Challenges and solutions for the eradication of sanitation backlogs in the policy context of Free Basic Sanitation

Despite the constitutional obligation for municipalities to provide Free Basic Sanitation (FBSan) services to all, many people living in informal settlements in South Africa are still lacking access to adequate sanitation facilities. This study used qualitative methods to examine challenges and identify solutions for the eradication of sanitation backlogs in informal settlement of South Africa in the policy context of the FBSan. Findings suggest that the disconnection between the policy and its application in practice has created a deep divide between the service providers and consumers as recipients of the services. Consumers’ perceptions and expectations are a major barrier to the acceptance of the sanitation services provided by municipalities, often resulting in violent protests. Service providers face challenges when addressing the disjuncture between what people aspire to and what is possible in providing sanitation services. These findings infer that consumers’ needs, sanitation practices and settlement conditions should be thoroughly examined prior to the selection and deployment of sanitation facilities in informal settlements. Consumers should be engaged and involved in the choice of sanitation technologies and facilities. Such engagement should evolve around various sanitation technologies and facilities applicable to the nature and context of informal settlements, so as to address negative perceptions, attitudes and behavior concerning services provided by municipalities. Addressing challenges related to the eradication of the sanitation backlogs in the policy context of FBSan services needs to be grounded in the clarification of sanitation policy, a deep understanding of consumers’ needs, challenges and practices as well as settlements conditions, coupled with meaningful consumers’ participation at various stages of the decision-making process and coordination amongst institutions involved. Municipalities need to engage all stakeholders (mainly consumers) in order to ensure that the selected infrastructure and service level deployed are consensual. Unless subjective clauses of the FBSan policy are clarified, monitoring, enforcement and accountability mechanisms established and implemented and, consumers are engaged in the decision making processes, the eradication of sanitation backlogs in informal settlements as currently planned may not materialize

A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy

Background: Urinary tract infections (UTIs) are common in pregnancy and account for the highest proportion of primary care antibiotic prescriptions issued to pregnant women in the UK. It is well known that antibiotic use is associated with increased antimicrobial resistance and therefore measures to minimise antibiotic use for UTI prevention have been studied. The efficacy and safety of these measures in pregnancy have not been addressed and therefore the aim of this study was to systematically review the literature to identify and evaluate potential measures to prevent UTIs in pregnant women. Methods: Ten databases (EMBASE, AMED, BNI, CINAHL, Medline, PubMed, PsycINFO, Cochrane Trials, Scopus and Science Direct) were systematically searched in July 2017 for studies reporting non-antibiotic measures to prevent UTIs in pregnancy. The terms (“urinary tract infection”or UTI or bacteriuria or cystitis) AND (prevention) AND (pregnan*) were used. The quality of the publications was appraised using the Critical Appraisal Skills Programme (CASP) checklists for cohort study, case-control study and randomised controlled trial. The results were synthesised using a textual narrative approach. Results: Search results yielded 3276 publications and after reviewing titles and removing duplicates, 57 full text articles were assessed for eligibility and eight were included in the review. Five different approaches (hygiene measures, cranberry juice, immunisation, ascorbic acid and Canephron® N) have been identified, all of which are reported to be safe in pregnancy. Conclusion: The quality of the evidence varied considerably and only hygiene measures were supported by evidence to be recommended in practice. Future work needs to concentrate on strengthening the evidence base through improved design and reporting of studies with a focus on immunisation, ascorbic acid and Canephron® N

Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21 st Newborn Case-Control Study protocol.

Background: INTERBIO-21 st is Phase II of the INTERGROWTH-21 st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21 st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment

Reimagining invasions; the social and cultural impacts of Prosopis on pastoralists in Southern Afar

Abstract Whilst the environmental impacts of biological invasions are clearly conceptualised and there is growing evidence on the economic benefits and costs, the social and cultural dimensions remain poorly understood. This paper presents the perceptions of pastoralist communities in southern Afar, Ethiopian lowlands, on one invasive species, Prosopis juliflora. The socio-cultural impacts are assessed, and the manner in which they interact with other drivers of vulnerability, including political marginalisation, sedentarisation and conflict, is explored. The research studied 10 communities and undertook semi-structured interviews and focus group discussions with pastoralists and agro-pastoralists. These results were supported by interviews with community leaders and key informants. The benefits and costs were analysed using the asset-based framework of the Sustainable Livelihoods Framework and the subject-focused approach of Wellbeing in Development. The results demonstrate that the costs of invasive species are felt across all of the livelihood capital bases (financial, natural, physical, human and social) highlighted within the framework and that the impacts cross multiple assets, such as reducing access through blocking roads. The concept of Wellbeing in Development provides a lens to examine neglected impacts, like conflict, community standing, political marginalisation and cultural impoverishment, and a freedom of definition and vocabulary to allow the participants to define their own epistemologies. The research highlights that impacts spread across assets, transcend objective and subjective classification, but also that impacts interact with other drivers of vulnerability. Pastoralists report deepened and broadened conflict, complicated relationships with the state and increased sedentarisation within invaded areas. The paper demonstrates that biological invasions have complex social and cultural implications beyond the environmental and economic costs which are commonly presented. Through synthesising methodologies and tools which capture local knowledge and perceptions, these implications and relationships are conceptualised