Future Projections of Urban Waste Flows aand their Impacts in African Metropolises Cities

This paper presents future trends of urban wastes and their impacts on the environment of African cities using plausible mitigation scenarios. To accomplish this, an integrated dynamic model for urban waste flows was developed, tested, calibrated and validated. Its parameter sensitivity was analyzed. Using population projection up to 2052 with different levels of technological implementation, policy enforcement and awareness raising, four runs were executed. The “business as usual” run showed that with no additional mitigation measures, the environmental quality in Kampala and Dar es salaam Cities deteriorates. The “more enforcement” and “more collection” scenarios showed good reduction in environmental loads but they perform less well in resource recovery. The “proper management” scenario that combines enhanced technological implementation, awareness raising and policy enforcement, produced the smallest environmental loads, and recovered the largest amount of resources. Thus, the city authorities, general public, community based organisations and Non-governmental organizations would have to increase their efforts in finances and commitment to improve the urban environmental quality and increase resource recovery

Rationale and study design of a cross sectional study documenting the prevalence of Heart Failure amongst the minority ethnic communities in the UK: the E-ECHOES Study (Ethnic - Echocardiographic Heart of England Screening Study)

Background: Heart failure is an important cause of cardiovascular morbidity and mortality. Studies to date have not established the prevalence heart failure amongst the minority ethnic community in the UK. The aim of the E-ECHOES (Ethnic - Echocardiographic Heart of England Screening Study) is to establish, for the first time, the community prevalence and severity of left ventricular systolic dysfunction (LVSD) and heart failure amongst the South Asian and Black African-Caribbean ethnic groups in the UK.Methods/Design: This is a community based cross-sectional population survey of a sample of South Asian (i.e. those originating from India, Pakistan, Bangladesh) and Black African-Caribbean male and female subjects aged 45 years and over. Data collection undertaken using a standardised protocol comprising a questionnaire incorporating targeted clinical history taking, physical examination, and investigations with resting electrocardiography and echocardiography; and blood sampling with consent. This is the largest study on heart failure amongst these ethnic groups. Full data collection started in September 2006 and will be completed by August 2009.Discussion: The E-ECHOES study will enable the planning and delivery of clinically and cost-effective treatment of this common and debilitating condition within these communities. In addition it will increase knowledge of the aetiology and management of heart failure within minority ethnic communities

Endomyocardial Fibrosis: Still a Mystery after 60 Years

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either “endomyocardial fibrosis” or “endomyocardial sclerosis” in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution

"I think my body has become addicted to those tablets" Chronic heart failure patients' understanding of and beliefs about their illness and its treatment: a qualitative longitudinal study from Uganda

Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services.Serial qualitative in-depth interviews were conducted with Heart Failure patients who were purposively sampled and recruited in Mulago National Referral Hospital until thematic saturation was reached. In-depth interviews were conducted at three time points over the course of their illness with intervals of 3 months between interviews. A grounded theory approach was used in data analysis. The University of Edinburgh ethics committee, Mulago Hospital Research Ethics committee and the Uganda National Council of Science and Technology (Reference numbers D/GC/178; MREC 33, SS 3083 respectively) approved the research.A total of 40 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer), were conducted with 21 patients. The findings revealed that heart failure patients were unaware of the symptoms of the illness and their definition of illness differed from that of health professionals. Patients understood their diagnosis, cause of illness, prognosis and the importance of the medicines differently from health professionals, and had insufficient information on self-care. Lay beliefs were used to explain many aspects of the illness and treatments. All these influenced where patients sought care and their adherence to treatment, self-care and follow up leading to uncontrolled disease.There is a high level of health illiteracy among heart failure patients in Uganda. Patients rely on lay beliefs to make health decisions and medical information is often miscomprehended. There is an urgent need for health education using culturally appropriate information

Simulating sanitation and waste flows and their environmental impacts in East African urban centres

Simulating Sanitation and Waste Flows and their Environmental Impacts in East African Urban Centres Abstract If improperly managed, urban waste flows can pose a significant threat to the quality of both the natural environment and public health. Just as many urban authorities in other developing countries, most cities in the vicinity of Lake Victoria (East Africa) have been unsuccessful in providing adequate solid waste and sanitation services to their residents. To effectively manage urban waste flows, the current and future trends for the solid waste and sanitation flows and their environmental impact need to be assessed. A model was developed that represents waste flows management through the social and natural systems of East African cities. This simulation tool was designed to enable the projection of future waste flow trends and their environmental impacts under different management regimes. The results for the model simulations indicate that the annual organic load to the inshore of Lake Victoria increased twofold between 2001 and 2011. The model projections also show that a lack of optimal measures to mitigate various waste flows would further deepen the current environmental crisis in the near future. The executed multi-criteria analysis reveals that mixtures of diverse waste technologies and management regimes matching with local socio-economic and environmental conditions have a positive impact on East African cities’ environmental quality. The integration of resource recovery into the formal waste management sector is found to improve the environmental performance of waste sector in East African cities. These results contribute to the development of an integrated policy support approach, which aims at strengthening the sustainable management of urban waste flows in East African cities. This could then form the basis for improving the urban environmental quality in these cities. Also, in agreement with the modernised mixture approach, this study can conclude that applying a mix of diverse waste technologies and management regimes, and matching these with the local conditions in each city will have positive impacts on East African cities’ environmental quality. This diversity in waste technologies and management strategies for waste flows should be driven by modernised mixture principles. This would safeguard the water quality for Lake Victoria from pollution by waste, and improve the well-being of humans depending on the lake.</p

The determination of an optimal waste management scenario for Kampala, Uganda

The quality of the environment in the city of Kampala is deteriorating. The city needs a novel waste management approach to improve the environmental quality in its heterogeneous settlement patterns. Earlier, an integrated urban waste flow model (IUWFM) was applied to project the future waste flows and their impacts on the environment of Kampala using four waste management scenarios. These scenarios were ‘business-as-usual’, ‘more enforcement’, ‘more collection’ and ‘proper management’. The robustness of the scenario results was determined by using a multi-criteria decision analysis. Twenty-four criteria were identified and grouped as environmental, economic, social, technological and general. Equal weights were assigned to these five sets of criteria. The four scenarios were evaluated against all criteria, and a sensitivity analysis was performed on the role of the equal weights on the choice of the scenarios. The results showed that ‘proper management’ scenario, which integrates diverse technologies and management programs matching with the local context, is the optimal approach to improve Kampala’s environmental quality. Scenarios that emphasized more waste collection, but less resource recovery were ranked in the middle. The scenario of maintaining the status quo performed worst. Application of a mix of diverse technologies and management programs matching the local conditions is the most optimal solution to improve Kampala’s environmental quality

Comparison of environmental performance for different waste management scenarios in East Africa: The case of Kampala City, Uganda

Poor waste flows management in East African cities has become an environmental and public health concerns to the city authorities and the general public. We assessed the environmental impacts of waste recycling in Kampala City, for four designed waste management scenarios, namely: (1) Scenario S1 representing the current status quo, (2) Scenario S2 maximizing landfill, (3) Scenario S3 combining composting, resource recovery, landfill and sewerage, and (4) Scenario S4 integrating anaerobic digestion, resource recovery, landfill and sewerage. These scenarios are quantitatively assessed for environmental impacts of global warming, acidification, nutrient enrichment, photochemical ozone formation, water pollution and resource conservation. Sensitivity analyses are performed on the robustness for the ranking of the scenarios. Scenario S4 integrating anaerobic digestion, resource recovery, landfill and sewerage performs best for all environmental impact categories. Sensitivity analysis shows that this assessment result is robust. Therefore, integrating waste recycling into the formal waste management system for Kampala would considerably reduce the environmental impacts of waste flows. Also, considering the similarities in municipal solid waste compositions, sanitation systems and settlement patterns among the large cities in East Africa, assimilating waste recycling into the formal waste management systems for these cities would results in minimal environmental impacts for their waste flows

Occurrence of crystal arthropathy in patients presenting with synovitis in Nairobi

Background: Crystal arthropathies represent a heterogeneous group of skeletal (musculo-skeletal) diseases associated with the deposition of mineralized material within joints and periarticular soft tissues. Gout is the most common and pathogenetically best understood crystal arthropathy, followed by basic calcium phosphate and calcium pyrophosphate dihydrate deposition diseases, and, in very rare cases, calcium oxalate crystal arthropathy. In Kenya there are no studies to demonstrate the prevalence of these diseases. This study endeavored to describe the different types of crystals seen in patients with synovitis in Nairobi from 1st January 2012 to 31st January 2014. Objective: To describe different types of crystals seen in patients with synovitis in Nairobi. Design: Descriptive prospective cross sectional study. Results: There were 260 samples received from patients with synovitis. Of them, 61 (23.5%) were from males while 199 (76.5%) were from females. The age range of the patients was from 14 – 110 years. The mean, median and mode were 59.6, 60 and 55 years respectively. Majority of the patients were in the 51-60 years age category. Most of the patients recruited had no crystals (n=211; 81.2%) diagnosed, with 14.2%(n=37) having uric acid crystals and 4.6 % (n=12) having CPPD crystals. For the patients who had uric acid crystals (n=37), when gender was cross tabulated against microscopy, males (n=32; 86.5%) were noted to have more uric acid crystals than females (n=5; 13.5%). Among patients diagnosed with CPPD (n=12), there were more females (n=9; 75%) patients compared to males (n=3; 25%). From the total population recruited (n=260), when age range categories were cross tabulated against microscopy, the age ranges 41-50 (n=9; 3.5%) 51-60 (n=12; 4.6%), and 61-70 (n=6; 2.3%) were noted to have more uric acid crystals than any other age category recruited. Patients in the age category 61-70 (n=6; 50 %) had more CPPD crystal detections than any other age category from the patients recruited. Conclusion: Crystal arthropathy is a major cause of synovitis in patients seen in Nairobi