Peri-urban Population Research Articles

Determinants of hypertension in a young adult Ugandan population in epidemiological transition-the MEPI-CVD survey.

BackgroundHigh blood pressure is the principal risk factor for stroke, heart failure and kidney failure in the young population in Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality in younger populations compared with the elderly; however, blood pressure control efforts in the young are hampered by scarcity of data on prevalence and factors influencing awareness, treatment and control of hypertension. We aimed to describe the prevalence of prehypertension and hypertension among young adults in a peri-urban district of Uganda and the factors associated with occurrence of hypertension in this population.MethodsThis cross-sectional study was conducted between August, 2012 and May 2013 in Wakiso district, a suburban district that that encircles Kampala, Uganda’s capital city. We collected data on socio-demographic characteristics and hypertension status using a modified STEPs questionnaire from 3685 subjects aged 18–40 years selected by multistage cluster sampling. Blood pressure and anthropometric measurements were performed using standardized protocols. Fasting blood sugar and HIV status were determined using a venous blood sample. Association between hypertension status and various biosocial factors was assessed using logistic regression.ResultsThe overall prevalence of hypertension was 15 % (95 % CI 14.2 – 19.6) and 40 % were pre-hypertensive. Among the 553 hypertensive participants, 76 (13.7 %) were aware of their diagnosis and all these participants had initiated therapy with target blood pressure control attained in 20 % of treated subjects. Hypertension was significantly associated with the older age-group, male sex and obesity. There was a significantly lower prevalence of hypertension among participants with HIV OR 0.6 (95 % CI 0.4–0.8, P = 0.007).ConclusionThere is a high prevalence of high blood pressure in this young periurban population of Uganda with sub-optimal diagnosis and control. There is previously undocumented high rate of treatment, a unique finding that may be exploited to drive efforts to control hypertension. Specific programs for early diagnosis and treatment of hypertension among the young should be developed to improve control of hypertension. The relationship between HIV infection and blood pressure requires further clarification by longitudinal studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2146-y) contains supplementary material, which is available to authorized users.

Maternal Determinants of Birth Weight in Northern Ghana.

ObjectivesWeight at birth is usually considered as an indicator of the health status of a given society. As a result this study was designed to investigate the association between birth weight and maternal factors such as gestational weight gain, pre—pregnancy BMI and socio—economic status in Northern Ghana.MethodsThe study was a facility-based cross-sectional survey conducted in two districts in the Northern region of Ghana. These districts were purposively sampled to represent a mix of urban, peri—urban and rural population. The current study included 419 mother-infant pairs who delivered at term (37–42 weeks). Mother’s height, pre-pregnancy weight and weight changes were generated from the antenatal records. Questionnaires were administered to establish socio-economic and demographic information of respondents. Maternal factors associated with birth weight were examined using multiple and univariate regressions.ResultsThe mothers were generally well nourished before conception (Underweight 3.82%, Normal 57.76%, Overweight 25.06% and Obesity 13.37%) but approximately half of them could not gain adequate weight according to Institute of Medicine recommendations (Low weight gain 49.64%, Adequate weight gain 42.96% and Excessive weight gain 7.40%). Infants whose mothers had excess weight gain were 431g (95% CI 18–444) heavier compared to those whose mothers gained normal weight, while those whose mothers gained less were 479g (95% CI -682– (-276) lighter. Infants of mothers who were overweight and obese before conception were 246g (95% CI 87–405) and 595g (95% CI 375–815) respectively heavier than those of normal mothers, whereas those whose mothers were underweight were 305g (95% CI -565 –(-44) lighter. The mean birth weight observed was 2.98 ± 0.68 kg.ConclusionOur findings show that pre-pregnancy body mass index and weight gain during pregnancy influence birth weight. Therefore, emphasis should be placed on counseling and assisting pregnant women to stay within the recommended weight gain ranges.

Identification of human intestinal parasites affecting an asymptomatic peri-urban Argentinian population using multi-parallel quantitative real-time polymerase chain reaction.

BackgroundIn resource-limited countries, stool microscopy is the diagnostic test of choice for intestinal parasites (soil-transmitted helminths and/or intestinal protozoa). However, sensitivity and specificity is low. Improved diagnosis of intestinal parasites is especially important for accurate measurements of prevalence and intensity of infections in endemic areas.MethodsThe study was carried out in Orán, Argentina. A total of 99 stool samples from a local surveillance campaign were analyzed by concentration microscopy and McMaster egg counting technique compared to the analysis by multi-parallel quantitative real-time polymerase chain reaction (qPCR). This study compared the performance of qPCR assay and stool microscopy for 8 common intestinal parasites that infect humans including the helminths Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and the protozoa Giardia lamblia, Cryptosporidium parvum/hominis, and Entamoeba histolytica, and investigated the prevalence of polyparasitism in an endemic area.ResultsqPCR showed higher detection rates for all parasites as compared to stool microscopy except T. trichiura. Species-specific primers and probes were able to distinguish between A. duodenale (19.1 %) and N. americanus (36.4 %) infections. There were 48.6 % of subjects co-infected with both hookworms, and a significant increase in hookworm DNA for A. duodenale versus N. americanus (119.6 fg/μL: 0.63 fg/μL, P < 0.001) respectively. qPCR outperformed microscopy by the largest margin in G. lamblia infections (63.6 % versus 8.1 %, P < 0.05). Polyparasitism was detected more often by qPCR compared to microscopy (64.7 % versus 24.2 %, P < 0.05).ConclusionsMulti-parallel qPCR is a quantitative molecular diagnostic method for common intestinal parasites in an endemic area that has improved diagnostic accuracy compared to stool microscopy. This first time use of multi-parallel qPCR in Argentina has demonstrated the high prevalence of intestinal parasites in a peri-urban area. These results will contribute to more accurate epidemiological survey, refined treatment strategies on a public scale, and better health outcomes in endemic settings.

Traditional medicine for the rich and knowledgeable: challenging assumptions about treatment-seeking behaviour in rural and peri-urban Nepal.

Traditional medicine is commonly assumed to be a crucial health care option for poor households in developing countries. However, little research has been done in Asia to quantify the reliance on traditional medicine and its determinants. This research contributes to filling in this knowledge gap using household survey data collected from 571 households in three rural and peri-urban sites in Nepal in 2012. Questions encompassed household socioeconomic characteristics, illness characteristics, and treatment-seeking behaviour. Treatment choice was investigated through bivariate analyses. Results show that traditional medicine, and especially self-treatment with medicinal plants, prevail as treatment options in both rural and peri-urban populations. Contrarily to what is commonly assumed, high income is an important determinant of use of traditional medicine. Likewise, knowledge of medicinal plants, age, education, gender and illness chronicity were also significant determinants. The importance of self-treatment with medicinal plants should inform the development of health policy tailored to people’s treatment-seeking behaviour.

Distinct gender differences in anthropometric profiles of a peri-urban South African HIV population: a cross sectional study.

BackgroundHighly active antiretroviral therapy (HAART) has extended life expectancy and enhanced the well-being of HIV-positive individuals. Since there are concerns regarding HAART-mediated onset of cardio-metabolic diseases in the long-term, we evaluated the anthropometric profile of black HIV-infected individuals in a peri-urban setting (Western Cape, South Africa).MethodsA cross sectional study design was followed to describe the gender differences in different HAART treatment groups. HIV-positive patients (n = 44 males, n = 102 females; 20–40 years) were recruited for three groups: 1) control (HIV-positive, HAART-naïve), 2) HIV-positive (<3 years HAART), and 3) HIV-positive (>3 years HAART).ResultsAll participants underwent comprehensive anthropometric and bio-electrical impedance analyses. No significant differences were observed in the male treatment groups. HAART-naïve females are mostly overweight (73.90 ± 2.79). This is followed by a period of muscle wasting seen in the triceps skinfold (29.30 ± 2.19 vs 20.63 ± 1.83; p < 0.01), muscle mass (22.23 ± 0.46 vs 19.82 ± 0.54; p < 0.01), and fat free mass (49.40 ± 1.08 vs 44.16 ± 1.21; p < 0.01) upon HAART initiation (<3 years HAART). Thereafter all parameters measured had levels similar to that seen for the female HAART-naïve group. Females on <3 years HAART exhibited significantly decreased body cell mass (p < 0.01), protein mass (p < 0.01), muscle mass (p < 0.01), fat free mass (p < 0.01), and fat mass (p < 0.001) versus matched HAART-naïve controls. The W:H ratio for the female treatment groups placed the females overall at a higher risk for developing cardiovascular disease compared to the males.ConclusionsThis study found striking gender-based anthropometric differences in black South African HIV-positive individuals on HAART. We also conclude from this observational study that no significant differences were found in the different male treatment groups. All female body composition parameters initially showed lower values (<3 years HAART). The female treatment group (>3 years HAART) displayed values similar to that seen in the HAART-naïve group. Higher W:H ratios in females receiving longer-term HAART potentially increases their risk for the future onset of cardio-metabolic complications.

Adult Oral Health Literacy Among Urban And Peri-Urban Population In And Around Chennai, India - A Comparative Study

ABSTRACT Aim Poor oral health literacy can impede one's ability to seek oral health and make appropriate oral health care decisions. The study was conducted with an aim to assess and compare the oral health literacy among urban and peri-urban adult population in Chennai, India. Materials and Methods A cross sectional study was conducted among 100 subjects each selected from peri-urban and urban areas in Chennai city. The oral health literacy was assessed by administering the Rapid Estimate of Adult Literacy in Dentistry (REALD-30). The data obtained was analyzed using Mann Whitney U test. Results The mean oral health literacy score for peri-urban people was 2.7 ± 1.19 and for urban people was 6.35 ± 2.12 and this difference was statistically significant (z value -10.37, p value - 0.001). Conclusion The oral health literacy of peri-urban adult population was found to be low when compared to the urban population.

Household out-of-pocket medical and dental expenses among residents of Modinagar city: A crossectional questionnaire study

Introduction: Out-of-pocket (OOP) payments are the principal source of health care finance in most Asian countries, and India is no exception. Availability and accessibility of the health care are important for the overall health status of any community. Aim: To assess the proportion of monthly family income spent on medical and dental expenses. Materials and Methods: A door to door survey was conducted in Govinpuri ward of Modinagar using dual stage random sampling. A 14-item open-ended questionnaire was used, which was filled by the investigator by interviewing the head of the family. Data were entered into Microsoft excel and analyzed using SPSS version 19 (SPSS Inc., Chicago, IL, USA). Results: A total of 101 families were included in the study. The major amount of the monthly family income was spent on medical treatment as compared to dental treatment. The average OOP expenditure on the dental and medical treatment was 2135.94 ± 656.8 international normalized ratio (INR) and 8771.28 ± 1056.43 INR ( P = 0.038), respectively. Medical insurance formed a substantial proportion of the monthly family expenditure as compared to dental insurance ( P = 0.023). The total medical expenses were 13.21%, and dental expenses were 8.84% of family income. Conclusion: The present study revealed that the family expenditure on medical and dental treatments differs significantly among the peri-urban population of Modinagar. The average three-month expenditure on the dental treatment was found to be rather depressing when compared to that on medical discourse. There was also a pronounced difference in the dental and medical insurance utilization among the study population.

A Closed Drum Carboniser for Converting Ligno-Cellulosic Residues to Biochar Pellets: A Nigerian Study

This paper describes an innovative technology that provides an alternative to management of wastes arising from grass cuttings, weeds and agro-forestry residues that are usually discarded unattended. These wastes are now converted into biochar pellets using a newly designed carboniser which is highly economical and can generate employment opportunities to peri-urban and rural low income populations. We used simple spent oil drum with an attached chimney and cassava based starch or clay (e.g. kaolin) as binder to make pellets from the burnt raw materials. This process does not require any moving parts, electricity or any additional fuel to convert the waste into charcoal pellets. We have field tested the carboniser with elephant grass (Pennistum purpureum) as feedstock. Technical performance was evaluated using parameters such as Production Capacity Ratio (PCR), Reliability Ratio (RR) and Efficiency Ratio (ER). Samples of elephant grass, biochar pellets and the ash produced after the biochar used for cooking were analysed for selected chemical characteristics (viz. sulphur, carbon, hydrogen, potassium and calorific value), using standard laboratory procedures. The results obtained gave production capacity and efficiency ratio of 83%; actual production capacity of 25 kg/hour; which is 100% reliable. The differences in the chemical parameters for the three samples were significant. Potassium, carbon and calorific values were observed in increasing order: ash < elephant grass < biochar. Biochar gave lowest values of hydrogen (12.36±0.01%) and sulphur (0.67±0.0%) contents while elephant grass contained highest values of these elements (13.28±.02% and 1.38±0.00%, respectively). This technology will benefit less educated rural and peri-urban populations to develop a small scale or medium scale entrepreneurship with low financial inputs and minimal skills and the product is a good cooking fuel and environment friendly with less or no smoke.

Quality of diagnostic and treatment practices of pulmonary tuberculosis management amongst health practitioners in Haryana, north India

Early diagnosis and supervised treatment remains the mainstay for tuberculosis (TB) control in India. A facility-based cross-sectional study was conducted to assess diagnostic and treatment practices of tuberculosis management as per the Revised National Tuberculosis Control Programme at a secondary level health facility in north India. This hospital mostly caters to rural and peri-urban populations in the Ballabgarh block of Faridabad district, Haryana. A sample size of 244 was calculated. Consecutive chest symptomatic patients were recruited in the study. Information about socio-demographic characteristics and treatment was obtained from a routine history-taking process in the outpatient clinic. Results were expressed as mean, standard deviation (SD) and odds ratio (OR) with 95% confidence interval (CI). A total of 250 pulmonary TB suspects were recruited, out of which 55.4% were males and mean age of study participants was 35.4 years (SD 14.6). Almost half (47.1%) of the participants had sought treatment from government hospitals, followed by 46.7% from private hospitals. Those who had visited a private facility were significantly more likely not to receive sputum acid-fast bacillus (AFB) diagnostic testing (OR=7.26, 95% CI 4.04-13.08), likely to be taking a second-line anti-TB drug as an antibiotic trial (OR=3.65, 95% CI 1.17-11.30), be empirically taking anti-TB drugs (OR=5.28, 95% CI 1.50-118.64) and getting a serological test done (OR=9.58, 95% CI 1.20-76.0) than those who went to a government health facility. Those who made at least three visits to a private facility were significantly more likely to have taken a second-line anti-TB drug as an antibiotic trial (OR=3.56, 95% CI 1.36- 9.28) and be empirically taking anti-TB drugs (OR=5.75, 95% CI 2.18-15.20) than those that made fewer than three visits. This study documented inappropriate diagnostic and treatment practices in TB management and highlights the need to generate awareness about it among health practitioners in north India.

Exposure to WASH-borne hazards: A scoping study on peri-urban Ger areas in Ulaanbaatar, Mongolia

The present scoping study seeks to address the sources of water, sanitation, and hygiene (WASH) exposure of residents of peri-urban Ger areas of Ulaanbaatar, Mongolia. Field observations and semi-structured key informant interviews were carried out during 2012 and 2013 to assess the existing WASH situation in the peri-urban Ger areas of Ulaanbaatar, Mongolia. In addition, a knowledge, attitude, and practice (KAP) survey was conducted by Action Contre la Faim (ACF) Mongolia in 210 households to identify the sources of WASH-borne hazards in a statistically representative way. Moreover, the quality of drinking water was analyzed both at the household (n = 210) and water point (kiosk) (n = 40) levels to assess the risk of chemical and pathogenic contaminants. Both field observations and interviews revealed that the sanitary environment of the Ger residents is characterized by the lack of a drainage system, unimproved sanitation technology (e.g. unhygienic pit latrines and soak pits), unsafe water supply, and insufficient collection, transportation, and storage mechanisms. Poor infrastructure is associated with low standards of living. The transmission of WASH-borne disease (e.g. diarrhea, dysentery, hepatitis A) is the gravest consequence and source of hazards. The results from the water quality analysis demonstrate that Ger residents are more exposed to biological contamination of stored drinking water by Escherichia coli during the summer (May to August) than in the winter (November to February). During the winter, 36% of household storage containers were contaminated by E. coli at an average level of 12.5 E. coli per 100 ml, while, during the summer, 56% of household storage containers were contaminated at an average level of 50 E. coli per 100 ml. KAP surveys further reveal that the common practice of Ger residents to discharge greywater (with higher chemical oxygen demand) into pit latrines, soak-pits, yards, and streets likely causes environmental pollution and health hazards. Multifaceted WASH-borne exposure was addressed by the scoping study such that various WASH interventions could be planned for the study area and beyond. To tackle the above challenges and problems, a range of appropriate interventions and programs are recommended to reduce the exposure of WASH-borne hazards in the study area and other parts of the world – in both urban and peri-urban settings. The recommendations include: the development and implementation of a water safety plan (WSP), an effective monitoring system for collection, transportation and storage at both water kiosk and household levels, user training for correct use of water containers, effective coordination among stakeholders (including urban planners), development of a household greywater disposal system, and implementation of a functioning solid waste management system. Prior to taking these actions, a detailed study on the ‘pollution load from peri-urban to urban’ should be carried out to assess the WASH-borne vulnerability of both peri-urban and central urban population.

Rheumatic fever and rheumatic heart disease in Gauteng on the decline: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

The incidence of rheumatic fever (RF) and its complications has waned over the past three to four decades throughout the Western world, but RF remains a problem in developing countries and in the indigenous populations of some well-resourced countries. A marked decline in children presenting with acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) has been observed over the past two decades at Chris Hani Baragwanath Academic Hospital (CHBAH) in southern Gauteng Province, South Africa, which mainly serves the periurban population of Soweto. To analyse the observed decline in ARF and RHD, and consider the reasons for the decrease. Review of children with ARF and RHD captured on a computerised database of all children seen in the Paediatric Cardiology Unit at CHBAH during 1993 - 2010. The records of 467 children with ARF and RHD were retrieved from the database. The majority provided addresses in Gauteng, Soweto and North West Province. The number of children documented to have ARF or RHD declined from 64 in 1993 to 3 in 2010. One-third of the patients underwent surgery, the majority mitral valve repair. Most of the patients requiring surgery had addresses in parts of Gauteng other than Soweto and other provinces, with relatively few originating from Soweto. The decline in the number of children with ARF and RHD presenting to CHBAH may be attributed to an improvement in socioeconomic conditions and better access to medical care for the referral population over the past two decades.

Concentraciones diagnósticas de tres insecticidas de uso en salud pública en una cepa experimental de Lutzomyia longipalpis (Diptera: Psychodidae) en Colombia

In Colombia, periurban populations of Lutzomyia longipalpis , vector of the causative agent of visceral leishmaniasis in the upper and middle valley of the Magdalena River, may be exposed to insecticide applications with different purposes. Thus, it is important to begin a susceptibility surveillance of this species to insecticides.To determine indicators of susceptibility to three insecticides habitually used in public health, such as malathion, deltamethrin and lambda-cyhalothrin in an experimental strain of L. longipalpis .We used the method proposed by the Centers for Disease Control and Prevention. Groups of 10 to 15 unfed females were exposed to different concentrations of the insecticides using 250 ml glass bottles as test chambers. Mortality was registered every five minutes for an hour. Diagnostic concentrations and lethal times for each insecticide were calculated.In the evaluated L. longipalpis strain, the diagnostic concentrations and times were 75 µg/ml and 25 minutes for malathion, 10 µg/ml and 35 minutes for deltamethrin, and 15 µg/ml during 30 minutes for lambda-cyhalothrin.Baseline data over mortality response to three insecticides were established in a susceptibility strain of L. longipalpis vector. These indicators will allow establishing comparisons with populations of L. longipalpis exposed regularly or sporadically to chemical control measures to detect changes in their resistance to these insecticides.

A cross-sectional study of household biomass fuel use among a periurban population in Malawi.

The Global Burden of Disease Study suggests almost 3.5 million people die as a consequence of household air pollution every year. Respiratory diseases including chronic obstructive pulmonary disease and pneumonia in children are strongly associated with exposure to household air pollution. Smoke from burning biomass fuels for cooking, heating, and lighting is the main contributor to high household air pollution levels in low-income countries like Malawi. A greater understanding of biomass fuel use in Malawi should enable us to address household air pollution-associated communicable and noncommunicable diseases more effectively. To conduct a cross-sectional analysis of biomass fuel use and population demographics among adults in Blantyre, Malawi. We used global positioning system-enabled personal digital assistants to collect data on location, age, sex, marital status, education, occupation, and fuel use. We describe these data and explore associations between demographics and reported fuel type. A total of 16,079 adults participated (nine households refused); median age was 30 years, there was a similar distribution of men and women, 60% were married, and 62% received secondary school education. The most commonly reported occupation for men and women was "salaried employment" (40.7%) and "petty trader and marketing" (23.5%), respectively. Charcoal (81.5% of households), wood (36.5%), and electricity (29.1%) were the main fuels used at home. Only 3.9% of households used electricity exclusively. Lower educational and occupational attainment was associated with greater use of wood. This large cross-sectional study has identified extensive use of biomass fuels in a typical sub-Saharan Africa periurban population in which women and people of lower socioeconomic status are disproportionately affected. Biomass fuel use is likely to be a major driver of existing communicable respiratory disease and the emerging noncommunicable disease (especially respiratory and cardiovascular) epidemic in this region. Our data will help inform the rationale for specific intervention studies and the development of appropriately targeted public health strategies to tackle this important and poverty-related global health problem.

Managing municipal wastes for energy generation in Nigeria

Abstract More than being source of pollution, health and related hazards, municipal waste can be source of energy, useful raw materials and other resources, if properly managed. As the urban and peri-urban populations in Nigeria increase, there is a need to look into ways of sustainably managing the bound to be increasing wastes. This paper explores the options for managing municipal wastes and advances the discussion towards the derivation of energy and enhancing material recovery in Nigeria. The data for this review work were sourced from previously published works and other secondary sources. In concluding this review, a conceptual framework and policy propositions for changing the municipal waste management paradigm in Nigeria are presented.

Physical activity level and its sociodemographic correlates in a peri-urban Nepalese population: a cross-sectional study from the Jhaukhel-Duwakot health demographic surveillance site.

BackgroundPhysical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban localities have always shown higher prevalence. Therefore, this study aimed to measure physical activity in three domains—work, travel and leisure—in a peri-urban community and assess its variations across different sociodemographic correlates.MethodsAdult participants (n = 640) from six randomly selected wards of the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) near Kathmandu responded to the Global Physical Activity Questionnaire. To determine total physical activity, we calculated the metabolic equivalent of task in minutes/week for each domain and combined the results. Respondents were categorized into high, moderate or low physical activity. We also calculated the odds ratio for low physical activity in various sociodemographic variables and self-reported cardiometabolic states.ResultsThe urbanizing JD-HDSS community showed a high prevalence of low physical activity (43.3%; 95% CI 39.4–47.1). Work-related activity contributed most to total physical activity. Furthermore, women and housewives and older, more educated and self-or government-employed respondents showed a greater prevalence of physical inactivity. Respondents with hypertension, diabetes or overweight/obesity reported less physical activity than individuals without those conditions. Only 5% of respondents identified physical inactivity as a cardiovascular risk factor.ConclusionsOur findings reveal a high burden of physical inactivity in a peri-urban community of Nepal. Improving the level of physical activity involves sensitizing people to its importance through appropriate multi-sector strategies that provide encouragement across all sociodemographic groups.

Genotypes of pathogenic Leptospira spp isolated from rodents in Argentina

Leptospirosis is the most widespread zoonosis in the world and significant efforts have been made to determine and classify pathogenic Leptospira strains. This zoonosis is maintained in nature through chronic renal infections of carrier animals, with rodents and other small mammals serving as the most important reservoirs. Additionally, domestic animals, such as livestock and dogs, are significant sources of human infection. In this study, a multiple-locus variable-number tandem repeat analysis (MLVA) was applied to genotype 22 pathogenic Leptospira strains isolated from urban and periurban rodent populations from different regions of Argentina. Three MLVA profiles were identified in strains belonging to the species Leptospira interrogans (serovars Icterohaemorrhagiae and Canicola); one profile was observed in serovar Icterohaemorrhagiae and two MLVA profiles were observed in isolates of serovars Canicola and Portlandvere. All strains belonging to Leptospira borgpetersenii serovar Castellonis exhibited the same MLVA profile. Four different genotypes were isolated from urban populations of rodents, including both mice and rats and two different genotypes were isolated from periurban populations.

Health as a sustainability indicator within water resources management in rural and peri-urban areas of central northern Namibia

In this paper, a modelling approach is presented which is able to analyze a water-supply regime in order to comprehend health-related aspects in water resources management. The area of investigation is the Cuvelai-Etosha Basin in central northern Namibia. Major health hazards for the rural and peri-urban population stem from the usage of unsafe water sources. In the systems analysis, the variable Health turned out to be one of the major sustainability indicators. Furthermore, the identification of cause–effect chains revealed that education is a key factor in improving users’ health situation, whereas poverty significantly degrades it.

Distribution of inorganic arsenic species in groundwater from Central-West Part of Santa Fe Province, Argentina

The distribution of inorganic arsenic species in groundwater used as drinking water supply by the peri-urban and rural population from central-western area of Santa Fe Province, Argentina, was studied. An analytical methodology based on an online system of atomic absorption spectrometry with hydride generation and flow injection (FI-HGAAS) was used for total inorganic arsenic determination. For speciation purposes, the distinction between As(V) and As(III) was performed through the on line coupling of FI-HGAAS to a solid phase system based on an anionic exchanger able to retain As(V) as oxyanion, allowing As(III) to be selectively determined. The concentration of As(V) was calculated as the difference between total arsenic and As(III) concentrations. Effects of matrix interference due to the nonselective behavior of the exchange resins were carefully laid. Results for 59 samples collected from 27 localities showed an almost exclusive predominance of pentavalent forms.

Comparison of small-scale providers' and utility performance in urban water supply: the case of Maputo, Mozambique

Following independence from colonial rule, African governments struggled to cope with the legacy of fragmented water services and new demands of peri-urban population growth. Privatization was presented as a panacea that would expand and improve water supply. Small-scale independent water providers (SSPs) were meanwhile often the only actors ensuring that services were available to the peri-urban poor. Nonetheless, they were ignored and even vilified in ‘pro-poor’ strategies of water supply reform. Recent studies have actually demonstrated the important role SSPs play in serving the poor in African cities, however, substantial knowledge gaps remain. This study of SSP activities in Maputo, Mozambique provides rigorous empirical evidence about the performance of fully private SSPs vis-à-vis a privatized utility at both the provider and household level. The findings belie long-held notions of informal water provision as inferior and inefficient and formal sector privatization as the preferred strategy for reaching the poor. Improving water supply in African cities requires an understanding of the specific advantages of provider-types and avoiding universal cures.

Critical challenges in establishing emergency physician driven emergency departments – A Durban experience

Emergency medicine (EM) has become a global discipline and plays an integral role in providing integrated emergency medical care. In South Africa, emergency medicine is a relatively new discipline, and while well-established in the Western Cape and Gauteng, it is still in its infancy in KwaZulu-Natal. Although training in EM has been on-going at the Pietermaritzburg and Ngwelezane complexes, there are currently no accredited training facilities in the Durban Metro area, and only two emergency physician-headed Emergency Departments (EDs) in the eThekwini region. Despite understanding the unique complexities of the KwaZulu-Natal health system, we still encountered numerous challenges in establishing functional emergency physician driven EDs in Durban. Challenges encountered were: • Lack of awareness of the existence of emergency medicine as a specialty. • Lack of interaction between emergency departments and other disciplines. • Inadequate staffing of the ED: the ED is still seen as a refuge for those who have nowhere else to work, and has not been a staffing priority for most facilities. • Poorly equipped, under-resourced emergency departments. • No evidence based practice guidelines and undefined inter-facility referral policies. • ED overcrowding and access block. Strategies reviewed to integrate Emergency Medicine in Durban hospitals: • Marketing Emergency Medicine – creating awareness of the function and goals of Emergency Medicine in delivering emergency medical care. • Breaking tradition – transform all ”casualties” into ”Emergency Departments”. Reaffirming to local hospital and Department of Health policy makers that emergency medical care should be performed by the provider who can most efficiently perform the task (where ’efficiency’ balances quality of care, cost and patient flow). • Coordinated patient care, early intervention and referral, and team work between different disciplines. • Using Emergency Medicine models and systems established in other regions as motivation for implementing Emergency Physician run EDs locally. What has been done so far? • Establishment of a Division of Emergency Medicine at the University of KwaZulu-Natal. • Canvassing of policy makers to establish ongoing postgraduate training in Emergency Medicine in the Durban Metro area has commenced. • Ongoing interaction with the Department of Health and the Provincial Health managers to establish norms and standards for emergency care in the region • Active recruitment of specialist emergency physicians to augment clinical structures and improve the training for registrars. The Western Cape experience has demonstrated the utility of an Emergency Physician led Emergency Department in improving the outcome of acute illness and trauma, which are strongly dependent on the early recognition of severity and the need for early intervention. We believe that a similar mind-set needs to be developed to service the increasing needs of the urban and peri-urban population served by eThekwini hospitals.