Rights, Knowledge, and Governance for Improved Health Equity in Urban Settings

All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: “the process of collective decision making and processes by which decisions are implemented or not implemented”: it is concerned with the distribution, exercise, and consequences of power. Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements. The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health are essential “not only for improving local governance, but also for understanding and addressing global political change” for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested

The interplay between environmental exposures and COVID-19 risks in the health of children

Abstract Background An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. Objectives To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. Methods An international group of researchers interested in children’s environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. Discussion Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a “dirty” environment in conveying protection – an example of the “hygiene hypothesis”; and what are the long term health effects of SARS-Cov-2 infection in early life. Conclusion A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario

Febrile illness diagnostics and the malaria-industrial complex: a socio-environmental perspective

Abstract Background Global prioritization of single-disease eradication programs over improvements to basic diagnostic capacity in the Global South have left the world unprepared for epidemics of chikungunya, Ebola, Zika, and whatever lies on the horizon. The medical establishment is slowly realizing that in many parts of sub-Saharan Africa (SSA), particularly urban areas, up to a third of patients suffering from acute fever do not receive a correct diagnosis of their infection. Main body Malaria is the most common diagnosis for febrile patients in low-resource health care settings, and malaria misdiagnosis has soared due to the institutionalization of malaria as the primary febrile illness of SSA by international development organizations and national malaria control programs. This has inadvertently created a “malaria-industrial complex” and historically obstructed our complete understanding of the continent’s complex communicable disease epidemiology, which is currently dominated by a mélange of undiagnosed febrile illnesses. We synthesize interdisciplinary literature from Ghana to highlight the complexity of communicable disease care in SSA from biomedical, social, and environmental perspectives, and suggest a way forward. Conclusion A socio-environmental approach to acute febrile illness etiology, diagnostics, and management would lead to substantial health gains in Africa, including more efficient malaria control. Such an approach would also improve global preparedness for future epidemics of emerging pathogens such as chikungunya, Ebola, and Zika, all of which originated in SSA with limited baseline understanding of their epidemiology despite clinical recognition of these viruses for many decades. Impending ACT resistance, new vaccine delays, and climate change all beckon our attention to proper diagnosis of fevers in order to maximize limited health care resources

Neighborhood urban environmental quality conditions probably drive malaria and diarrhea mortality in Accra, Ghana

Fobil J, Fobil J, Krämer A, May J. Neighborhood urban environmental quality conditions probably drive malaria and diarrhea mortality in Accra, Ghana. In: International Journal of Infectious Diseases. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES. Vol 14. ELSEVIER SCI LTD; 2010

Age and sex specific pattern of urban malaria and diarrhea mortalities in Accra

Fobil J, Fobil J, Krämer A, May J. Age and sex specific pattern of urban malaria and diarrhea mortalities in Accra. In: International Journal of Infectious Diseases. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES. Vol 14. ELSEVIER SCI LTD; 2010

An investigation of users’ attitudes, requirements and willingness to use mobile phone-based interactive voice response systems for seeking healthcare in Ghana: a qualitative study

Brinkel J, Dako-Gyeke P, Krämer A, May J, Fobil JN. An investigation of users’ attitudes, requirements and willingness to use mobile phone-based interactive voice response systems for seeking healthcare in Ghana: a qualitative study. Public Health. 2017;144:125-133

UV irradiation of Shigella dysenteriae induced the transformation and excision of a presumed integrated lysogenic prophage Shd-4L10 into a lytic phase

Repeated exposures of Shigella dysenteriae strain A to ultra-violetradiation (253.7 nm) with in-tervening outgrowth of survivors gave rise to clear bacteriophage plaques. Isolation, propagation and partial purification of the new Shd-4L10 phages showed that they are similar in morphology to the Myxobacteriaphage Mx-4described earlier. The new phages retained the general charac-teristics of S. dystenteriae phageShd-4L3,including serological properties and phage typing. It is suggested that ultra-violet irradiation may have played a role in the transformation and excision of the presumed lysogen of S. dysenteriaestrain A into a lytic phase. PhageShd-4L10was subse-quently partially characterized. It has a density of 1.61, a DNA: protein ratio 0f 0.42 and thus a cryptogram of D/2:54.3/32.5:X/X: B/O. The phage was further characterised by fractionation of its protein using SDS-polyacrilamide gel electrophoresis. DNA extracted from phages was hy-drolysed with restriction endonuclease R., EcoR1. The restriction fragments were catalogued and their apparent molecular weights calculated from electrophoresis gels calibrated with frag-ments from DNA of coliphage ë. From the total fragments obtained with nuclease R., EcoR1, the apparent minimum molecular weight of phage Shd-4L10DNA was found to be 54.3 x 106 Daltons. The molecular weight of the phage DNA was also calculated from measurements of contour length of purified DNA samples, using the formula MW = 1.97 x 1010 l/(magnification), where l is the measured length of DNA in centimetres). The very close relatedness with phage Shd-4L3 was confirmed by these techniques