Poor Urban Areas Research Articles

Dialysis, COVID-19, Poverty, and Race in Greater Chicago: An Ecological Analysis

Rationale & ObjectivePersons with end-stage kidney disease receiving in-center maintenance hemodialysis may be at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and severe outcomes with coronavirus disease 2019 (COVID-19). The objective of this study was to examine the correlation of SARS-CoV-2 positivity rate per capita and COVID-19–associated deaths with number of dialysis stations and demographics of residents within zip codes in Cook County, IL.Study DesignEcological analysis.Setting & ParticipantsData for SARS-CoV-2 test results and COVID-19–associated deaths during January 21 to June 15, 2020, among the 5,232,412 residents living within the 163 zip codes in Cook County, IL, were merged with demographic and income data from the US Census Bureau. The total number of positive test results in this population was 84,353 and total number of deaths was 4,007.AssessmentsNumber of dialysis stations and stations per capita within a zip code were calculated. SARS-CoV-2–positive test results per capita were calculated as number of positive test results divided by the zip code population. COVID-19–associated deaths per capita were calculated as COVID-19 deaths among residents for a given zip code divided by the zip code population.Analytic ApproachSpearman rank correlation coefficients were calculated to examine the correlation of SARS-CoV-2–positive tests per capita and COVID-19–associated deaths per capita with dialysis stations, demographics, and household poverty. To account for multiple testing, statistical significance was considered as P < 0.005.ResultsAmong the 163 Cook County zip codes, there were 2,501 dialysis stations. Positive test results per capita were significantly associated with number of dialysis stations (r = 0.25; 95% CI, 0.19 to 0.29; P < 0.005) but not with dialysis stations per capita (r = 0.02; 95% CI, −0.03 to 0.08; P = 0.7). Positive test results per capita also correlated significantly with number of households living in poverty (r = 0.57; 95% CI, 0.53-0.6; P < 0.005) and percentage of residents reporting Black race (r = 0.28; 95% CI, 0.23-0.33; P < 0.005) and Hispanic ethnicity (r = 0.68; 95% CI, 0.65-0.7; P < 0.001;). COVID-19–associated deaths per capita correlated significantly with the percentage of residents reporting Black race (r = 0.24; 95% CI, 0.19-0.29; P < 0.005) and with percentage of households living in poverty (r = 0.34; 95% CI, 0.29-0.38; P < 0.005). The association between the number of COVID-19–associated deaths per capita and total number of dialysis stations (r = 0.20; 95% CI, 0.14-0.25; P = 0.01) did not achieve a priori significance, whereas the association with dialysis stations per capita (r = 0.12; 95% CI, 0.07-0.17; P = 0.01) was not significant.LimitationsAnalysis is at the zip code level and not at the person level.ConclusionsThe number of dialysis stations within a zip code correlates with the SARS-CoV-2 positivity rate per capita in Cook County, IL, and this correlation may be driven by population density and the demographics of the residents. These findings highlight the high risk of SARS-CoV-2 exposure for patients with end-stage kidney disease living in poor urban areas.

POOR HOUSEHOLDS EXPENDITURE FOR PREVENTIVE AND CURATIVE HEALTH NEEDS

The purpose of this research is to analyze: 1) patterns and allocation of household expenditure in poor urban and rural areas for preventive and curative health needs in Jambi Province; 2) socio-economic factors that affect their expenditure. Data is gath-ered thorough poor households at the locus of chosen village. To analyze the patterns and allocation of household expenditures, descriptive statistical measures as well as single and cross frequency tables is used. Furthermore, to analyze the factors influenc-ing, multiple regression model is used. The results found that: 1) the average health expenditure per capita per year of was IDR 67,391. It is 1.37 percent of the total annu-al expenditure per capita, or only 3.56 percent of the total per capita annual expendi-ture for non-food needs. Furthermore, detailed health expenditures for curative and preventive, it was found that 73.36 percent of health expenditures for poor households were for curative needs and only 26.64 percent were allocated for preventive health needs; 2) socioeconomic factors that significantly influence health expenditure are: family head age, head of the family education, field and business status, per capita expenditure, and structure of household members according to age, education and main activities. Therefore to improve health poor household service requires a massive campaign to encourage them to go to service center. This service is granted by local governments, though it still have difficulties to be implemented on health insurance scheme in Indonesia (BPJS).

Prevalence of Non-Engineered Buildings and Population at Risk for a Probable Earthquake: A Cross-Sectional Study from an Informal Settlement in Tehran, Iran

Constructions in informal settlements not respected any applying rules, regulations of urban planning, and building codes with high population density, are the municipality challenge. We aimed to identify level of buildings seismic vulnerability and population at risk in Tehran's Farahzad informal settlement in 2017. In this observational cross-sectional study, residential buildings were assessed for seismic performance of constructions. We screened 160 buildings according to Iranian national guidelines by Rapid Seismic Visual Screening Method as a tool to calculate and determine Level of Retrofitting (LR) scores of buildings. We also interviewed residents of the buildings to collect data regarding socio-demographic data, individual disability status, Disaster Assessment of Readiness and Training (DART) regarding household disaster preparedness, and time occupancy in the buildings. Overall, 160 buildings with 209 households and 957 individuals were surveyed. 97.5% of buildings were formed of heavy construction materials. None of them were categorized as engineered buildings and LR of residential buildings ranged from 82.4% to 163.8% with a mean 117.9%. LR scores of more than 100% were capped as 100%. Vulnerable groups of the sample population include under-five years old (8.7%), 60 yr old and above (6.7%), and 9.1% of households had at least one disabled member. 16.7% of households were living in homes with dense area. The DART score for 94.3% of surveyed households was zero. Disaster managers in Tehran municipality must design and implement a comprehensive risk reduction plan in poor urban areas as vulnerable regions for earthquake hazard.

Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa

More than half of the world population lives in the cities and around one billion in poor urban areas. These numbers are projected to increase, while Sub-Saharan Africa is the region with the highest rate of informal settlements due his rapid urbanization. The urban informal settlements of Sub-Saharan Africa house everyday health risks. These risks have considerable cumulative impacts on the wellbeing and health of the urban vulnerable group. Despite the public health consequences of urbanization and the increase of informal settlements number in African cities, there is a paucity in data about the risks at small scale and the vulnerability in poor urban areas. Through the database search engine of MEDLINE, WHO Library and Information Networks for Knowledge and website of Urban Africa Risk Knowledge; from information of the existing literature, this paper tried to analyse the everyday health risks, and vulnerabilities in urban informal settlement in Sub-Saharan Africa region. A search combining keywords associated with health risks and informal settlement in Sub-Saharan Africa were used to identify the relevant documents, and this search yielded 86 articles, of which 15 met the criteria for inclusion in the analysis. The risks of communicable diseases due to inadequate sanitation have been the most frequent subjects of study. Informal settlers in Sub-Saharan Africa face everyday health risks arising from lack of clean water, adequate sanitation, and life in overcrowding houses. Consequently, there is a burden of communicable and non-communicable diseases, undernourishment and injuries. The most vulnerable group is children under five with a high rate of mortality. Everyday health risks in urban informal settlements must be taken into account for a better understanding of the full spectrum of urban risks. This is essential in the establishment of efficient public health policies and intervention in urban areas.

Impact of extreme weather conditions on healthcare provision in urban Ghana.

Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6°C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.

Opioids, Race, and Drug Enforcement: Exploring Local Relationships Between Neighborhood Context and Black–White Opioid-Related Possession Arrests

Opioid abuse has redefined drug problems in communities and shifted police activities to redress substance use. Changing neighborhood context around opioid issues may affect arrests and racial disparities in their imposition. This study presents a spatial analysis of arrests involving Blacks and Whites for possession of heroin, synthetic narcotics, and opium offenses. We identify the ecological conditions associated with opioid-related arrests using geographically weighted regression (GWR) methods that illuminate local patterns by allowing coefficients to vary across space. GWR models reveal spatial and racial differences in opioid-related possession arrest rates. Calls for police service for overdoses increase White arrests in more advantaged, rural communities. Economic disadvantage and racial diversity in neighborhoods more strongly elevate possession arrest rates among Blacks relative to Whites. Overdose calls predict Black arrests in poorer urban areas. Findings underscore police responsiveness to opioid problems and Black–White differences in how opioid users interact with the criminal justice system.

Overweight and obesity and associated factors in adults in a poor urban area of Northeastern Brazil.

The changes that occurred in the health/disease process, especially in the field of nutrition, corroborate the replacement of nutritional deficiencies with the pandemic emergency of overweight (overweight/obesity). To analyze the prevalence and factors associated with overweight in adults living in a poor urban area in Recife, Northeast Brazil. This is a cross-sectional study with a sample of 644 adults aged 20-59 years. Possible associations of overweight with demographic, socioeconomic, behavioral and morbidity factors were analyzed through Poisson Regression, considering as statistically significant those with p < 0.05. The prevalence of overweight was 70.3%, being lower in the age range of 20-29 years, greater in the range of 30-39 years and stabilizing in the others. In the final multivariate model, it was observed that the age group, economic class, diabetes mellitus and high blood pressure were directly associated with overweight, while bean consumption showed an inverse association. The high prevalence of overweight found indicates that poor communities are already included in the nutritional transition process that is in course in country. The significant result of overweight found at this poor urban area imposes the need to include this problem as a public health priority in these communities.

Variation in fruit and vegetable purchasing patterns in Leeds: using novel loyalty card transaction data

AbstractIntroduction:Traditional dietary assessment methods in research can be challenging, with participant burden to complete an interview, diary, 24 h recall or questionnaire and researcher burden to code the food record to obtain a nutrient breakdown. Self-reported assessment methods are subject to recall and social desirability biases, in addition to selection bias from the nature of volunteering to take part in a research study. Supermarket loyalty card transaction records, linked to back of pack nutrient information, present a novel opportunity to use objective records of food purchases to assess diet at a household level. With a large sample size and multiple transactions, it is possible to review variation in food purchases over time and across different geographical areas.Materials and methods:This study uses supermarket loyalty card transactions for one retailer's customers in Leeds, for 12 months during 2016. Fruit and vegetable purchases for customers who appear to shop regularly for a ‘complete’ shop, buying from at least 7 of 11 Living Cost and Food Survey categories, were calculated. Using total weight of fruits and vegetables purchased over one year, average portions (80g) per day, per household were generated. Descriptive statistics of fruit and vegetable purchases by age, gender and Index of Multiple Deprivation of the loyalty card holder were generated. Using Geographical Information Systems, maps of neighbourhood purchases per month of the year were created to visualise variations.Results:The loyalty card holder transaction records represent 6.4% of the total Leeds population. On average, households in Leeds purchase 3.5 portions of fruit and vegetables per day, per household. Affluent and rural areas purchase more fruit and vegetables than average with 22% purchasing more than 5 portions/day. Conversely poor urban areas purchase less, with 18% purchasing less than 1 portion/day. Highest purchases are in the winter months, with lowest in the summer holidays. Loyalty cards registered to females purchased 0.4 portions per day more than male counterparts. The over 65 years purchased 1.5 portions per day more than the 17–24 year olds. A clear deprivation gradient is observed, with the most deprived purchasing 1.5 portions less per day than the least deprived.Discussion:Loyalty card transaction data offer an exciting opportunity for measuring variation in fruit and vegetable purchases. Variation is observed by age, gender, deprivation, geographically across a city and throughout the seasons. These insights can inform both policymakers and retailers regarding areas for fruit and vegetable promotion.

Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination.

Intestinal helminths are extremely widespread and highly prevalent infections of humans, particularly in rural and poor urban areas of low and middle-income countries. These parasites have chronic and often insidious effects on human health and child development including abdominal problems, anaemia, stunting and wasting. Certain animals play a fundamental role in the transmission of many intestinal helminths to humans. However, the contribution of zoonotic transmission to the overall burden of human intestinal helminth infection and the relative importance of different animal reservoirs remains incomplete. Moreover, control programmes and transmission models for intestinal helminths often do not consider the role of zoonotic reservoirs of infection. Such reservoirs will become increasingly important as control is scaled up and there is a move towards interruption and even elimination of parasite transmission. With a focus on southeast Asia, and the Philippines in particular, this review summarises the major zoonotic intestinal helminths, risk factors for infection and highlights knowledge gaps related to their epidemiology and transmission. Various methodologies are discussed, including parasite genomics, mathematical modelling and socio-economic analysis, that could be employed to improve understanding of intestinal helminth spread, reservoir attribution and the burden associated with infection, as well as assess effectiveness of interventions. For sustainable control and ultimately elimination of intestinal helminths, there is a need to move beyond scheduled mass deworming and to consider animal and environmental reservoirs. A One Health approach to control of intestinal helminths is proposed, integrating interventions targeting humans, animals and the environment, including improved access to water, hygiene and sanitation. This will require coordination and collaboration across different sectors to achieve best health outcomes for all.

Effects of a Self-efficacy Theory-Based Training Program for Peers of Patients with Type 2 Diabetes.

Training peer leaders to deliver patient education is expected to be a low-cost approach to providing healthcare in urban-poor areas affected by a shortage of healthcare professionals. The purpose of this study was to examine the effects of a training program on the self-efficacy and knowledge of peer leaders with type 2 diabetes. A single-group longitudinal survey with baseline, intervention, and follow-up periods was conducted at a diabetes clinic in a small municipality in Metro Manila, Philippines. The intervention, a self-efficacy theory-based training program for peer-leaders of diabetic patients conducted in August 2017, comprised hands-on learning, demonstrations, quizzes, role-playing, group sharing, physical exercise, and a buffet lunch. The primary outcome was participants' self-efficacy for management of their diabetes. Secondary outcomes were participants' knowledge of diabetes and levels of emotional distress, motivation, and confidence for guiding their peers, satisfaction with the training program, hemoglobin A1c, and quality of life. At 12 and 18 months after the intervention, participants' knowledge of diabetes was significantly increased compared with baseline (both P < 0.05). At earlier time points, an increasing, but not significant, trend was observed. The change in knowledge of diabetes from baseline to 18 months after intervention tended to be positively correlated with the change in self-efficacy (r = 0.594, P = 0.054). No significant differences were observed for any of the other outcomes, although the descriptive statistics showed an increasing trend for all of the outcomes except motivation. The training program significantly improved participants' knowledge of diabetes at 12 and 18 months after the training programs compared with baseline. A positive correlation between the changes in the levels of knowledge and self-efficacy suggested that the observed improvement of self-efficacy was facilitated by the improvement of knowledge of diabetes.

Effects of a scalable home-visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial.

BackgroundAn estimated 63.4 million Indian children under 5 years are at risk of poor development. Home visits that use a structured curriculum to help caregivers enhance the quality of the home stimulation environment improve developmental outcomes. However, achieving effectiveness in poor urban contexts through scalable models remains challenging. MethodsUsing a cluster randomised controlled trial, we evaluated a psychosocial stimulation intervention, comprising weekly home visits for 18 months, in urban slums of Cuttack, Odisha, India. The intervention is complementary to existing early childhood services in India and was run and managed through a local branch of a national NGO. The study ran from August 2013 to July 2015. We enrolled 421 children aged 10–20 months from 54 slums. Slums were randomised to intervention or control. Primary outcomes were children's cognitive, receptive language, expressive language and fine motor development assessed using the Bayley‐III. Prespecified intent‐to‐treat analysis investigated impacts and heterogeneity by gender. Trial registrations: ISRCTN89476603, AEARCTR‐0000169.ResultsEndline data for 378 (89.8%) children were analysed. Attrition was balanced between groups. We found improvements of 0.349 of a standard deviation (SD; p = .005, stepdown p = .017) to cognition while impacts on receptive language, expressive language and fine motor development were, respectively, 0.224 SD (p = .099, stepdown p = .184), 0.192 SD (p = .085, stepdown p = .184) and 0.111 (p = .385, stepdown p = .385). A child development factor improved by 0.301 SD (p = .032). Benefits were larger for boys. The quality of the home stimulation environment also improved. ConclusionsThis study shows that a potentially scalable home‐visiting intervention is effective in poor urban areas.

Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study.

BackgroundIn Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia.MethodsA cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels.ResultsData from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25–11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19–2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64–5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17–2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86–65.34).ConclusionsHigh diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC).

Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC).

Obesity and Polypharmacy among African American Older Adults: Gender as the Moderator and Multimorbidity as the Mediator.

Despite high prevalence of obesity and polypharmacy among African American (AA) older adults, little information exists on the associations between the two in this population. This study explored the association between obesity and polypharmacy among AA older adults who were residing in poor urban areas of South Los Angeles. We also investigated role of gender as the moderator and multimorbidity as the mediator of this association. In a community-based study in South Los Angeles, 308 AA older adults (age ≥ 55 years) were entered into this study. From this number, 112 (36.4%) were AA men and 196 (63.6%) were AA women. Polypharmacy (taking 5+ medications) was the dependent variable, obesity was the independent variable, gender was the moderator, and multimorbidity (number of chronic medical conditions) was the mediator. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), income, marital status, self-rated health (SRH), and depression were the covariates. Logistic regressions were used for data analyses. In the absence of multimorbidity in the model, obesity was associated with higher odds of polypharmacy in the pooled sample. This association was not significant when we controlled for multimorbidity, suggesting that multimorbidity mediates the obesity-polypharmacy link. We found significant association between obesity and polypharmacy in AA women not AA men, suggesting that gender moderates such association. AA older women with obesity are at a higher risk of polypharmacy, an association which is mainly due to multimorbidity. There is a need for screening for inappropriate polypharmacy in AA older women with obesity and associated multimorbidity.

Claiming status and contesting sexual violence and harassment among community health activists in Delhi

Drawing on an ethnographic fieldwork in an urban poor area in Delhi, this paper examines how Accredited Social Health Activists (ASHAs) experience and critique sexual violence and harassment in the city. Inherent in these women’s critiques is blaming of urban poor men who belong to their social class, resonating with middle-class discourses emerging in urban India. Simultaneously, in their accounts of sexual violence in domestic spaces, women invoked notions of romantic love and familial success. I argue that this discursive tension around urban poor men is linked to women’s attempts to assert and claim higher social status and respectability in the context of highly divided and gendered city. ASHAs made claims and asserted themselves in the multiple arenas of urban life, as their work on women’s health required cultivation of knowledge and engagement with public spaces, intimate spheres, and cultivation of familial roles propagated by the public healthcare programme. Through a reading of de Certeau’s concept of tactics as limited trajectories of claims to urban environments developed among the powerless, I show how access to urban spaces can be revisited as a negotiation and a claim, rather than being shaped only by existing social status. And, I show how responding with readiness to multiple conditions of urban poverty involves negotiation of those claims pertaining both public and private spaces and spheres.

The role of new ‘smart technology’ to provide water to the urban poor: a case study of water ATMs in Delhi, India

A new form of coin-operated or electronic card-operated water vending machine; popularly known as the water ATMs (Automated Teller Machine) are gaining popularity as a ‘smart’ yet a ‘low-cost’ technology to provide safe water at nominal rates in India. Water ATMs are being currently experimented as a market-based solution on the idea of social entrepreneurship to provide safe drinking water to the urban poor in Delhi who are inadequately served by the public utility network. Based on a primary survey, the present case study aims to look at the challenges and opportunities these water ATMs pose. The study assesses its scope for further expansion as a solution to water security for urban poor residing in low income areas by analysing the issues of both supply side as well as demand side management of this technology. It is believed that water ATMs have tremendous potential to reduce waterborne diseases affecting the lives of millions of people in India and can minimize plastic waste and prevent plastic contamination as posed by the booming packaged water industries. Though water tariffs are nominal, water ATMs, for the first time are operating on the model of a paid community standpipe, in urban poor areas in India. So the big question remains whether the water ATMs can be seen as a complimentary source of safe water to the urban poor or it can be turned into an alternative option for universal coverage of piped network.

Climbing the water ladder in poor urban areas: Preferences for ‘limited’ and ‘basic’ water services in Accra, Ghana

While providing drinking water on premises to all citizens in urban areas may be desirable, economic and institutional challenges coupled with poverty, insecure tenure, and other barriers prevent many water utilities from providing private taps to all households. To meet growing water demand and fill gaps in service delivery, alternative forms of public water service provision are critical. We implemented a choice experiment in Nima-Maamobi, a poor, underserved urban settlement in Accra, Ghana, to investigate household preferences for public standpipes based on the basic and limited water service categories under the WHO/UNICEF Joint Monitoring Programme's new water ladder. We also elicited local preferences for potential service administrators of the standpipes. Choice responses provided by 344 respondents were analyzed using a generalized multinomial logit model. Households were willing to pay up to US$1.25 for a 20-liter bucket of safe drinkable water, which is consistent with the average household water expenditure in the study site. Households spend at least 22% of their monthly income on water. Households' willingness to pay varied according to alternative levels of accessibility, availability, and quality of water services. Households showed strong preferences for community-based committees and nongovernmental organizations over the current water utility and the municipal assembly. The policy implications of the findings are discussed.

Mapping of Occupations of the Populations in Urban Poor Areas

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ANALYZING SOCIAL COHESION IN OPEN SPACES OF MULTIETHNIC POOR NEIGHBORHOODS: A GROUNDED THEORY STUDY

During the past two decades, economic crises and climate change have triggered mass migrations from rural areas to big cities and metropolises. Considering that the destination cities often lack the required capacity to systematically accommodate these newcomers, immigrants settle in unofficially on city margins. Since these immigrants have different ethnicities, the informal settlements constructed by them turn into multiethnic informal Settlements in which development of proper social ties becomes impeded. As a result, social cohesion is weakened and eventually ceases to exist among the residents in open community spaces. In this regard, the present study aims to analyze this process and the effects of multiethnicity on social cohesion in the open community spaces of poor urban areas and the role of environmental factors in this mechanism. The Hesar Imam Khomeini neighborhood, which is located in Hamadan Province and has a rural core, has given shelter to Lurish, Kurdish, Turkish and Persian-speaking immigrants during recent years, which makes it a suitable sample for study. Because of the existing limitations and in order to achieve the goal of the study, the grounded theory was used to conduct the research. In-depth interview was carried out on sixteen residents of the neighborhood, four individuals from each ethnicity. After coding the interviews using the theory, a grounded model of the study was formed. The results indicate that multiethnicity has negatively affected behavior settings, vibrancy and consequently social cohesion in the open community spaces of the area of study through the three factors of “different expectations from neighborhood space”, “different time of attendance in open spaces” and “different residence size”. It can be proposed that “creating spatial shared values” is one of the most effective strategies which can be used for narrowing gaps and increasing social cohesion in multiethnic neighborhoods.

Contested causes of flooding in poor urban areas in Accra, Ghana: an actor-oriented perspective

It is well known that urbanisation and climate change are likely to induce more floods in existing flood-prone African cities. Previous contributions on the causes of flooding in urban areas mostly do not consider the actors involved in adaptation and do not acknowledge the diversity of knowledge they possess. In this study, the causes of urban floods in an African city are explored from an actor-oriented perspective. The Kendall coefficient of concordance method is used to analyse interviews with household members and community leaders living in flood-prone communities as well as technocrats involved in public flood adaptation at the metropolitan level. The level of agreement on the causes of flooding is low among the actors, making the case for integrating informal actors into the formal flood adaptation structures at the metropolitan level. This will harness the diversity of knowledge on how flood risk unfolds for the purpose of local adaptation to urban floods in African cities.