The authors investigate links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa. A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression. Participants had high levels of hazardous and harmful drinking, while 36% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4-fold higher sexual violence and 8 times higher odds of physical violence. Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence.
Poverty and health
Increasing urbanization will be one of the defining features of the 21st century. This produces particular environmental challenges, but also creates opportunities for urban development that can contribute to broader goals of improving the quality of life for urban residents while achieving greater levels of global sustainability. Focusing on the City Development Strategy (CDS), the report draws on two main sets to determine the effectiveness of using the CDS to integrate environmental issues into city planning processes. Firstly, it draws on an analysis of documentation from 15 cities in Africa, Asia and Latin America that have engaged in the process of developing a City Development Strategy under the auspices of Cities Alliance. Secondly, it incorporates insights from in-depth Learning and Leadership Groups conducted with three additional cities (Metro Manila [Philippines] [specifically Makati City and Quezon City], Kampala [Uganda] and Accra [Ghana]) that have engaged in this process. The report does not present the results of these workshops directly, but rather uses the insights from these to contribute to a broader understanding of the potential for the incorporation of environmental concerns in urban planning and management, the barriers to this, and the opportunities to overcome these. This report is intended primarily to encourage and support urban decision-makers to integrate environmental concerns more centrally in their planning and management activities.
The African continent is currently in the midst of simultaneously unfolding and highly significant demographic, economic, technological, environmental, urban and socio-political transitions. Africa’s economic performance is promising, with booming cities supporting growing middle classes and creating sizable consumer markets. But despite significant overall growth, not all of Africa performs well. The continent continues to suffer under very rapid urban growth accompanied by massive urban poverty and many other social problems. These seem to indicate that the development trajectories followed by African nations since post-independence may not be able to deliver on the aspirations of broad based human development and prosperity for all. This report, therefore, argues for a bold re-imagining of prevailing models in order to steer the ongoing transitions towards greater sustainability based on a thorough review of all available options. That is especially the case since the already daunting urban challenges in Africa are now being exacerbated by the new vulnerabilities and threats associated with climate and environmental change.
Globally, 2.8 billion people rely on household solid fuels. Reducing the resulting adverse health, environmental, and development consequences will involve transitioning through a mix of clean fuels and improved solid fuel stoves (IS) of demonstrable effectiveness. To date, achieving uptake of IS has presented significant challenges. the authors performed a systematic review of factors that enable or limit large-scale uptake of IS in low- and middle-income countries. The authors conducted systematic searches through multidisciplinary databases, specialist websites, and consulting experts. The review drew on qualitative, quantitative, and case studies and used standardized methods for screening, data extraction, critical appraisal, and synthesis. They identified 31 factors influencing uptake from 57 studies conducted in Asia, Africa, and Latin America. All domains matter. Although factors such as offering technologies that meet household needs and save fuel, user training and support, effective financing, and facilitative government action appear to be critical, none guarantee success: All factors can be influential, depending on context. The nature of available evidence did not permit further prioritization. Achieving adoption and sustained use of IS at a large scale requires that all factors, spanning household/community and program/societal levels, be assessed and supported by policy.
In present-day South Africa people are daily confronted with individual or group scenes of violence in places people live in poverty. Despite political promises, the common experience is of a housing shortage, poor education, few jobs and very little prospect of alleviating profound poverty. This article explores the possible and potential links between poverty and violence, in order to gain deeper insight into their intrinsic meaning and the circularity of linkage between the two. In order to do so, it revisits the definitions of poverty and violence, emphasises the extremely important role ‘human needs’ play in both poverty and violence,
examines the phenomenon of the ‘behavioural sink’ which refers to the
negative effect of overcrowding on humans as biological beings and establishes whether theories on male violence offer insight into the problem.
The environment is taking center stage in local, national and global discourse and policies. This increasing focus is occurring in a neo-liberal context defined by unprecedented land grabs, increasing militarization of natural resource use and governance, and privatization/commercialization of the environment facilitated by the neo-liberal market hegemony. Climate change has come to dominate contemporary environmental debates and to shape development policy. African Social Scientists in, usually in collaboration with scholars from other continents, have begun to respond to the climate crisis, focusing particularly on its implications on various facets of development and livelihoods. Given the urgency of environmental challenges facing the continent, the author argues that an African social science perspective to inform appropriate policy responses is urgent. What is needed is an approach that gives new impetus to environmental research in the social sciences and humanities, ensuring better integration into all the disciplines and recognition of the extreme urgency of the need to develop appropriate paradigms on the environment-development linkages.
Architects and urban designers have a responsibility towards the evolution of the infrastructural landscape and identity. By changing the community skyline, they impact on the community’s sense of belonging. The authors propose that globalisation is the creative hand behind an undesirable uniformity in cities around the world and questions whether it is deconstructing the unique identity of African cities and a denial of Africa roots. This is argued to be important for the social context, including equitable access to services and resources by the residents and the impact on their health and well-being since social welfare is strongly entwined with physical well-being. The authors argue for a more thoughtful urban planning as the continuation of the present, haphazard construction puts future generations at risk of inheriting a place that is not only lacking in design but also an embodied cultural identity necessary for social wellbeing.
This report explores the paradox of food insecurity in Malawi, with inpredictable rainfalls and a focus on a maize staple that is vulnerable to uncertain weather patterns. Further between 1998 and 2001, the World Bank and International Monetary Fund recommended that the Malawi government cut spending. The government eliminated a small but effective program of seed and fertilizer distribution, and maize production fell 40 percent by 2002. The World Bank and IMF then persuaded the government to sell off its food reserves. These measures are reported by the author to underlie a famine that prompted the government to resume its food reserves and to re-establish a broad input subsidy program intended to put good seeds and fertilizer into the hands of poor farmers, a programme that international funders refused to support as it was seen as inimical to free market principles. The programme was reported to be a success, and within a few years Malawi had grown enough maize to export some to neighboring countries. The 2002 famine motivated activists to campaign for a Right to Food Bill that enshrines in law every Malawian’s right to “the progressive realization of the right to food,” committing the government to advance such rights. The Right to Food Bill awaits legislative approval. Further government is distributing seeds for beans, pigeon peas, groundnuts, soybeans to diversify diets, offer crops that ripen at different times of the year, and replenish the soil with nitrogen and organic matter. Farmers have rejecting the high-tech agriculture heavily promoted by international funders and are rebuilding the fertility of depleted soils by intercropping nutritious legumes while growing a vitamin-rich, resilient variety of maize. The author suggests that maybe this is what the progressive realization of the right to food will look like in Malawi.
Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Household and health system costs per malaria episode ranged from approximately US$ 5 for non-complicated malaria in Tanzania to US$ 288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0–1 and 1–4 years were US$ 11.8 and US$ 13.8 in Ghana, US$ 6.9 and US$ 8.1 in Tanzania, and US$ 7.6 and US$ 8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$ 1.29 for children aged 2–11 months in Tanzania to a maximum of US$ 22.9 for children aged 0–24 months in Kenya. The total annual costs (in millions) were estimated at US$ 37.8, US$ 131.9 and US$ 109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$ 11.99, US$ 6.79 and US$ 20.54, respectively. This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions.
The author examines associations between ambient air pollutants and respiratory outcomes among schoolchildren in Durban, South Africa, in a cross sectional survey of primary schools from within each of seven communities in two regions of Durban (the highly industrialised south compared with the non-industrial north) and measurement of particulate matter (PM), sulphur dioxide (SO2) and carbon monoxide at each school, and nitrogen oxides (NOx) at other sites. Children had a prevalence of asthma symptoms of any severity of 32%, higher in schools with higher SO2 levels. Schoolchildren from industrially exposed communities experienced higher covariate-adjusted prevalences of persistent asthma than children from communities distant from industrial sources. The authors indicate that the findings are strongly suggestive of industrial pollution-related adverse respiratory health effects among these children.