by HT and ADT, observed suckling and weighed newborns. Underweight status was determined using WHO growth standards.

RESULTS: Hypothermia prevalence (axillary temperature <36.5 degrees C) was 30.9%. Prevalence varied by season but insignificantly. Hypothermia was insignificantly associated with poor suckle (31% vs 19.7%, p=0.21) and undernutrition (33.3% vs 25.3%, p=0.4). HT had moderate diagnostic accuracy when compared with ADT (kappa: 0.38, sensitivity: 74.5%, specificity: 68.5%).

CONCLUSIONS: HT emerged simpler and programmatically feasible. There is a need to examine whether trained and supervised community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple signs of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked to the program to ensure prompt management of illness.

7. J Biosoc Sci. 2010 Jul;42(4):511-30

Intra- and inter-household differences in antenatal care, delivery practices and postnatal care between last neonatal deaths and last surviving children in a peri-urban area of India.

Ghosh R, Sharma AK. Department of Humanities and Social Sciences, Indian Institute of Technology, Kanpur, India.

Nearly a quarter of the world’s neonatal deaths take place in India. The state of Uttar Pradesh alone accounts for one-quarter of all neonatal deaths in the country. In this study 892 married women aged less than 50 years living in a peri-urban area of Kanpur city in Uttar Pradesh were interviewed. In all, 109 women reported neonatal deaths. Characteristics of the last neonatal deaths of these 109 women were compared with those of the last surviving children.

Also, characteristics of women who had a neonatal death were compared with those of 783 women who had no neonatal death. It was found that as compared with neonatal deaths, the last surviving children of the 109 women had: (a) significantly better antenatal tests during pregnancy, intake of iron/folic acid tablets and higher percentage of tetanus toxoid immunization; (b) safer delivery practices such as a higher percentage of institutional delivery, sterilization of instruments and application of antiseptic after removal of umbilical cord; (c) postnatal care, such as application of antiseptic to the navel and postnatal checkups; and (d) higher maternal age and greater birth spacing.

Likewise, better antenatal care and safer delivery practices and postnatal care were observed among the 783 women with no neonatal deaths, when compared with women who had experienced neonatal death. The complexities of inter- and intra-household differences in health care are discussed. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.

8. Lancet Neurol. 2010 Aug;9(8):786-792.

Stroke incidence in rural and urban Tanzania: a prospective, community-based study.

Walker R, Whiting D, Unwin N, Mugusi F, Swai M, Aris E, Jusabani A, Kabadi G, Gray WK, Lewanga M, Alberti G.

Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.

BACKGROUND: There are no methodologically rigorous studies of the incidence of stroke in sub-Saharan Africa. We aimed to provide reliable data on the incidence of stroke in rural and urban Tanzania.

METHODS: The Tanzania Stroke Incidence Project (TSIP) recorded stroke incidence in two well defined demographic surveillance sites (DSS) over a 3-year period from June, 2003. The Hai DSS (population 159 814) is rural and the Dar-es-Salaam DSS (population 56 517) is urban. Patients with stroke were identified by use of a system of community-based investigators and liaison with local hospital and medical centre staff. Patients who died from stroke before recruitment into the TSIP were identified via verbal autopsy, which was done on all those who died within the study areas.

FINDINGS: There were 636 strokes during the 3-year period (453 in Hai and 183 in Dar-es-Salaam). Overall crude yearly stroke incidence rates were 94.5 per 100 000 (95% CI 76.0-115.0) in Hai and 107.9 per 100 000 (88.1-129.8) in Dar-es-Salaam. When age-standardised to the WHO world population, yearly stroke incidence rates were 108.6 per 100 000 (95% CI 89.0-130.9) in Hai and 315.9 per 100 000 (281.6-352.3) in Dar-es-Salaam.

INTERPRETATION: Age-standardised stroke incidence rates in Hai were similar to those seen in developed countries. However, age-standardised incidence rates in Dar-es-Salaam were higher than seen in most studies in developed countries; this could be because of a difference in the prevalence of risk factors and emphasises the importance of health screening at a community level. Health policy makers must continue to monitor the incidence of stroke in sub-Saharan Africa and should base future funding decisions on such data. FUNDING: The Wellcome Trust.

9. Science. 2010 Jul 19.

Effectiveness and Safety of Tenofovir Gel, an Antiretroviral Microbicide, for the Prevention of HIV Infection in Women.

Karim QA, Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, Kharsany AB, Sibeko S, Mlisana KP, Omar Z, Gengiah TN, Maarschalk S, Arulappan N, Mlotshwa M, Morris L, Taylor D; on behalf of the CAPRISA 004 Trial Group. Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa.

The CAPRISA 004 trial assessed effectiveness and safety of a 1% vaginal gel formulation of tenofovir, a nucleotide reverse transcriptase inhibitor, for the prevention of HIV acquisition in women. A double-blind, randomized controlled trial was conducted comparing tenofovir gel (n = 445) with placebo gel (n = 444) in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural KwaZulu-Natal, South Africa. HIV serostatus, safety, sexual behavior, and gel and condom use were assessed at monthly follow-up visits for 30 months. HIV incidence in the tenofovir gel arm was 5.6 per 100 women-years, i.e., person time of study observation (38/680.6 women-years), compared to 9.1 per 100 women-years (60/660.7 women-years) in the placebo gel arm (incidence rate ratio = 0.61; P = 0.017). In high adherers (gel adherence >80%), HIV incidence was 54% lower (P = 0.025) in the tenofovir gel arm. In intermediate adherers (gel adherence 50 to 80%) and low adherers (gel adherence <50%), the HIV incidence reduction was 38% and 28%, respectively. Tenofovir gel reduced HIV acquisition by an estimated 39% overall and by 54% in women with high gel adherence. No increase in the overall adverse event rates was observed. There were no changes in viral load and no tenofovir resistance in HIV seroconverters. Tenofovir gel could potentially fill an important HIV prevention gap, especially for women unable to successfully negotiate mutual monogamy or condom use.

10. Soc Sci Med. 2010 Jul;71(1):62-70.

Choosing early pregnancy termination methods in Urban Mozambique.

Mitchell EM, Kwizera A, Usta M, Gebreselassie H. Academic Medical Center, University of Amsterdam, CINIMA, Amsterdam, Netherlands. mitchelle@kncvtbc.nl

Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision making strategies, method preferences and experiences with misoprostol and vacuum aspiration for early abortion. Client screenings (n=1799), structured clinical surveys (n=837), in-depth exit interviews (n=70), and nurse focus groups (n=2) were conducted. Triangulation of qualitative and quantitative data revealed seemingly contradictory findings.

Choice of method reflected women’s heightened concerns about privacy, pain, quality of home support, HIV infection risk, sexuality, and safety of research participation. Urban Mozambican women are highly motivated to find early pregnancy termination techniques that they deem socially and clinically low-risk. Although 42% found vaginal misoprostol self-administration challenging and 25% delayed care for over a week to amass funds for user fees, almost all (96%) reported adequate preparation and comfort with home management.

Women reported satisfaction with all methods and quality of care, even if the initial method failed or pain management or postabortion contraception were not offered. A more nuanced understanding of what women value most can yield service delivery models that are responsive and effective in reducing maternal death and disability from unsafe abortion.

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Urban Health Bulletin – June 2010

Below are citations and abstracts to 13 urban health studies published in June 2010.

HYGIENE/SANITATION/WATER

1 – Arch Dis Child. 2010 Jun 22.

Reported care giver strategies for improving drinking water for young children.

McLennan JD, Farrelly A. University of Calgary, Calgary, Canada.

Objectives – Care givers may engage in a variety of strategies to try and improve drinking water for children. However, the pattern of these efforts is not well known, particularly for young children in high-risk situations. The objective of this study was to determine care giver-reported strategies for young children with (1) undernutrition and (2) living in an unplanned poor peri-urban community in the Dominican Republic.

Methods – Practices reported by care givers of young children from a community and clinic group were extracted from interviews conducted between 2004 and 2008 (n = 563). These results were compared to two previous similar samples interviewed in 1997 (n = 341).

Results – Bottled water is currently the most prevalent reported strategy for improving drinking water for young children. Its use increased from 6% to 69% in the community samples over the last decade and from 13% to 79% in the clinic samples. Boiling water continues to be a common strategy, particularly for the youngest children, though its overall use has decreased over time. Household-level chlorination is infrequently used and has dropped over time.

Conclusions – Care givers are increasingly turning to bottled water in an attempt to provide safe drinking water for their children. While this may represent a positive trend for
protecting children from water-transmitted diseases, it may represent an inefficient approach to safe drinking water provision that may place a financial burden on low-income families.

2 – Waste Manag. 2010 Jun;30(6):1138-48.

Solid waste workers and livelihood strategies in Greater Port-au-Prince, Haiti.

Noel C.

The University of the West Indies, Institute for Sustainable Development, Environmental Management Unit, 13 Gibraltar Camp Way, Mona Campus, Kingston, Jamaica. claudelnoel@gmail.com

The solid waste management industry in Haiti is comprised of a formal and an informal sector. Many basic activities in the solid waste management sector are being carried out within the context of profound poverty, which exposes the failure of the socioeconomic and political system to provide sufficient job opportunities for the urban population. This paper examines the involvement of workers in the solid waste management industry in Greater Port-au-Prince and the implications for livelihood strategies. The findings revealed that the Greater Port-au-Prince solid waste management system is very inclusive with respect to age, while highly segregated with regard to gender. In terms of earning capacity, the results showed that workers hired by the State agencies were the most economically vulnerable group as more than 50% of them fell below the official nominal minimum wage. This paper calls for better salary scales and work compensation for the solid waste workers.

3 – J Water Health. 2010 Jun;8(2):355-64.

Assessment of E. coli and Salmonella spp. infection risks associated with different fecal sludge disposal practices in Thailand.

Yajima A, Koottatep T.

Department of Global Agricultural Science, Graduate School of Agricultural and Life Science, University of Tokyo, 1-1-1 Yayoi, Tokyo 113-8657, Japan. yajimaa@gmail.com

The proper management of fecal sludge (FS), to block the transmission pathways of pathogens, is rarely enforced in many parts of the world. Health risks associated with different disposal practices of FS in peri-urban settings of a large metropolis in Thailand were assessed; Tha Klong sub-district with indiscriminate FS dumping, and Klong Luang sub-district which has an FS treatment system. The study showed that indiscriminate FS dumping from along the canal banks and discharge of market waste were likely the major sources of E. coli and Salmonella spp. in contamination of the canal water. The increased microbial pathogen concentrations near the FS treatment facility also indicated contamination risks from poorly designed treatment facilities. Quantitative microbial risk assessment (QMRA) indicated very high water-related infection risk levels compared to the actual locally recorded disease occurrences. These results indicated that the QMRA model needs to be modified to take account of immunological differences between populations in developed countries, where the model was developed, and developing countries. In addition, further sensitivity factors are needed to reflect different societal behavior patterns, and therefore contact with
potentially contaminated water, in different sub-populations of many less developed communities.

DIARRHEAL DISEASES

4 – Epidemiol Infect. 2010 Jun 14:1-7.

Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine.

Arvelo W, Blum LS, Nahar N, VON Seidlein L, Nahar L, Pack RP, Brooks AW, Pach A, Breiman RF, Luby SP, Ram PK. Centers for Disease Control and Prevention, Atlanta, GA, USA.

Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents
stated that they would opt to get the vaccine and would pay a median of $0.05 (range U.S.$0.01-0.15) for it, equivalent to <1% of their median weekly income. There was almost universal perception that an effective vaccine to prevent bloody diarrhoea was highly beneficial and acceptable. While respondents valued a vaccine for prevention of bloody diarrhoea, they were only willing to pay minimally for it. Therefore, achieving a high rate of Shigella vaccine coverage may require subsidy of vaccine purchase.

HIV/AIDS STUDIES

5 – AIDS Behav. 2010 Jun;14(3):721-30.

Community-based DOT-HAART accompaniment in an urban resource-poor setting.

Muñoz M, Finnegan K, Zeladita J, Caldas A, Sanchez E, Callacna M, Rojas C, Arevalo J, Sebastian JL, Bonilla C, Bayona J, Shin S. Socios En Salud Sucursal Perú, Lima, Peru.

From December 2005 to April 2007, we enrolled 60 adults starting antiretroviral therapy (ART) in a health district of Lima, Peru to receive community-based accompaniment with supervised antiretroviral (CASA). Paid community health workers performed twice-daily home visits to directly observe ART and offered additional medical, social and economic support to CASA participants. We matched 60 controls from a neighboring district by age, CD4 and primary referral criteria (TB status, female, neither). Using validated instruments at baseline and 12 months (time of DOT-HAART completion) we measured depression, social support, quality of life, HIV-related stigma and self-efficacy. We compared 12 month clinical and psychosocial outcomes among CASA versus control groups. CASA participants experienced better clinical and psychosocial outcomes at 12 months, including proportion with virologic suppression, increase in social support and reduction in HIV-associated stigma.

6 – AIDS. 2010 Jun 9.

Early immunologic response and subsequent survival among malnourished adults receiving antiretroviral therapy in Urban Zambia.

Koethe JR, Limbada MI, Giganti MJ, Nyirenda CK, Mulenga L, Wester CW, Chi BH, Stringer JS.

OBJECTIVE:: To evaluate the relationship between early CD4 lymphocyte recovery on antiretroviral therapy (ART) and subsequent survival among low body mass index (BMI) HIV-1-infected adults.

DESIGN:: Retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

METHODS:: We evaluated ART-treated adults enrolled in care for more than 6 months. We stratified this study population according to World Health Organization (WHO) malnutrition criteria: normal (BMI >/=18.5 kg/m), mild (17.00-18.49), moderate (16.00-16.99), and severe (<16.0). We used Cox proportional hazards regression to estimate the subsequent risk of death associated with absolute CD4 cell count change over the first 6 months on ART. To account for effect modification associated with baseline CD4 cell count, a weighted summary measure was calculated.

RESULTS:: From May 2004 to February 2009, 56 612 patients initiated ART at Lusaka district clinics; of these, 33 097 (58%) were included in this analysis. The median change in 0-6 month CD4 cell count in each baseline BMI strata varied from 127 to 131 cells/mul. There was a statistically significant, inverse association between baseline BMI and the post 6-month hazard for mortality only among those patients with less than 100 cells/mul increase in the first 6 months of ART. A CD4 cell count increase of at least 100 cells/mul over the first 6 months of ART was not associated with a higher hazard for mortality, regardless of baseline BMI.

CONCLUSIONS:: Low baseline BMI and attenuated CD4 cell count response at 6 months had a compounding, negative impact on post 6-month survival. Specific guidelines for monitoring ART response using immunologic criteria may be warranted for low BMI patients.

7 – Arch Gynecol Obstet. 2010 Jun;281(6):991-4.

Obstetric and perinatal outcome in HIV positive women receiving HAART in urban Nigeria.

Olagbuji BN, Ezeanochie MC, Ande AB, Oboro VO.

Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria.

PURPOSE: To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls.

METHODS: A prospective matched case-control study.

RESULTS: HIV positive women were significantly more likely to have anaemia in pregnancy [p < 0.001, odds ratio (95% CI) 5.66 (3.0-10.5)], intrauterine growth restriction [p = 0.002, odds ratio (95%CI) 13.82 (1.8-106.7)], preterm labour [p = 0.03, odds ratio (95% CI) 2.89 (1.2-7.0)] and birth weight less than 2,500 g [p < 0.0001, odds ratio (95% CI) 5.43 (2.4-12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups.

CONCLUSION: Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women.

MALARIA AND OTHER VECTOR-BORNE DISEASES

8 – BMC Infect Dis. 2010 Jun 16;10(1):173.

Geographical and environmental approaches to urban malaria in Antananarivo (Madagascar).

Rakotomanana F, Ratovonjato J, Randremanana RV, Randrianasolo L, Raherinjafy R, Rudant JP, Richard V.

BACKGROUND: Previous studies, conducted in the urban of Antananarivo, showed low rate of confirmed malaria cases. We used a geographical and environmental approach to investigate the contribution of environmental factors to urban malaria in Antananarivo.

METHODS: Remote sensing data were used to locate rice fields, which were considered to be the principal mosquito breeding sites. We carried out supervised classification by the maximum likelihood method. Entomological study allowed vector species determination from collected larval and adult mosquitoes. Mosquito infectivity was studied, to assess the risk of transmission, and the type of mosquito breeding site was determined. Epidemiological data were collected from November 2006 to December 2007, from public health centres, to determine malaria incidence. Polymerase chain reaction was carried out on dried blood spots from patients, to detect cases of malaria. Rapid diagnostic tests were used to confirm malaria cases among febrile school children in a school survey. A geographical information system was constructed for data integration. Altitude, temperature, rainfall, population density and rice field surface area were analysed and the effects of these factors on the occurrence of confirmed malaria cases were studied.

RESULTS: Polymerase chain reaction confirmed malaria in 5.1% of the presumed cases. Entomological studies showed An. arabiensis as potential vector. Rice fields remained to be the principal breeding sites. Travel report was considered as related to the occurrence of P. falciparum malaria cases.

CONCLUSION: Geographical and environmental factors did not show direct relationship with malaria incidence but they seem ensuring suitability of vector development. Absence of relationship may be due to a lack of statistical power. Despite the presence of An. Arabiensis, scarce parasitic reservoir and rapid access to health care do not constitute optimal conditions to a threatening malaria transmission. However, imported malaria case is suggestive to sustain the pocket transmission in Antananarivo.

9 – Trans R Soc Trop Med Hyg. 2010 Jun;104(6):406-11.

Sand flies naturally infected by Leishmania (L.) mexicana in the peri-urban area of Chetumal city, Quintana Roo, México.

Sánchez-García L, Berzunza-Cruz M, Becker-Fauser I, Rebollar-Téllez EA. Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Medicina Experimental, Hospital General de México, Dr Balmis 148, Col. Doctores, México D.F. 06726, México. zinacla 68@yahoo.com.mx

The surveillance of prevalent Leishmania sand fly vectors is an important issue for epidemiological studies in populated areas where leishmaniasis is endemic. In this study, we collected sand flies from a peri-urban area in the southeast of Mexico. Natural infection with Leishmania (L.) mexicana was studied by PCR using a Leishmania internal transcribed spacer of the ribosomal RNA gene for amplification. Infected Lutzomyia olmeca olmeca, Lu. shannoni and Lu. cruciata sand flies were collected mainly during the high transmission season (November to March), coinciding with the highest sand fly densities. Additionally, positive specimens of Lu. olmeca olmeca were also captured during July and August. The infected sand flies were from primary forest (subperennial forest) and secondary forest (18-25 years old and 10-15 years old respectively). Sand flies collected with Disney and Shannon traps were the ones found to be infected with L. (L.) mexicana. We conclude that the high-risk period in which L. (L.) mexicana is transmitted in the peri-urban area of Chetumal City is from July to March and that transmission is associated with both the subperennial forest and the secondary forest.

RESPIRATORY DISEASES

10 – Trop Med Int Health. 2010 Jun 1;15(6):762-71.

Prevalent high-risk respiratory hygiene practices in urban and rural Bangladesh.

Nasreen S, Azziz-Baumgartner E, Gurley ES, Winch PJ, Unicomb L, Sharker MA, Southern D, Luby SP. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.

Objectives – To identify existing respiratory hygiene risk practices, and guide the development of interventions for improving respiratory hygiene.

Methods – We selected a convenience sample of 80 households and 20 schools in two densely populated communities in Bangladesh, one urban and one rural. We observed and recorded respiratory hygiene events with potential to spread viruses such as coughing, sneezing, spitting and nasal cleaning using a standardized assessment tool.

Results – In 907 (81%) of 1122 observed events, households’ participants coughed or sneezed into the air (i.e. uncovered), 119 (11%) into their hands and 83 (7%) into their clothing. Twenty-two per cent of women covered their coughs and sneezes compared to 13% of men (OR 2.6, 95% CI 1.6-4.3). Twenty-seven per cent of persons living in households with a reported monthly income of >72.6 US$ covered their coughs or sneezes compared to 13% of persons living in households with lower income (OR 3.2, 95% CI 1.6-6.2). In 956 (85%) of 1126 events, school participants coughed or sneezed into the air and 142 (13%) into their hands. Twenty-seven per cent of coughs/sneezes in rural schools were covered compared to 10% of coughs/sneezes in urban schools (OR 2.3, 95% CI 1.5-3.6). Hand washing was never observed after participants coughed or sneezed into their hands.

Conclusion – There is an urgent need to develop culturally appropriate, cost-effective and scalable interventions to improve respiratory hygiene practices and to assess their effectiveness in reducing respiratory pathogen transmission.

OTHER STUDIES

11 – BMC Gastroenterol. 2010 Jun 16;10(1):62.

Helicobacter pylori in apparently healthy children aged 0-12 years in urban Kampala, Uganda: a community-based cross sectional survey.

Hestvik E, Tylleskar T, Kaddu-Mulindwa DH, Ndeezi G, Grahnquist L, Olafsdottir E, Tumwine JK.

BACKGROUND: Helicobacter pylori is one of the most common causes of bacterial infection in human beings. Studies have showed a high prevalence of Helicobacter pylori among people in low-income countries and colonization early in life. A monoclonal antigen test, performed on faeces, HpSA(R)ImmunoCardSTAT, has a high sensitivity, specificity and accuracy and the faecal test can be performed in all ages, also in resource-limited settings. The main objective of this study was to determine the prevalence and factors associated with Helicobacter pylori colonization in apparently healthy children aged 0-12 years in urban Kampala, Uganda.

METHOD: We tested 427 apparently healthy children, age 0-12 years (211 males, 216 females), in a cross sectional survey for Helicobacter pylori colonization using HpSA(R)ImmunoCardSTAT. A short standardized interview with socio-demographic information and medical history was used to assess risk factors. RESULTS: The overall prevalence of Helicobacter pylori in the 427 children was 44.3 % (189 out of 427). Early colonization was common, 28.7 %, in children younger than 1 year of age. The age specific rates were 46.0 % in children age 1-<3 years, 51.7 % in children age 3-<6 years, 54.8 % in children age 6-<9 years and 40.0 % in children age 9-<12 years. There was a significant difference in prevalence by gender; female 38.5 % versus male 49.8 % and by type of housing; permanent house 38.5 % versus semi-permanent house 48.6 %. Congestive living and education level of the female caretaker showed a clear trend for a difference in prevalence. Factors independently associated with Helicobacter pylori colonization included: drugs taken last three months, using a pit latrine, sources of drinking water and wealth index.

CONCLUSION: The prevalence of Helicobacter pylori colonization among urban Ugandan children is high at an early age and increases with age. The impact of Helicobacter pylori colonization on children's health in Uganda needs to be further clarified.

12 – Parasitol Res. 2010 Jun 8.

Gastrointestinal and ectoparasites from urban stray dogs in Fortaleza (Brazil): high infection risk for humans?

Klimpel S, Heukelbach J, Pothmann D, Rückert S. Biodiversity and Climate Research Centre (BiK-F), Johann Wolfgang Goethe-University, Georg-Voigt-Str. 14-16, 60325, Frankfurt am Main, Germany, sklimpel@gmx.net.

Dogs are important definite or reservoir hosts for zoonotic parasites. However, only few studies on the prevalence of intestinal parasites in urban areas in Brazil are available. We performed a comprehensive study on parasites of stray dogs in a Brazilian metropolitan area. We included 46 stray dogs caught in the urban areas of Fortaleza (northeast Brazil). After euthanization, dogs were autopsied. Ectoparasites were collected, and the intestinal content of dogs were examined for the presence of parasites. Faecal samples were collected and analysed using merthiolate iodine formaldehyde concentration method.

A total of nine different parasite species were found, including five endoparasite (one protozoan, one cestode and three nematode species) and four ectoparasite species (two flea, one louse and one tick species). In the intestinal content, 3,162 specimens of four helminth species were found: Ancylostoma caninum (prevalence, 95.7%), Dipylidium caninum (45.7%), Toxocara canis (8.7%) and Trichuris vulpis (4.3%). A total of 394 ectoparasite specimens were identified, including Rhipicephalus sanguineus (prevalence, 100.0%), Heterodoxus spiniger (67.4%), Ctenocephalides canis (39.1%) and Ctenocephalides felis (17.4%). In the faeces, intestinal parasites were detected in 38 stray dogs (82.6%), including oocysts of Giardia sp. (2.2%) and eggs of the nematode A. caninum (82.6%). Neither eggs nor larval stages of D. caninum, T. canis or T. vulpis were detected in dog faeces. Sensitivity of faecal examination for A. caninum was 86.4% (95% confidence interval, 72.0-94.3) but zero percentage for the other intestinal helminth species.

Our data show that stray dogs in northeast Brazil carry a multitude of zoonotic ecto- and endoparasites, posing a considerable risk for humans. With the exception of A. caninum, sensitivity of faecal examination was negligible.

13 – Trop Med Int Health. 2010 Jun 1;15(6):664-72.

Spatial analysis of tuberculosis in an Urban West African setting: is there evidence of clustering?

Touray K, Adetifa IM, Jallow A, Rigby J, Jeffries D, Cheung YB, Donkor S, Adegbola RA, Hill PC. Bacterial Diseases Programme, MRC Laboratories, Banjul, The Gambia.

Objectives – To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering.

Methods – In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents.

Results – Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region.

Conclusions – There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.

Urban Health Bulletin – May 2010

Below is an annotated bibliography of 12 recently published urban health studies. The entries are listed alphabetically by journal title.

1 Acta Trop. 2010 Apr 24.

An exploratory survey of malaria prevalence and people’s knowledge, attitudes and practices of mosquito larval source management for malaria control in western Kenya.

Imbahale SS, Fillinger U, Githeko A, Mukabana WR, Takken W. Laboratory of Entomology, Wageningen University and Research Centre, P.O. Box 8031, 6700 EH Wageningen, The Netherlands; Kenya Medical Research Institute, Centre for Global Health Research, P.O. Box 1578, 40100, Kisumu, Kenya.

A large proportion of mosquito larval habitats in urban and rural communities in sub-Saharan Africa are man-made. Therefore, community-based larval source management (LSM) could make a significant contribution to malaria control in an integrated vector management approach. Here we implemented an exploratory study to assess malaria prevalence and people’s knowledge, attitudes and practices on malaria transmission, its control and the importance of man-made aquatic habitats for the development of disease vectors in one peri-urban lowland and two rural highland communities in western Kenya. We implemented monthly cross-sectional malaria surveys and administered a semi-structured questionnaire in 90 households, i.e. 30 households in each locality. Malaria prevalence was moderate (3.2-6.5%) in all sites. Nevertheless, residents perceived malaria as their major health risk. Thirty-two percent (29/90) of all respondents did not know that mosquitoes are responsible for the transmission of malaria. Over two-thirds (69/90) of the respondents said that mosquito breeding site could be found close to their homes but correct knowledge of habitat characteristics was poor. Over one-third (26/67) believed that immature mosquitoes develop in vegetation. Man-made pools, drainage channels and burrow pits were rarely mentioned. After explaining where mosquito larvae develop, 56% (50/90) felt that these sites were important for their livelihood. Peri-urban residents knew more about mosquitoes’ role in malaria transmission, could more frequently describe the larval stages and their breeding habitats, and were more likely to use bed nets even though malaria prevalence was only half of what was found in the rural highland sites (p<0.05). This was independent of their education level or socio-economic status. Hence rural communities are more vulnerable to malaria infection, thus calling for additional methods to complement personal protection measures for vector control. Larval source management was the most frequently mentioned (30%) tool for malaria control but was only practiced by 2 out of 90 respondents. Targeting the larval stages of malaria vectors is an underutilized malaria prevention measure. Sustainable elimination or rendering of such habitats unsuitable for larval development needs horizontally organized, community-based programs that take people’s needs into account. Innovative, community-based training programs need to be developed to increase people’s awareness of man-made vector breeding sites and acceptable control methods need to be designed in collaboration with the communities.

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2 Am J Hum Biol. 2010 May;22(3):285-90.

Sociodemographic determinants of growth among Malian adolescent females.

Leslie TF, Pawloski LR. Department of Geography and Geoinformation Science, George Mason University, 4400 University Dr MS 6C3, Fairfax, VA 22030, USA. tleslie@gmu.edu

In Africa, research concerning the social determinants of poor nutritional status has typically focused on children under 5 years of age and has used defined categorical boundaries based on international reference standards. In this article, stunting and wasting of 1,157 Malian adolescent girls is measured through both categorical and continuous data. The focus on adolescent girls is significant because there is relatively little literature examining this group, and because adolescence marks the time when girls gain greater workload responsibilities, autonomy of food choices, and, as a result of the adolescent growth spurt, require the greatest amount of caloric intake respective to their weight since infancy. To differentiate stunting and wasting causes, a number of socioeconomic, geographic, and demographic factors are explored. The findings suggest that continuous data provides a basis for modeling stunting and wasting superior to utilizing international reference categories. Estimations show that decreasing age, the presence of servants, a greater number of wives in a compound, and residence in a large urban area correlate with improved nutritional status while wealthier families appear to correlate with greater stunting and wasting, and no correlation exists with estimated energy expenditure. Future studies should incorporate continuous data, and the need exists for greater analysis of social determinants of growth indicators among adolescent females. Further, these findings have significant implications in the development of nutrition intervention programs aimed at the vulnerable population in Mali, leading us to conclude that factors beyond socioeconomic indicators such as household structure and location should be more fully examined.

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3 Arch Dis Child. 2010 Apr 6.

Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa.

Garenne M.

The health of children improved dramatically worldwide during the 20th century, although with major contrasts between developed and developing countries, and urban and rural areas. The quantitative evidence on urban child health from a broad historical and comparative perspective is briefly reviewed here. Before the sanitary revolution, urban mortality tended to be higher than rural mortality. However, after World War I, improvements in water, sanitation, hygiene, nutrition and child care resulted in lower urban child mortality in Europe. Despite a similar mortality decline, urban mortality in developing countries since World War II has been generally lower than rural mortality, probably because of better medical care, higher socio-economic status and better nutrition in urban areas. However, higher urban mortality has recently been seen in the slums of large cities in developing countries as a result of extreme poverty, family disintegration, lack of hygiene, sanitation and medical care, low nutritional status, emerging diseases (HIV/AIDS and tuberculosis) and other health hazards (environmental hazards, accidents, violence). These emerging threats need to be addressed by appropriate policies and programmes.

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4 Environ Res. 2010 May;110(4):355-62.

Prenatal and adolescent blood lead levels in South Africa: child, maternal and household risk factors in the Birth to Twenty cohort.

Naicker N, Norris SA, Mathee A, von Schirnding YE, Richter L. Medical Research Council of South Africa, Environment and Health Research Unit, PO Box 87373, Houghton 2041, Johannesburg, South Africa. nisha.naicker@mrc.ac.za

INTRODUCTION: The risk factors for lead exposure in developing countries have not been fully described. This study looks at child, maternal and household factors associated with increased risk of lead exposure at birth and at 13 years of age in the Birth to Twenty cohort.

METHODS: Mothers were recruited from antenatal clinics in the Johannesburg-Soweto metropolitan area in 1990 (n=3273). Lead levels were analysed in cord blood collected at birth (n=618) and at 13 years (n=1546). Data on selected child, maternal and household factors were collected using a structured questionnaire in the third trimester and at 13 years of age. Statistical analyses were conducted to determine the associated risk factors.

RESULTS: The mean blood lead level at birth was 5.85 microg/dl, and at 13 years of age it was 5.66 microg/dl. The majority of children had blood lead levels above 5 microg/dl (52% at birth and 56% at 13 years). At birth, being a teenage mother and having low educational status were strong predictors for elevated cord blood lead levels. Being a male child, having an elevated cord blood level, and lack of household ownership of a phone were significant risk factors for high blood lead levels at 13 years.

CONCLUSION: Significant associations found in the study point to the low socio-economic status of lead-affected mothers and children. These poor circumstances frequently persist into later childhood, resulting in continued high lead levels. Thus broader measures of poverty alleviation and provision of better education may help decrease the risk of exposure.

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5 Global Health. 2010 May 4;6(1):8.

“For someone who’s rich, it’s not a problem”. Insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam’s urban poor.

Kolling M, Winkley K, von Deden M.

The prevalence of chronic non-communicable disease, such as type 2 diabetes mellitus (T2DM), is rising worldwide. In Africa, T2DM is primarily affecting those living in urban areas and increasingly affecting the poor. Diabetes management among urban poor is an area of research that has received little attention. Based on ethnographic fieldwork in Dar es Salam, the causes and conditions for diabetes management in Tanzania have been examined. In this paper, we focus on the structural context of diabetes services in Tanzania; the current status of biomedical and ethnomedical health care; and health-seeking among people with T2DM. We demonstrate that although Tanzania is actively developing its diabetes services, many people with diabetes and low socioeconomic status are unable to engage continuously in treatment. There are many challenges to be addressed to support people accessing diabetes health care services and improve diabetes management.

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6 Health Place. 2010 May;16(3):573-80.

Urban advantage or Urban penalty? A case study of female-headed households in a South African city.

Goebel A, Dodson B, Hill T. Queen’s University, Kingston, Ontario, Canada. goebela@queensu.ca

Basic services have improved in many urban areas of South Africa, which should improve health and well-being. However, poverty and ill-health persist and are unequally distributed by race, class and place. This paper explores conditions of the most marginalized group, female-headed households, in a case study of Msunduzi Municipality (formerly Pietermaritzburg). Data from two household surveys conducted in 2006 show important patterns regarding the incidences of and coping strategies around, illnesses and deaths. While some positive environmental health outcomes are apparent, considerable stresses face households in relation to HIV/AIDS related deaths, poverty, and lack of health services. The insights of both urban environmental health and feminist geography assist in explaining the gendered and spatialized patterns of health in post-apartheid urban South Africa.

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7 Health Policy. 2010 Apr;95(1):62-8.

Rural-urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria.

Okeke TA, Okeibunor JC. Department of Community Medicine, College of Medicine, University of Nigeria, P.O. Box 3295, Enugu Campus, Enugu, Nigeria. thdokeke@yahoo.co.uk

OBJECTIVES: To identify the differences in health-seeking for childhood malaria treatment, between urban and rural communities in Nigeria, with a view to providing information to policy makers that will be used to improve malaria control.

METHODS: Quantitative and qualitative research methods were employed in eliciting information. A pre-tested structured questionnaire was administered to 1200 caretakers of children under 5 years who had malaria 2 weeks prior to the survey period. Focus group discussions were held with mothers and in-depth interviews with health care providers.

RESULTS: Health-seeking for malaria, differed significantly between rural and urban mothers. While majority (64.7%) of urban caretakers patronized private/government health facilities, most (62%) of their rural counterparts resorted to self-treatment with drugs bought over-the-counter, from patent medicine vendors. Hospitals were geographically more accessibility to urban than rural dwellers. Rural mothers only go to hospital when the problem persists or becomes worse, which results in delay in seeking appropriate and timely care.

CONCLUSION: Urban and rural mothers differed in their responses to childhood fevers. Training drug vendors and caretakers are important measures to improve malaria control. Health facilities with good quality services and readily available drugs should be provided.

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8 J Pediatr (Rio J). 2010 May 3;86(3).

Association between malnutrition in children living in slums, maternal nutritional status, and environmental factors.

Silveira KB, Alves JF, Ferreira HS, Sawaya AL, Florêncio TM. Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil.

OBJECTIVE: To investigate the association of malnutrition in children living in substandard settlements (slums) of Maceió, AL, Brazil, with maternal nutritional status and environmental conditions.

METHODS: Cross-sectional study involving a probability sample of 2,075 mothers (18 to 45 years) and their children (4 months to 6 years), living in the slums of the city of Maceió. First, we conducted a cluster analysis with the purpose of choosing the settlements and the administrative region of the city of Maceió with the lowest human development index (HDI). After this analysis, the 7th Administrative Region was designated for the study, including its 23 substandard settlements. Socioeconomic, demographic, anthropometric, and maternal and child health data were collected by means of household survey. The statistic analysis included the odds ratio of a child to be malnourished, and the univariate regression was used to check which maternal variables were associated with this malnutrition.

RESULTS: Chronic malnutrition (-2 standard deviations/height for age) was found in 8.6% of children and was associated with mother’s age and educational level, type of residence, number of rooms, flooring, water supply, and low birth weight (< 2,500 g) in children aged </= 24 months. We also found association between child malnutrition and maternal height. Such association was not observed regarding body mass index.

CONCLUSIONS: The high prevalence of malnutrition observed in these settlements was related to social and environmental conditions and short maternal height, who had weight deficit or weight excess.

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9 J Prev Interv Community. 2010 Apr;38(2):147-61.

Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe.

Dunbar MS, Maternowska MC, Kang MS, Laver SM, Mudekunye-Mahaka I, Padian NS. Women’s Global Health Imperative, RTI International, San Francisco, California, USA.

This study tested the feasibility of a combined microcredit and life-skills HIV prevention intervention among 50 adolescent female orphans in urban/peri-urban Zimbabwe. Quantitative and qualitative data were collected on intervention delivery, HIV knowledge and behavior, and economic indicators. The study also tested for HIV, HSV-2, and pregnancy. At 6 months, results indicated improvements in knowledge and relationship power. Because of the economic context and lack of adequate support, however, loan repayment and business success was poor. The results suggest that microcredit is not the best livelihood option to reduce risk among adolescent girls in this context.

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10 J Urban Health. 2010 May 7.

Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums.

Ndugwa RP, Cleland J, Madise NJ, Fotso JC, Zulu EM. London School of Hygiene and Tropical Medicine, London, UK, robert.ndugwa@lshtm.ac.uk.

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.

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11PLoS Negl Trop Dis. 2010 Mar 16;4(3):e631.

Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.

Penrose K, de Castro MC, Werema J, Ryan ET. Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America. kpenrose@post.harvard.edu

BACKGROUND: As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world’s fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania.

METHODOLOGY/PRINCIPAL FINDINGS: Cholera incidence was examined in relation to the percentage of a ward’s residents who were informal, the percentage of a ward’s informal residents without an improved water source, the percentage of a ward’s informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km(2) in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest.

CONCLUSIONS/SIGNIFICANCE: Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world’s urban population continues to expand.

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12 Trans R Soc Trop Med Hyg. 2010 Apr 23.

Cohort trial reveals community impact of insecticide-treated nets on malariometric indices in urban Ghana.

Klinkenberg E, Onwona-Agyeman KA, McCall PJ, Wilson MD, Bates I, Verhoeff FH, Barnish G, Donnelly MJ. Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; International Water Management Institute, PMB CT 112, Cantonments, Accra, Ghana.

The efficacy of insecticide-treated nets (ITNs) in prevention of malaria and anaemia has been shown in rural settings, but their impact in urban settings is unknown.  We carried out an ITN intervention in two communities in urban Accra, Ghana, where local malaria transmission is known to occur. There was evidence for a mass or community effect, despite ITN use by fewer than 35% of households. Children living within 300 m of a household with an ITN had higher haemoglobin concentrations (0.5g/dl higher, P=0.011) and less anaemia (odds ratio 2.21, 95% CI 1.08-4.52, P=0.031 at month 6), than children living more than 300 m away from a household with an ITN, although malaria parasitaemias were similar. With urban populations growing rapidly across Africa, this study shows that ITNs will be an effective tool to assist African countries to achieve their Millennium Development Goals in urban settings.

October/November 2009 Urban Health Bulletin

The latest issue of the Urban Health Bulletin is now posted on the Environmental Health at USAID website at: http://www.ehproject.org/PDF/ehkm/urban_health-octnov09.pdf (pdf, 106KB)

This issue contains citations and abstracts of 20 recently published studies from: Benin, Brazil, India, Indonesia, Kenya,  Morocco,  Mozambique, Pakistan and Zambia. 

Please contact USAID’s Urban Health Advisor, Anthony Kolb, akolb@usaid.gov , if you have any comments or would like to have your projects or reports featured in the Urban Health Bulletin.

Urban Health Bulletin – July/August 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-jul_aug09.pdf (pdf)

This issue contains citations and abstracts of 25 peer-review studies selected by Anthony Kolb, USAID’s Urban Health Advisor.

Urban Health Bulletin, May/June 2009

The latest Urban Health Bulletin contains citations and abstracts to 20 recently published studies that were reviewed and selected by Anthony Kolb, USAID’s Urban Health Advisor,
Email: akolb@usaid.gov

Link – http://www.ehproject.org/PDF/ehkm/urban_health-may_jun09.pdf

Below are citations to the studies in this issue:

Urban Health Analysis

1 – Am J Hum Biol. 2009 Jun 16. Children’s work, earnings, and nutrition in urban Mexican shantytowns.

2 – Arch Dis Child. 2009 Jul 1. The effects of social variables on symptom-recognition and medical care-seeking behaviour for acute respiratory infections in infants in urban Mongolia.

3 – BMC Cardiovasc Disord. 2009 Jun 8; 9:23. The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT Study.

4 – BMC Public Health. 2009 May 22;9:149. Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison.

5 – International Journal of Drug Policy, Volume 20, Issue 3, Risk Environment and Drug Harms, May 2009, Pages 237-243. The social context of initiation into injecting drugs in the slums of Makassar, Indonesia

6 – Int J Equity Health. 2009 Jun 5;8:21. Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai.

7 – Int J Health Geogr. 2009 Jun 8;8:32. The 2005 census and mapping of slums in Bangladesh: design, select results and application.

8 – Reprod Health. 2009 Jun 16;6(1):9. Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?

Urban Environmental Health

9 – Cities, Volume 26, Issue 3, June 2009, Pages 125-132. Community-led infrastructure provision in low-income urban communities in developing countries: A study on Ohafia, Nigeria

10 – International Journal of Hygiene and Environmental Health, Volume 212, Issue 4, July 2009, Pages 387-397. Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia

11 – Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 103, Issue 5, May 2009, Pages 506-511. Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants

12 – Water Sci Technol. 2009;59(12):2341-50. Community-focused greywater management in two informal settlements in South Africa.

Urban Vector Disease

13 – Cad Saude Publica. 2009 Jul; 25(7):1543-51. Factors associated with the incidence of urban visceral leishmaniasis: an ecological study in Teresina, Piauí State, Brazil.

14 – Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-37-41. Leptospirosis: a worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations.

15 – Geospat Health. 2009 May; 3(2):189-210. Urban agriculture and Anopheles habitats in Dar es Salaam, Tanzania.

16 – Malar J. 2009 Jun 24;8(1):138. Highly focused anopheline breeding sites and malaria transmission in Dakar.

17 – Malar J. 2009 May 14; 8:103. Development of vegetable farming: a cause of the emergence of insecticide resistance in populations of Anopheles gambiae in urban areas of Benin.

18 – Trop Med Int Health. 2009 Jun 28. Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR.

Urban HIV/AIDS

19 – AIDS Care. 2009 May;21(5):615-21. Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India.

20 – BMC Public Health. 2009 May 27;9:153. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

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.

Urban Health Bulletin – Sep/Oct 2008

Urban Health Bulletin, September/October 2008 (pdf, 135KB) – Environmental Health at USAID.

Anthony Kolb, USAID’s Urban Health Advisor, has selected 28 recently published urban health studies and below are titles of some of the studies in this issue.

Urban Health Analysis
1 Challenging assumptions about women’s empowerment: social and economic resources and domestic violence among young married women in urban South India.
2 Quantification of Urbanization in Relation to Chronic Diseases in Developing Countries: A Systematic Review.
3 Epidemiology and the macrosocial determinants of health.
Urban Environmental Health
12 Spatial analysis of risk factor of cholera outbreak for 2003-2004 in a peri-urban area of Lusaka, Zambia.
13 Spatial and demographic patterns of Cholera in Ashanti region – Ghana.
14 Improving access to water supply and sanitation in urban India: microfinance for water and sanitation infrastructure development.
Urban Vector Disease
21 Human population, urban settlement patterns and their impact on Plasmodium falciparum malaria endemicity.
22 Mosquito larval habitats and public health implications in Abeokuta, Ogun State, Nigeria.