Suchergebnisse

The article Understanding Living Conditions and Deprivation in Informal Settlements of Kisumu, Kenya, written by Sheillah Simiyu, Sandy Cairncross and Mark Swilling, was originally published electronically on the publisher's internet portal (currently SpringerLink)

Informal settlements are a common occurrence in developing countries. Each settlement, however, has unique living conditions which require improvement efforts that are specifically tailored to the settlement. This study, carried out in Kisumu's informal settlements, had two aims: to describe living conditions and to propose areas of improvement within the settlements. The study adopted two approaches: the living conditions framework and the multi-dimensional poverty index. Results indicate that deprivation is widespread at the individual and housing unit level, but the settlements are served with public services such as schools and health centres which residents can access. At the compound level, compounds lack infrastructural services such as water, sanitation and solid waste disposal, and where they are available, these services are shared. This study highlights the importance of basic service provision, upgrading of housing and supporting of existing income-generating opportunities within the settlements. Development efforts should involve all stakeholders, including landlords, tenants, community groups and governmental and non-governmental organisations.

Guinea worm disease, dracunculiasis or dracontiasis, is an ancient disease with records going back over 4500 years, but until the beginning of the 20th century, little was known about its life cycle, particularly how humans became infected. In 1905, Robert Thomas Leiper was sent by the British colonial authorities to West Africa to investigate the spread of Guinea worm disease and to recommend measures to prevent it. While carrying out his investigations, he made important contributions to the aetiology, epidemiology and public health aspects of Guinea worm disease and provided definitive answers to many outstanding questions. First, he tested the validity of previous theories; second, he confirmed the role of water fleas, which he identified as Cyclops, as the intermediate hosts in the life cycle; third, he investigated the development of the parasite in its intermediate host; and fourth, he recommended measures to prevent the disease. [The crustacean Order Cyclopoida in the Family Cyclopidae contains 25 genera, including Cyclops which itself contains over 400 species and may not even be a valid taxon. It is not known how many of these species (or indeed species belonging to related genera) can act as intermediate hosts of Dracunculus medinensis nor do we know which species Fedchenko, Leiper and other workers used in their experiments. It is, therefore, best to use the terms copepod, or copopoid crustacean rather than Cyclops in scientific texts. In this paper, these crustaceans are referred to as copepods except when referring to an original text.] Leiper described the remarkable changes that took place when an infected copepod was placed in a dilute solution of hydrochloric acid; the copepod was immediately killed, but the Dracunculus larvae survived and were released into the surrounding water. From this, he concluded that if a person swallowed an infected copepod, their gastric juice would produce similar results. He next infected monkeys by feeding them copepods infected with Guinea worm larvae, and thus conclusively demonstrated that humans became infected by accidentally ingesting infected crustaceans. Based on these conclusions, he advocated a number of control policies, including avoidance of contaminated drinking water or filtering it, and these preventive measures paved the way for further research. The challenge to eradicate Guinea worm disease was not taken up until about seven decades later since when, with the support of a number of governmental and non-governmental organizations, the number of cases has been reduced from an estimated 3·5 million in 1986 to 25 in 2016 with the expectation that this will eventually lead to the eradication of the disease.

The institutional arrangements for management of water supply and sanitation in Brazil result from the sector's long history. Initially, British capital was involved, but by the early twentieth century most of the infrastructure was in public hands. Public health engineering was originally closely allied with public health, but gradually municipal engineering diverged from the health sector and the municipalities began building their own water and sewerage systems. Many municipalities have retained control. The figures show significant progress in the past two decades, increasing WSS coverage. However, more than half the rural population still lack improved sanitation facilities, a large proportion of systems require improvements, and the global figures also conceal substantial geographical and socioeconomic disparities. Brazil is seeing a new phenomenon; private capital buys shares in publicly owned water and sewerage companies and forms joint enterprises with them to seek concessions. It blurs the distinction between public and private, and could blur the vision of the inexperienced and under-resourced regulatory bodies. The federal government recently approved a new national plan for water and sanitation. The last one determined the course of the sector for more than 20 years. Time will tell whether this one is as influential.

Progress in rural access to sanitation is far behind agreed targets, especially in Sub-Saharan Africa. As a result, new policies are being defined which shift the role of public investment from infrastructure to sanitation promotion, and give the responsibility of service delivery to local government. This paper analyses the role that local governments can have in sanitation promotion in this new framework. The implementation of the National Sanitation Campaign in Tanzania is analysed using the problem driven governance and political economy analysis methodology. Results show that direct implementation enhances local governments' commitment, but that not all functions carried out are suited to their capacities, motivations and constraints. The challenges identified emerge as a combination of technical weaknesses in the implementation of the adopted methodologies, the political economy of local governments, and the economic and social particularities of rural areas, which are similar to other countries across the region. Recommendations for a more effective service delivery model are made, balancing the role of local government between direct execution, coordination and supportive supervision. The fact of having a government programme with some direct implementation can bring about important differences in the national ownership of, and interest in rural sanitation, which are greatly needed.

Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place—one in Zimbabwe implemented by an NGO and the other in Rwanda as part of a Randomized Control Trial. Both interventions achieved high levels of community response, although the Zimbabwe project was more cost-effective, achieving blanket coverage of all households in the area with over 90% compliance in 12 recommended practices at a cost of US$4.5 per beneficiary in 8 months. In Rwanda, the spread of the intervention reached only 58% of the households in the first year costing US$13.13 per beneficiary. By the end of three years, the spread had increased to 80% with over 80% of the 4056CHC Members adopting 10 new practices without any extra cost to the project. Although the Zimbabwe program showed better Value for Money, being more efficient, long term sustainability to prevent slippage of hygiene behaviour change depends on a strong monitoring system. Scaling up hygiene behaviour change is best achieved systematically by building the capacity of the Environmental Health Department to take responsibility for the supervision of CHCs in every village. Investing in an integrated national program, which can enable Government to coordinate NGO efforts, is a more cost-effective use of scarce resources in the long term.

BACKGROUND: The eastern provinces of the Democratic Republic of the Congo have been identified as endemic areas for cholera transmission, and despite continuous control efforts, they continue to experience regular cholera outbreaks that occasionally spread to the rest of the country. In a region where access to improved water sources is particularly poor, the question of which improvements in water access should be prioritized to address cholera transmission remains unresolved. This study aimed at investigating the temporal association between water supply interruptions and Cholera Treatment Centre (CTC) admissions in a medium-sized town. METHODS AND FINDINGS: Time-series patterns of daily incidence of suspected cholera cases admitted to the Cholera Treatment Centre in Uvira in South Kivu Province between 2009 and 2014 were examined in relation to the daily variations in volume of water supplied by the town water treatment plant. Quasi-poisson regression and distributed lag nonlinear models up to 12 d were used, adjusting for daily precipitation rates, day of the week, and seasonal variations. A total of 5,745 patients over 5 y of age with acute watery diarrhoea symptoms were admitted to the CTC over the study period of 1,946 d. Following a day without tap water supply, the suspected cholera incidence rate increased on average by 155% over the next 12 d, corresponding to a rate ratio of 2.55 (95% CI: 1.54-4.24), compared to the incidence experienced after a day with optimal production (defined as the 95th percentile-4,794 m3). Suspected cholera cases attributable to a suboptimal tap water supply reached 23.2% of total admissions (95% CI 11.4%-33.2%). Although generally reporting less admissions to the CTC, neighbourhoods with a higher consumption of tap water were more affected by water supply interruptions, with a rate ratio of 3.71 (95% CI: 1.91-7.20) and an attributable fraction of cases of 31.4% (95% CI: 17.3%-42.5%). The analysis did not suggest any association between levels of residual chlorine in the water fed to the distribution network and suspected cholera incidence. Laboratory confirmation of cholera was not available for this analysis. CONCLUSIONS: A clear association is observed between reduced availability of tap water and increased incidence of suspected cholera in the entire town of Uvira in Eastern Democratic Republic of the Congo. Even though access to piped water supplies is low in Uvira, improving the reliability of tap water supply may substantially reduce the incidence of suspected cholera, in particular in neighbourhoods having a higher access to tap water. These results argue in favour of water supply investments that focus on the delivery of a reliable and sustainable water supply, and not only on point-of-use water quality improvements, as is often seen during cholera outbreaks.

Formative research findings from the fast-growing Babati town were used to assess the prevalence of sanitation and hygiene practices among individuals and institutions and associated factors. A cross-sectional study involving household surveys, spot-checks, focus group discussions, in-depth interviews, and structured observations of behaviors showed that 90% of households have sanitation facilities, but 68% have safely managed sanitation services. The most common types of household sanitation facilities were pit latrines with slab (42%) followed by flush/pour flush toilets (32%). Therefore, the management of wastewater depends entirely on onsite sanitation systems. The majority of households (70%) do not practice proper hygiene behaviors. Thirteen percent of the households had handwashing stations with soap and water, handwashing practice being more common to women (38%) than men (18%). The reported handwashing practices during the four critical moments (handwashing with soap before eating and feeding, after defecation, after cleaning child's bottom, and after touching any dirt/dust) differed from the actual/observed practices. Households connected to the town's piped water supply were more likely to practice handwashing than those not directly connected. Sanitation and hygiene behaviors of the people in the study area were seen to be influenced by sociodemographic, cultural, and economic factors. The conditions of sanitation and hygiene facilities in public places were unsatisfactory. There is an urgent need to ensure that the sanitation and hygiene services and behaviors along the value chain (from waste production/source to disposal/end point) are improved both at the household level and in public places through improved sanitation services and the promotion of effective hygiene behavior change programs integrated into ongoing government programs and planning.