Policy brief, number 11, 2014

[From Introduction] Urbanisation in sub-Saharan Africa: changing the locus of poverty. Urbanisation is a global phenomenon that is changing the face of the Earth, as well as how people earn a living and secure their livelihoods. In 2006 the number of urban people in the world surpassed the number of rural people, and this gap will continue to grow. In only 16 years (by 2030) just under two-thirds of the world's people will be urban dwellers. Whilst most of the developed world and large parts of Latin America already have more than threequarters of their populations living in cities and towns, most countries in Asia and sub-Saharan Africa are still catching up. This means that they are experiencing massive migrations from rural to urban areas as rural people wish to swap the insecurities of rural living for the allure of secure employment and better services for health, education, sanitation and transport in towns and cities. Sub-Saharan Africa (SSA) is the most rapidly urbanising region of the globe. According to UN-Habitat, in 1990, only 28 % of the region's inhabitants lived in towns and cities; that increased to approximately 32 % in 2001 and 41 % in 2010. The size of the urban population is likely to surpass the rural one around 2025. Contrary to popular belief, most urban residents in SSA (and globally) live in small towns rather than massive megacities; with just over half living in towns of less than 200,000 people and 78 % living in towns of less than 500,000 residents. Only 14 % of urban dwellers live in cities of more than one million people. Many new urban households maintain strong links to relatives and clans in rural areas, with circular migration patterns emerging as the urban transition takes place over several decades. The implications of this extremely rapid urbanisation in SSA countries for livelihoods and poverty are widely debated. UN-Habitat highlights a relatively unique aspect of urbanisation in SSA as being the accompanying high rate of growth in informal settlements or slums. In other words, not all rural migrants to towns and cities find secure incomes or shelter. Some slum areas have become permanent features where inter-generational poverty is reproduced. Although urban areas are producing an increasing share of national wealth in SSA countries, some argue that slowly the nexus of poverty is shifting towards urban areas. Rates of poverty are high in rural areas of SSA, but migration and internal population growth means that in some countries the number of urban poor almost matches the number of rural poor, and it is likely to grow. The informal economy contributes an average of 40 – 45 % of total urban GDP, which is higher than any other region of the world

Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990–2016

Background: Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016. Methods: Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, International Labour Organisation, household surveys, and the Barro-Lee education dataset. Findings: From 1990 to 2016, remarkable shifts in adolescent health occurred. A decrease in disease burden in many countries has been offset by population growth in countries with the poorest adolescent health profiles. Compared with 1990, an additional 250 million adolescents were living in multi-burden countries in 2016, where they face a heavy and complex burden of disease. The rapidity of nutritional transition is evident from the 324·1 million (18%) of 1·8 billion adolescents globally who were overweight or obese in 2016, an increase of 176·9 million compared with 1990, and the 430·7 million (24%) who had anaemia in 2016, an increase of 74·2 million compared with 1990. Child marriage remains common, with an estimated 66 million women aged 20–24 years married before age 18 years. Although gender-parity in secondary school completion exists globally, prevalence of NEET remains high for young women in multi-burden countries, suggesting few opportunities to enter the workforce in these settings. Interpretation: Although disease burden has fallen in many settings, demographic shifts have heightened global inequalities. Global disease burden has changed little since 1990 and the prevalence of many adolescent health risks have increased. Health, education, and legal systems have not kept pace with shifting adolescent needs and demographic changes. Gender inequity remains a powerful driver of poor adolescent health in many countries. Funding: Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundatio

Patient-derived organoids and orthotopic xenografts of primary and recurrent gliomas represent relevant patient avatars for precision oncology

Patient-based cancer models are essential tools for studying tumor biology and for the assessment of drug responses in a translational context. We report the establishment a large cohort of unique organoids and patient-derived orthotopic xenografts (PDOX) of various glioma subtypes, including gliomas with mutations in IDH1, and paired longitudinal PDOX from primary and recurrent tumors of the same patient. We show that glioma PDOXs enable long-term propagation of patient tumors and represent clinically relevant patient avatars that retain histopathological, genetic, epigenetic, and transcriptomic features of parental tumors. We find no evidence of mouse-specific clonal evolution in glioma PDOXs. Our cohort captures individual molecular genotypes for precision medicine including mutations in IDH1, ATRX, TP53, MDM2/4, amplification of EGFR, PDGFRA, MET, CDK4/6, MDM2/4, and deletion of CDKN2A/B, PTCH, and PTEN. Matched longitudinal PDOX recapitulate the limited genetic evolution of gliomas observed in patients following treatment. At the histological level, we observe increased vascularization in the rat host as compared to mice. PDOX-derived standardized glioma organoids are amenable to high-throughput drug screens that can be validated in mice. We show clinically relevant responses to temozolomide (TMZ) and to targeted treatments, such as EGFR and CDK4/6 inhibitors in (epi)genetically defined subgroups, according to MGMT promoter and EGFR/CDK status, respectively. Dianhydrogalactitol (VAL-083), a promising bifunctional alkylating agent in the current clinical trial, displayed high therapeutic efficacy, and was able to overcome TMZ resistance in glioblastoma. Our work underscores the clinical relevance of glioma organoids and PDOX models for translational research and personalized treatment studies and represents a unique publicly available resource for precision oncology

Multiple benefits and values of trees in urban landscapes in two small towns in northern South Africa

Cities and towns can be conceptualised as complex social-ecological systems or landscapes that are composed of different spatial elements. Trees in urban landscapes provide a variety of tangible and intangible benefits (ecosystem services) that may be valued differently across diverse households and individuals. Here, we consider how the benefits and values of trees to urban residents vary across public and private spaces in three low income neighbourhoods in two medium-sized towns in northern South Africa. We find that the most asset poor residents in informal settlements derive significant benefits from the provisioning services offered by trees in natural green spaces on the ‘urban periphery’; in particular they value supplies of wood for energy, whilst also recognising the importance of regulating services such as shade. Trees in such spaces help these immigrants cope with a lack of infrastructure, services and disposable income after their move to the city. In new, low-cost housing neighbourhoods, the importance of trees in providing shade and shelter in gardens is emphasised due to the hot and dusty nature of these settlements, while residents in older township neighbourhoods make more mention of the aesthetic value of trees in private spaces as well as the fruits they provide. In all neighbourhoods, attitudes towards trees in public spaces were mixed because of their perceived association with crime, although low income households did make extensive use of tree products from natural areas. The relevance of the results for urban planning and greening in low income areas is discussed