Multi-Step Transition in Housing Provision and Progressivedevelopment of Urban Settlements: Case of Davao City, Philippines

In 2015, the United Nations published World Urbanization Prospects declaring that 54% of the world’s population now lives in urban areas while it is estimated that this figure will reach 66% by 2050 with nearly 90% of this increase located in Asia and Africa (United Nations 2015). In this context of unprecedented urbanisation coupled with widespread urban poverty, squatter settlements are often the only means of affordable shelter for the urban poor. In Asia and Africa (and elsewhere), governments are committed to providing shelter for the low income sector of their respective nations as a basic human right. However, housing policy and programmes in developing countries, like the Philippines, are often based on models (applied with varying degrees of success) which originate in high-income countries. Known, alternatively, as a ‘one-step regularisation model’; ‘instant development’; or, a ‘product approach’, this model is intended to relocate the urban poor from a squatter settlement to a regular housing market in a single step. Despite the diffusion of this model, this approach has often resulted in more problems rather than offering effective solutions. Given these alarming statistics and the housing implications, this research examines the phenomenon of a ‘multi-step transition’ process to evaluate housing for the urban poor and incremental or ‘progressive development’ within settlements in developing countries. The research comprises a case study which examined 74 low income households in 11 urban settlements in Davao City, Philippines; a country which is classified as a lower-middle income country (United Nations 2015). Based on detailed site analysis, and comprehensive interviews with policy makers, NGOs and householders, the shelters were classified into five different types ranging from informal to formal housing types. The data revealed how the urban poor had become legal owners of formal housing units in due course. Formal housing status was achieved in one of three ways. Firstly, through a multi-step transition process whereby informal housing units were gradually upgraded to formal status. Secondly, through the provision of low cost housing units with assistance from the government for land development and security of tenure, and participation by NGOs to construct the housing. Thirdly, through the conventional provision of housing units by the government or the private sector; a one-step regularisation model. This research focuses on the role of citizen participation in housing provision. To do so, the multi-step transition process is examined with reference to interdisciplinary literature on the topic as well as the politics of citizen participation specific to the Philippines. This process tended to happen in two ways. Either, an inhabitant moved from one housing type to another in a different location, or, an informal housing unit was upgraded to become a formal housing unit in the same location. In the latter case, pro-poor housing policies, sites and services programmes and community mortgage programmes coupled with self-help housing initiatives and NGO assistance led to secure tenure, the physical development of the settlements, and finally the refurbishment of individual houses according to the building code. This multi-step transition process offers valuable lessons about effective and sustainable housing interventions which can enhance the status and well-being of the urban poor in developing countries. Moreover, the findings have the potential to inform housing policy in this sector.Thesis (Ph.D.) -- University of Adelaide, School of Architecture & Built Environment, 201

Assessment of housing for the urban poor in the four local Government units in southern Mindanao, Philippines

Paper presented at the XXXIII IAHS World Congress on Housing, 27-30 September 2005,"Transforming Housing Environments through Design", University of Pretoria.ABSTRACT: Shelter for the urban poor is always a problem in the process of urbanization in developing countries. The objective of this paper is to assess the demand and provision of urban poor housing in the four local government units in Southern Mindanao, Philippines. Home lot ownerships were accessed through government shelter programs, while houses were provided by the urban poor themselves and through the assistance of NGOs. Even if gaps between need and delivery are unavoidable in every shelter programs, but the participatory approach of this research contributed positively to the approaches in local housing policies. The evolution of slum into a more permanent urban fabric was illustrated, and this must be further understood for a more feasible shelter program.Authors of papers in the proceedings and CD-ROM ceded copyright to the IAHS and UP. Authors furthermore declare that papers are their original work, not previously published and take responsibility for copyrighted excerpts from other works, included in their papers with due acknowledgment in the written manuscript. Furthermore, that papers describe genuine research or review work, contain no defamatory or unlawful statements and do not infringe the rights of others. The IAHS and UP may assign any or all of its rights and obligations under this agreement

SHELTER FOR THE URBAN POOR IN SANPASADA

With urbanization comes the problem of shelter provision for the urban poor in developing countries like the Philippines. The objective of this paper is to assess the socialized housing provision for the urban poor in the local government units of the Municipality of Sta. Cruz, Panabo City, Island Garden City of Samal, and Davao City (also known as SANPASADA). The assessment of the physical stock as an indicator includes the provision of land and the housing structure.  The study shows that both local and national government units mostly assisted only in the lot acquisition of housing beneficiaries. The provision of housing structures was mostly provided through the initiative and ingenuity of the urban poor beneficiaries or with the assistance of the non-government organizations. Site development and the provision of infrastructure and utilities were done phase by phase through the initiative of the homeowners associations and from limited assistance of local government units.  It is generally recommended that to promote a comprehensive approach in the provision of shelter needs of the urban poor, both the local and national government units should encourage the active participation and collaboration with NGOs and urban poor beneficiaries

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ~30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

A multi-country analysis of COVID-19 hospitalizations by vaccination status

Background: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes. Methods: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed. Findings: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed. Conclusions: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history. Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities