Cardiovascular disease is a rising health burden among the world’s poor with hypertension as the main risk factor. In sub-Saharan Africa, hypertension is increasingly affecting the urban population of which a substantial part lives in slums. This study aims to give insight into the profile of patients with hypertension living in slums of Nairobi, Kenya. Socio-demographic and anthropometric data as well as clinical measurements including BP from 440 adults with hypertension aged 35 years and above living in Korogocho, a slum on the eastern side of Nairobi, Kenya, was be collected at baseline and at the first clinic visit. The study population showed high prevalence of overweight and abdominal obesity as well as behavioural risk factors such as smoking, alcohol and a low vegetable and fruit intake. Furthermore, the majority of hypertensive patients do not take anti-hypertensive medication and the ones who do show little adherence.
Poverty and health
According to the latest estimates from the World Health Organization/United Nations Children’s Fund Joint Monitoring Programme for water and sanitation (JMP), 2.5 billion people worldwide do not have access to any type of improved sanitation. Current definitions do not account for the diversity of shared sanitation: all shared toilet facilities are by default classified as unimproved by JMP because of the tendency for shared toilets to be poorly managed and unhygienic. However, the authors argue that shared sanitation should not be automatically assumed to be unimproved. They also argue that it is necessary to have a new look at how we define shared sanitation and to use specific subcategories including household shared (sharing between a limited number of households who know each other), public toilets (intended for a transient population, but most often the main sanitation facility for poor neighbourhoods) and institutional toilets (workplaces, markets etc.). This sub-classification will, it is argued, identify those depending on household shared sanitation, which the authors consider to be only a small step away from achieving access to private and improved sanitation. This subcategory of shared sanitation is, therefore, worth discussing in greater detail. The authors argue that the focus for future sanitation programmes should be on improving the hygienic standards of shared facilities to a level that satisfies and protects sanitation users.
In Ghana, unplanned and spontaneous urbanization has trapped many in slum dwellings with its attendant poverty, insecurity, and poor housing and general environmental conditions. Slum dwellers’ choices of livelihood activities are restricted under various socio-economic and planning constraints. Using mixed methods, this paper explored the conditions under which slum dwellers can maximize the prospects of their environment and minimize the challenges therein. The findings indicate that slum dwellers have a diversity of livelihood assets and potentials, yet limited access to planned adaptation remains a main challenge. Many dwellers result to autonomous supplementary occupations to cope with the challenges of urbanization. The authors argue for a redefinition of the mandate of urban planning, as a response to spontaneous urbanization, and for tools for sustainable livelihood at the local level.
Recent evidence of the negative impact of household air pollution on health suggests that it is time to upgrade national surveys to inform decision-making on improved fuels and cookstoves. More than 40% of the world’s population rely on solid fuels such as wood, crop residues or dung for their cooking and heating needs. Household air pollution, caused by cooking indoors with solid fuels, is the third leading risk factor for morbidity and mortality globally. In 2010, 3.5 million deaths and 4.3% of global disability adjusted life years were attributable to household air pollution. Pollutants from inefficient combustion of solid fuels, especially black carbon particles, also contribute to global climate change. This study discusses the implications of cooking apparatus, fuel collection practices, air pollution exposure and fuels for other purposes. The morbidity and mortality linked to cooking with solid fuels are significant, with particular implications for women and children. The impetus for assessing new indicators is motivated by a need to more fully understand how the household energy sector is changing in low- and middle-income countries. The information gained from improved indicators has the potential to better inform the targeting of resources and design of strategies for reducing household air pollution.
A new report by the World Bank- Rising through Cities in Ghana-analyses the rapid transformation of a country whose urban population has grown from 4 million in 1984 to more than 14 million today. 51% of Ghanaians now live in cities. Over the same period annual GDP growth has averaged 5.7%, the number of industrial and service jobs has increased by 21% and the capital city, Accra, has registered a 20% reduction in poverty. In August 2014, a fiscal debt crisis forced the government to request financial assistance from the International Monetary Fund. In May 2015, Accra residents peacefully protested the failure to resolve a three-year long electric power crisis that has sapped businesses and hindered economic growth. The World Bank has presented a report with data on urban development in Ghana and this paper provides a critical analysis of the report and a link to the original publication.
When parents migrate, leaving their children in the origin country, transnational families are formed. Transnational family studies on children who are “left behind” indicate that children suffer psychologically from parental migration. Many of the factors identified as affecting children's responses to parental migration however are not considered in child psychology and family sociology studies. This study aimed to bridge these areas of knowledge by quantitatively investigating the association between transnational families and children's psychological well-being. It analyzed a survey conducted in three African countries in 2010–11 (Ghana N = 2760; Angola N = 2243; Nigeria N = 2168) amongst pupils of secondary schools. The study compared children in transnational families to those living with their parents in their country of origin. Children's psychological well-being was measured through the Strengths and Difficulties Questionnaire. Multiple regression analyses reveal that children in transnational families fare worse than their counterparts living with both parents but not in Ghana where living conditions mediate this relationship. Specific characteristics of transnational families and country contexts mattered: (1) changing caregivers is associated with poorer well-being in all countries; (2) which parent migrates does not make a difference in Ghana, when mothers migrate and fathers are caregivers results in poorer well-being in Nigeria, and both mother's and father's migration result in worse outcomes in Angola; (3) the kin relationship of the caregiver is not associated with poorer well-being in Ghana and Nigeria but is in Angola; (4) children with parents who migrate internationally do not show different results than children whose parents migrate nationally in Ghana and Nigeria but in Angola international parental migration is associated with poorer psychological well-being. The study showed that broader characteristics in the population rather than parental migration per se are associated with decreased levels of well-being.
This study determined knowledge, perceptions and practices as regards to malaria, climate change, livelihoods and food insecurity in a rural farming community in central Tanzania. Using a cross-sectional design, heads of households were interviewed on their knowledge and perceptions on malaria transmission, symptoms and prevention and knowledge and practices as regards to climate change and food security. A total of 399 individuals (mean age = 39.8 ± 15.5 years) were interviewed. Nearly all (94.7%) knew that malaria is acquired through a mosquito bite. Three quarters (73%) reported that most people get sick from malaria during the rainy season. About 50% of the respondents felt that malaria had decreased during the last 10 years. The household coverage of insecticide treated mosquito nets was high (95.5%). Ninety-six percent reported to have slept under a mosquito net the previous night. Only one in four understood the official Kiswahili term (Mabadiliko ya Tabia Nchi) for climate change. However, there was a general understanding that the rain patterns have changed in the past 10 years. Sixty-two percent believed that the temperature has increased during the same period. Three quarters of the respondents reported that they had no sufficient production from their own farms to guarantee food security in their household for the year. Three quarters (73.0%) reported to having food shortages in the past five years. About half said they most often experienced severe food shortage during the rainy season. The authors concluded that farming communities in Kilosa District have little knowledge on climate change and its impact on malaria burden, but that food insecurity. They recommend integrating control of malaria and food insecurity interventions.
Good house construction may reduce the risk of malaria by limiting the entry of mosquito vectors. The authors assessed how house design may affect mosquito house entry and malaria risk in Uganda. 100 households were enrolled in each of three sub-counties: Walukuba, Jinja district; Kihihi, Kanungu district; and Nagongera, Tororo district. CDC light trap collections of mosquitoes were done monthly in all homes. All children aged six months to ten years (n = 878) were followed prospectively for a total of 24 months to measure parasite prevalence every three months and malaria incidence. Homes were classified as modern (cement, wood or metal walls; and tiled or metal roof; and closed eaves) or traditional (all other homes). The human biting rate was lower in modern homes than in traditional homes. The odds of malaria infection were lower in modern homes across all the sub-counties, while malaria incidence was lower in modern homes in Kihihi but not in Walukuba or Nagongera. The authors concluded that house design is likely to explain some of the heterogeneity of malaria transmission in Uganda and represents a promising target for future interventions, even in highly endemic areas.
Zimbabwe has had a notable record of innovation and use of appropriate technologies in primary health care (PHC), particularly in environmental health. These technologies are generally defined as small-scale, decentralized, people centred, labour-intensive, energy-efficient, environmentally sound, and locally controlled. This pilot assessment aimed to explore and map specific appropriate technology innovations being developed and used at community level for health in rural and urban districts of Zimbabwe. The assessment looked at the technologies, their materials, purpose and use and related issues around their development and use, with the evidence gathered by community based researchers within three main themes (i) food safety and nutrition, (ii) water, sanitation, waste management and housing and (iii) prevention and control of diseases. The results are presented in tables, with pictures of the technologies. While noting the limited size of the sample, the results suggest the wealth of innovations and appropriate technologies that exist, and the possibilities that may be found from a more systematic and wider assessment.
Millions of South Africans still lack access to basic sanitation, including at least 500 000 in Cape Town. The report found that 26 percent of the toilets in Khayelitsha’s informal settlements do not work, with 15 percent of them blocked, 12 percent without water, and 6 percent without a sewage pipe. The report’s key findings also showed a lack of proper worker safeguards: janitors do not have proper training, protective gear, or the required cleaning equipment, and only one in eight cleaners is inoculated against disease. By attempting to verify public service delivery and facilitating transparency and accountability, the community-led social audit approach has been successful in exposing—and, over time, reducing—corruption and enhancing basic services in India and Ghana, and elsewhere in the global South. In South Africa, the community used a social audit to investigate how ZAR 60 million (about US$5 million) of public resources was utilized. The audit included the residents of Khayelitsha and various partners in inspecting 528 toilets and interviewing 193 Khayelitsha residents and 31 janitors. The report calls for specific and workable government actions to rectify gaps in services that are provided by the private sector via the local municipality.