Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements – ScienceOpen
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      Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

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          Abstract

          The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

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          Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System

          The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor.
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            Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya

            Background Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya. Methods Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults. Results Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese. Conclusion The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.
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              A review and framework for understanding the potential impact of poor solid waste management on health in developing countries

              Background The increase in solid waste generated per capita in Africa has not been accompanied by a commensurate growth in the capacity and funding to manage it. It is reported that less than 30% of urban waste in developing countries is collected and disposed appropriately. The implications of poorly managed waste on health are numerous and depend on the nature of the waste, individuals exposed, duration of exposure and availability of interventions for those exposed. Objective To present a framework for understanding the linkages between poor solid waste management, exposure and associated adverse health outcomes. The framework will aid understanding of the relationships, interlinkages and identification of the potential points for intervention. Methods Development of the framework was informed by a review of literature on solid waste management policies, practices and its impact on health in developing countries. A configurative synthesis of literature was applied to develop the framework. Several iterations of the framework were reviewed by experts in the field. Each linkage and outcomes are described in detail as outputs of this study. Result The resulting framework identifies groups of people at a heightened risk of exposure and the potential health consequences. Using the iceberg metaphor, the framework illustrates the pathways and potential burden of ill-health related to solid waste that is hidden but rapidly unfolding with our inaction. The existing evidence on the linkage between poor solid waste management and adverse health outcomes calls to action by all stakeholders in understanding, prioritizing, and addressing the issue of solid waste in our midst to ensure that our environment and health are preserved. Conclusion A resulting framework developed in this study presents a clearer picture of the linkages between poor solid waste management and could guide research, policy and action.
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                Author and article information

                Contributors
                jcorburn@berkeley.edu
                David.Vlahov@yale.edu
                bmberu@aphrc.org
                lriley@berkeley.edu
                caiaffa.waleska@gmail.com
                sabina@bracu.ac.bd
                albert.ko@yale.edu
                sparc84@gmail.com
                smrutisj@gmail.com
                eliana.martinez@udea.edu.co
                saroj@clinmed.cmb.ac.lk
                a.siddharth.in@gmail.com
                sir_nguendoyongsi@hotmail.com
                janeweru1@gmail.com
                oumaso@cardiff.ac.uk
                katia@cedaps.org.br
                Tolu.Oni@mrc-epid.cam.ac.uk
                hany.m.ayad@alexu.edu.eg
                Journal
                J Urban Health
                J Urban Health
                Journal of Urban Health : Bulletin of the New York Academy of Medicine
                Springer US (New York )
                1099-3460
                1468-2869
                24 April 2020
                24 April 2020
                : 1-10
                Affiliations
                [1 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, School of Public Health & Department of City & Regional Planning, , University of California, ; Berkeley, CA USA
                [2 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Nursing, ; Orange, CT USA
                [3 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, Urbanization and Wellbeing Unit, , African Population and Health Research Centre (APHRC), ; Nairobi, Kenya
                [4 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, Infectious Diseases and Vaccinology, School of Public Health, , University of California, ; Berkeley, CA USA
                [5 ]GRID grid.8430.f, ISNI 0000 0001 2181 4888, Epidemiology and Public Health, , Federal University of Minas Gerais School of Medicine, ; Belo Horizonte, Brazil
                [6 ]GRID grid.52681.38, ISNI 0000 0001 0746 8691, Brac School of Public Health, , Brac University, ; Dhaka, Bangladesh
                [7 ]GRID grid.47100.32, ISNI 0000000419368710, Epidemiology of Microbial Diseases, , Yale School of Public Health, ; New Haven, CT USA
                [8 ]GRID grid.465062.3, ISNI 0000 0004 1768 3020, Society for the Promotion of Area Resource Centre (SPARC), ; Mumbai, India
                [9 ]GRID grid.412881.6, ISNI 0000 0000 8882 5269, Research Group of Epidemiology, , University de Antioquia, ; Medellín, Colombia
                [10 ]GRID grid.8065.b, ISNI 0000000121828067, University of Colombo, ; Colombo, Sri Lanka
                [11 ]Urban Health Resource Centre, Delhi, India
                [12 ]Université de Yaoundé II-Cameroon, Soa, Cameroon
                [13 ]Akiba Mashinani Trust (AMT), Nairobi, Kenya
                [14 ]Cardiff Law and Global Justice, Cardiff, UK
                [15 ]Centro de Promoção da Saúde, Rio de Janeiro, Brazil
                [16 ]GRID grid.5335.0, ISNI 0000000121885934, MRC Epidemiology unit, , University of Cambridge, UK & School of Public Health and Family Medicine, ; Cambridge, UK
                [17 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, University of Cape Town, ; Cape Town, South Africa
                [18 ]GRID grid.7155.6, ISNI 0000 0001 2260 6941, Alexandria University, ; Alexandria, Egypt
                Article
                438
                10.1007/s11524-020-00438-6
                7182092
                32333243
                432b3b76-fc73-46b9-9836-cff0cc67af80
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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                Public health
                slums,informal settlements,equity,coronavirus,community health,global health
                Public health
                slums, informal settlements, equity, coronavirus, community health, global health

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