Water Justice City Profile: Dar es Salaam, Tanzania

Translocal Learning for Water Justice. (WatJust) is an action-learning alliance led by Prof. Adriana Allen at the Development Planning Unit (DPU, University College London). Launched in September 2014, WatJust explores the transformative potential of alternative water supply arrangements—small-scale, low-cost management practices, and new configurations of water governance—undertaken for and by the peri-urban poor in three urban regions: Kolkata (India), Dar es Salaam (Tanzania) and Cochabamba (Bolivia). The documentation and analysis of these practices aims to build the foundations of an innovative, grounded and in-depth exploration of the extent to which such arrangements can enhance water justice in a context where unmet needs are growing fastest, and where conventional centralised networks are unlikely to become the norm any time soon. Foundational to the project is the establishment of a translocal learning alliance in collaboration with the three project partnerships. This report represents one of three profiles exploring the specific and localized manifestations of water injustices and alternative arrangements, mapping these approaches as a source of dialogue, comparison, and learning

Efficacy of Agricultural Extensions and Environmental Conservation Awareness on the Sustainability of Urban Agricultural Practice: Case of Daraja Mbili and Lemala Wards in Arusha City, Tanzania

Urban agricultural activities can have a minimum or a substantial contribution to the livelihoods of people. They can either conserve or pollute the environment and degrade the land. The information about ensuring agricultural productivity with less effect on the environment is dynamic and the causes of dynamisms are not clear. The study was conducted to examine the cause of dynamisms in relation to changing institutional frameworks and political regimes. The study used qualitative research design and a case study strategy and 60 respondents were interviewed. We did content analysis to analyse qualitative data. The findings revealed that agricultural extension services and trainings, as well as environmental conservation awareness about good agricultural practice were provided to farmers and non-farmers, although the success was not promising. The uncoordinated agricultural activities were rhetorically managed and sometimes managed in uncoordinated ways. In tune with provision of agricultural extension services and awareness of conserving the environment to farmers, the mere conservation of the environment was not successful, unless it had a possibility of increasing agricultural productivity and helping farmers to get their livelihood needs

Knowledge co-production for urban equality

This working paper serves as the basis for a critical examination of the notion of knowledge co-production. The paper examines how the idea of knowledge co-production has emerged in relation to the parallel but distinct concept of service co-production and the participatory development planning tradition. It also examines the variety of processes of knowledge co-production that may take place in the context of academic research. In doing so, the working paper highlights the centrality of knowledge co-production in the Knowledge in Action for Urban Equality (KNOW) project’s research strategy, with a focus on actionable knowledge that may support transformative trajectories towards urban equality. Such an approach is based on the view that knowledge production underpins the process, ethics, and outcomes of any urban development intervention

Health Effects of Pesticide Exposure among Formulators, Repackers and Store Workers in Nairobi, Kenya

Though it is widely believed that adverse health effects occur among farm workers who handle pesticides, few studies have been done to quantify the extent to which pesticide formulators, re-packers and store workers are affected. The present study assessed the prevalence of signs and symptoms of illness due to pesticide exposure among factory workers in Nairobi Kenya using a descriptive cross- sectional study design on consenting factory workers. A questionnaire was administered enquiring about their biodata, work practices and occurrence of signs and symptoms associated with pesticide poisoning. Data was coded, entered into MS Access database and analyzed using SPSS version 11.5. Test for significance was done using chi-square to identify key variables associated with pesticide poisoning. Workers who had been in employment for less than one year reported a higher prevalence of signs and symptoms associated to pesticide poisoning such as burning skin (P = 0.004) and dizziness (P = 0.006). Workers who handled organochlorine pesticide had higher prevalence of burning of skin (P = 0.002), convulsions (P = 0.003), twitching (P = 0.004), painful swallowing (P = 0.004), dermatitis (P = 0.019) and headache (P = 0.028) among other pesticide exposure related symptoms. Workers who had handled pesticides for a longer period of time appeared to have less signs and symptoms of pesticide poisoning probably suggesting that long term exposure to pesticides either imparted some form of acquired immunity to pesticides or that their longer experience resulted in better risk perception and management. Keywords: pesticide, organochlorine, organophospate, formulator, poisoning

Partnerships to improve access and quality of public transport - a case report: Dar es Salaam, Tanzania

This book presents findings from project R7786 Partnerships to improve access and quality of urban public transport for the urban poor carried out by the authors as part of the Knowledge and Research (KaR) programme of the Infrastructure and Urban Development Department, Department for International Development (DFID) of the British Government. The purpose of the project was to identify, explore, and document critical issues in the provision of transport services for and in low-income settlements in developing countries. The identified issues can be used at policy and operational levels to provide better transport services to low-income communities in urban areas. In the research methodology, a sustainable livelihoods framework was used to set the research framework. The city of Dar es Salaam has grown rapidly since the late 1940s. In the 1948 census the population was 69,227; by the census in 1957 it had grown to 128,742. During this period the city remained highly concentrated, with its boundaries on average less than five kilometres from the sea front or the then town centre. The growth has continued and the estimated population in 2000 was 2,286,730, with a continuing annual growth rate of about 4.5 per cent against the national average of 2.8 per cent

Long-Term Costs and Health Impact of Continued Global Fund Support for Antiretroviral Therapy

Background: By the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART) in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020. Methods and Findings: Survival on first-line and second-line ART regimens is estimated based on annual retention rates reported by national AIDS programs. Costs per patient-year were calculated from country-reported ARV procurement prices, and expenditures on laboratory tests, health care utilization and end-of-life care from in-depth costing studies. Of the 3.5 million ART patients in 2011, 2.3 million will still need treatment in 2020. The annual cost of maintaining ART falls from $1.9 billion in 2011 to$1.7 billion in 2020, as a result of a declining number of surviving patients partially offset by increasing costs as more patients migrate to second-line therapy. The Global Fund is expected to continue being a major contributor to meeting this financial need, alongside other international funders and domestic resources. Costs would be $150 million less in 2020 with an annual 5$150-370 million less with a 5%-12% annual decline in second-line prices, but $200 million higher in 2020 with phase out of stavudine (d4T), or$200 million higher with increased migration to second-line regimens expected if all countries routinely adopted viral load monitoring. Deaths postponed by ART correspond to 830,000 life-years saved in 2011, increasing to around 2.3 million life-years every year between 2015 and 2020. Conclusions: Annual patient-level direct costs of supporting a patient cohort remain fairly stable over 2011-2020, if current antiretroviral prices and delivery costs are maintained. Second-line antiretroviral prices are a major cost driver, underscoring the importance of investing in treatment quality to improve retention on first-line regimens

The contribution of international health volunteers to the health workforce in sub-Saharan Africa

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The human resource for health situation in Zambia: deficit and maldistribution

<p>Abstract</p> <p>Introduction</p> <p>Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care.</p> <p>Population and methods</p> <p>We used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them.</p> <p>Results</p> <p>The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers).</p> <p>The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces.</p> <p>This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763.</p> <p>In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other.</p> <p>The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus.</p> <p>Discussion and Conclusions</p> <p>This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity.</p

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the worlds child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 1519 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes. (c) 2023, The Author(s)

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.814.4 million) incident T2D cases, representing 70.3% (68.871.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.027.1%)), excess refined rice and wheat intake (24.6% (22.327.2%)) and excess processed meat intake (20.3% (18.323.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.487.7%)) and Latin America and the Caribbean (81.8% (80.183.4%)); and lowest proportional burdens were in South Asia (55.4% (52.160.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. (c) 2023, The Author(s)