Characterizing the spatial mismatch between intimate partner violence related healthcare services and arrests in Miami-Dade County, Florida

Abstract Background Routine screening and intervention for intimate partner violence (IPV) in healthcare settings constitutes an important secondary prevention strategy for identifying individuals experiencing IPV early and connecting them with appropriate services. Considerable variation in available IPV-related healthcare services exists and interventions are needed to improve the quality of these services. One way to prioritize intervention efforts is by examining the level of services provided in communities most at risk relative to local incidence or prevalence of IPV. To inform future interventions, this study examined the spatial relationship between IPV-related healthcare services and IPV arrests in Miami-Dade County, Florida, and identified predictors of the observed spatial mismatch. Methods Survey data collected in 2014 from 278 health facilities pertaining to IPV services were geocoded, computed into a density layer, and aggregated at the census tract level to create a population-based normalized comprehensiveness score (NCS) as a proxy for IPV-related healthcare resources. IPV arrests from 2011 to 2015, collected from the county court, were geocoded and summarized by census tracts to serve as a proxy for IPV prevalence. These measures were combined into a resource disparity score (RDS) that compared relative service density to relative arrest rates, where positive RDS represented over-resourced neighborhoods and negative RDS corresponded to under-resourced neighborhoods. We used correlation analyses and a two-phase spatial modeling approach to evaluate correlates of NCS and RDS. Results A spatial lag model did not yield an association between NCS and IPV arrests, demonstrating a spatial mismatch, which we visualized using a Geographic Information System (GIS). A spatial error model revealed that the percentage of white non-Hispanic residents was positively associated with RDS, while percent black non-Hispanic, median age, ethnic heterogeneity, and economic disadvantage were negatively associated with RDS. Conclusions These findings underscore the need to further evaluate the adequacy of IPV-related healthcare resources for secondary prevention relative to local IPV arrest rates, particularly within economically disadvantaged neighborhoods. Our approach demonstrates the utility of GIS for identifying potential priority regions for IPV prevention efforts and resource allocation

Household water insecurity experiences and their perceived determinants in a low-income community of Cartagena, Colombia, during a water service expansion project

Traditional water indicators primarily focus on water quantity and quality, but emergent research demonstrates that measurement of lived experiences with water availability, accessibility, and use is important for understanding how household water insecurity impacts health and well-being. Few empirical studies have explored which household water insecurity experiences are most salient, or their potential causes, in Latin American cities. We analyzed data from 266 households in a low-income settlement of Cartagena, Colombia, to identify correlates and perceived determinants of water insecurity. The most prevalent household water insecurity experiences were water supply interruptions (96%), water worry (94%), and anger about the water situation (90%). Unexpected water interruptions and use of non-piped primary drinking water sources were associated with greater household water insecurity scores, water worry subscores, and hygiene subscores. Respondents perceived water issues in their community to be caused by deficiencies in gray infrastructure (49%), which included deficiencies in water distribution, treatment, or storage technologies. Social infrastructure (36%), including issues with political, economic, or administrative systems, was also cited as a barrier to water security. We did not detect significant relationships between water insecurity scores and the attribution of these problems to gray or social infrastructure, but there may be relationships between these factors and duration of residency and using a non-piped water source. These findings underscore the importance of socio-political factors and community engagement for improving urban water insecurity through slum-upgrade projects

In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle income countries

Introduction: Water fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean. Methods: In a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model. Results: Thirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (OR 1.50, 95% CI 1.15 to 1.96); rural (OR 4.80, 95% CI 2.83 to 8.15) or periurban residence (OR 2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (1.09, 95% CI 1.07 to 1.10) and reliance on surface water (OR 1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (OR 1.72, 95% CI 1.19 to 2.49). Conclusion These data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions

Connecting the dots between climate change, household water insecurity, and migration

Climate change is now considered a primary global driver of migration, with water insecurity theorized to be a key determinant. Most studies have focused on large-scale climate migration events triggered by extreme weather events such as droughts, storms, or floods. But there are few studies of how climate change shapes the everyday household-level experience of water insecurity and subsequent migration decision-making, beyond the contexts of disasters and agricultural livelihoods—an invisible ‘slow drip’ of migration. This review proposes a complementary, alternative framework for linking climate change, household-level water insecurity, and environmental migration by positioning household water insecurity as a critical pathway for shaping migration decision-making in the context of socio-environmental change. We present evidence that household water insecurity is a push factor that motivates household members to migrate due to water-related disruptions to physical and mental health, livelihoods beyond agriculture, and social relationships. We close with implications for anti-poverty and development initiatives, and for water interventions to mitigate forced climate migration

Tapping customers: a spatially-explicit, open-source platform for crowdsourcing water service data in Ghana

Municipal water rationing has become increasingly common in developing urban centres, leading to substantial variation in service levels among residential customers. This paper introduces an open-source tool called Improving Quality of Urban Water Service by Engaging SMS Technology (IQUEST), a geographic decision support system that harnesses crowdsourced water data to enable Ghana Water Company Limited (GWCL) to monitor residential water service quality in Accra, Ghana. This paper presents the conceptual model, general architecture, and user interface, and highlights the potential for other municipal water managers to implement a decision support tool in a resource-constrained setting

Advancing human capabilities for water security: A relational approach

We argue that a relational water security framework informed by the capabilities approach offers new ways to consider politics and cultures of water. Each dimension allows us to better contextualize water security beyond just an object (H2O) to be secured for a certain population. Instead, the relational perspective demands a fuller consideration of the political structures and processes through which water is secured, with emphasis on the social relations of access as opposed to simply the politics around water supply. We also attend to cultural dimensions, such as the meanings of water and customary practices that are not easily captured by standardized metrics. By including these dimensions, we necessarily broaden analytical space to evaluate water security as a relational and dynamic process tied to lived experience rather than as solely parameterized conditions in relation to access, quality, or availability of water. We first move to explain our broader conceptualization of water security as linked to human capabilities, then explore in more detail the specific engagements with politics and culture in the sections that follow

Evidence of recent dengue exposure among malaria parasite-positive children in three urban centers in Ghana.

Blood samples of 218 children ages 2-14 years old with confirmed malaria in hospitals across Ghana were tested for dengue virus exposure. We detected dengue-specific immunoglobulin M (IgM) antibodies in 3.2% of the children, indicating possible coinfection, and IgG antibodies in 21.6% of them, which suggests previous exposure. Correlates of exposure are discussed

Development and Validation Protocol for an Instrument to Measure Household Water Insecurity Across Cultures and Ecologies the Household Water InSecurity Experiences (HWISE) Scale

Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts. Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which waterrelated problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups. Ethics and dissemination Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful

The Household Water InSecurity Experiences (HWISE) Scale: Development and Validation of a Household Water Insecurity Measure for Low-Income and Middle-Income Countries

Objective Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings. Methods Cross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models. Findings Twelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach’s alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold \u3c25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established. Conclusions The HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water

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