Urban environmental challenges in developing countries—A stakeholder perspective

Developing countries face significant urban environmental challenges due to rapid urbanisation, population growth, inability to effectively tackle climate and environmental risks, inefficient governance and environmental management, the prevalence of corruption and a chronic shortage of investment. Environmental degradation is often acute in politically unstable countries such as Iraq. Several post-war urban development and regeneration projects are currently underway in Iraq, but without evident participation from the wider public in decision-making. This study investigated stakeholders’ perception of urban environmental challenges—their level of importance and priority in the Iraqi context. A nationwide survey (n=643) was conducted using a 25-item structured questionnaire where respondents’ views were gathered on a 5-point Likert-type scale, in addition to demographic information. Principal component analysis (PCA) and statistical tests were applied to investigate the relationship between the perceptions of urban environmental challenges and demographic factors. Five principal components were identified, namely: water, waste, and materials; environmental impact; natural hazard; personal mobility; and transport. The results showed that about 70% of the respondents considered ‘water conservation’ as the most important urban environmental challenge, followed by ‘increase choice of transport modes’. 67.2% of the respondents rated ‘efficient infrastructure and utilities’ as a very important factor, and was ranked the third. All demographic characteristics except location showed statistically significant differences in perception. The relatively high importance placed by the respondents on infrastructure related items such as water, transport and utilities demonstrate a possible link between the perceptions and: (a) the citizens’ day to day experience and hardship, and (b) the lack of adequate infrastructure and service provisions in Iraq, due to political instability in the recent decades

A framework for the sustainability assessment of urban design and development in Iraqi cities

The assessment of urban sustainability is increasingly being seen as essential to mitigate the undesirable impacts of urbanisation in cities while improving communities’ resilience to environmental, social and economic changes. Several urban sustainability assessment tools (USATs) have been developed to make such informed decision-making. In addition to their role as an enabler for stakeholder engagement and increased public awareness throughout the lifecycle of an urban development project, USATs act as a catalyst to increase market demand for sustainable products and services by providing a mechanism for recognising excellence. Most current USATs have been developed based on the needs of developed nations which are different from those of developing countries, especially those affected by natural disasters and man-made events e.g. wars. Iraq has endured several decades of war and subsequent international sanctions which have affected its overall economy, infrastructure, public services and utilities. In consequence, rebuilding, rehabilitation and the development of new cities and urban areas are currently underway but without evidence of attention to sustainability and public participation in decision-making. This research aimed to investigate the factors affecting urban sustainability in Iraq through a literature review and stakeholder consultations, leading to the development of a comprehensive sustainability assessment framework for urban design and development projects. The proposed framework included attention to the local environmental, social and economic aspects and urban challenges, in addition to how to promote awareness and stakeholder participation. The methodology included: (a) an analytical comparison of a range of global USATs to define relevant urban indicators; (b) determination of the urban challenges in the Iraqi context, through an extensive review of the literature; (c) investigation of key local urban challenges from the stakeholder perspective by conducting a nationwide questionnaire, and (d) identification and prioritisation of local assessment factors by consultation with a panel of experts, conducting a consensus-built method and application of the Analytic Hierarchy Process (AHP) to allocate credits and rating formulas. This comprehensive consultation methodology is a unique contribution of the research to identify the key quantitative and qualitative assessment factors. The Iraqi urban sustainability assessment framework (IUSAF) comprises of 89 urban factors, ten of which are mandatory, which can be considered fundamental urban factors to assess the sustainability of a project. The results have revealed that ‘water’ was ranked as the most important factor with 8.5% of the total weight, ‘safety and security’ was second at 7.9 %, followed by ‘transportation and infrastructure’, ‘housing’, and ‘local economy’, demonstrating a link between deficiencies in the provision of environmental and socio-economic infrastructure in Iraq. These findings evidence that the IUSAF is based on an understanding of key local urban challenges and issues, this significantly different from a range of USATs currently in use, regarding urban factors (indicators, sub-indicators), their priorities and weighting systems. The IUSAF was validated using three urban development case studies of varying complexities. The applicability analysis reported the IUSAF as appropriate to assess urban sustainability. The final results of the testing process have validated the need for IUSAF to assess existing urban design and development which has been planned and developed in an unsustainable manner. IUSAF stands to create many substantial benefits as it has the capacity to raise awareness about urban sustainability issues for developers, specialists and decision-makers and to constitute a plan of action for current and new urban development projects in Iraqi cities

Coastal community resilience frameworks for disaster risk management

Extreme weather events due to climate change and growing economic and development activities along coastlines have resulted in increased risks from natural and human-induced disasters—affecting the safety and livelihoods of coastal communities. Assessing community resilience to disasters is, therefore, an essential step toward mitigating their current and future risks. This study provides a systematic review of coastal community resilience frameworks for disaster risk management, covering their content, structure, and assessment. Sixty-four critical resilience criteria under four dimensions are identified by analyzing the convergence and divergence of the consideration of assessment indicators in the reviewed frameworks. Existing frameworks focus mostly on ‘governance and institutions,’ ‘infrastructure,’ and ‘society and the economy.’ Despite significant risks, the impacts on the environment and potential risks of climate change are not prioritized. Only 22% of the frameworks consider future risks, rendering the remainder inadequate for assessing projected risks from climate change. None of the frameworks consulted the full spectrum of stakeholders (public, government, and experts) during the development process, which compromised their applicability, acceptability, and effectiveness. 56% of the frameworks considered a single hazard type. Community resilience is inherently multi-dimensional. Therefore, the interrelationships between multiple hazards should be adequately addressed in future frameworks

Urban sustainability assessment framework development: The ranking and weighting of Iraqi indicators using analytic hierarchy process (AHP)

The consideration of local contexts in urban sustainability assessment is important for developing countries because of their varying needs and priorities. Using Iraq as a case study, a stakeholder-driven structured methodology is presented which identifies and ranks context-relevant indicators and assigns weights for aggregating indicator scores by applying analytic hierarchy process (AHP). Results indicate that the identified factors and their weights and priorities for Iraq were markedly different from the widely-used tools — suggesting that global tools are not directly applicable in developing countries. In contrast with the ‘ecological’ focus in the global assessment frameworks, economic and infrastructural aspects of urban development are of greater importance in developing countries. Decades of political instability and the resulting deterioration of infrastructures in Iraq are manifested in the related indicators being rated highly important by the stakeholders, and their corresponding high weighting in the developed Iraqi urban sustainability assessment framework (IUSAF). ‘Water’, ‘safety’, and ‘transportation and infrastructure’ indicators were awarded high weighting scores of 8.5%, 7.9% and 7.8%, respectively. IUSAF is envisaged to play a key role in the promotion of built environment sustainability in Iraq by stimulating market demand for sustainable buildings, cities and conurbations

Environmental, social and economic challenges for urban development: stakeholder’s perception in a developing economy

Due to rapid urbanization, more than half of the world's population now live in cities. By the year 2050, the urbanized population will increase to two–thirds of the global population, which prompted increased international attention to identifying environmental, social and economic challenges of urban development encompassing diverse aspects such as energy, water, waste, infrastructure, transportation, public services, and housing. Public perception of the intrinsic indicators is essential to enhance their participation in the process, especially in the developing countries that are undergoing significant changes requiring buy-in from the stakeholders. A nationwide survey (N=620) was carried out in Iraq using a 29-item structured questionnaire to investigate environmental, social and economic challenges of urban development with reference to Iraq. The items were identified through an extensive review of the literature, which was reduced dimensionality using principal component analysis (PCA). In addition to applying statistical tests on the responses to investigate the relationship between the items and demographic characteristics. Seven principal components have been identified, namely, minimize impacts; water, materials and waste; culture and investments; natural hazards; mobility and transportation; and safety. The item Safety of public places was ranked as the most important factor between urban indicators, followed by Water Conservation, Preservation of historic buildings, and Increasing housing projects, respectively. While, the item Earthquakes from the natural hazard group was classified as the least important indicator between all items. The study concluded the necessity to identify environmental, social and economic challenges of urban development in different urban environments, through the investigation of stakeholder perspectives and analysis the urban indicators by adopting computer-based assessment approach for raising the concerns and proving the validity, accuracy, and reliability of the survey data. The local priorities of urban development challenges have been identified that is represent a fundamental step to support communities in making a decision that is considered a very crucial concern for planners, designers, and policy-makers to achieve a healthy environment, social well-being, and economic prosperity toward adopting the long- term sustainability of urban development projects

The Association of Hypertension with Increased Mortality Rate During the COVID-19 Pandemic: An Update with Meta-analysis

Background and Aim The impact of multiple risk factors on COVID-19 mortality has been previously reported in multiple systematic reviews and meta-analyses. The aim of this review is to provide a comprehensive update on the association between hypertension (HTN) and mortality in patients with COVID-19. Methods A systematic review and meta-analysis were performed and followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A search was achieved using PubMed, Scopus, and Cochrane Databases for research publications on hypertension, COVID-19, and mortality published between December 2019 and August 2022. Results A total of 23 observational studies involving 611,522 patients from 5 countries (China, Korea, the UK, Australia, and the USA) were included in our study. The confirmed number of COVID-19 with HTN cases in each study ranged from 5 to 9964. The mortality ranged from 0.17% to 31% in different studies. Pooled results show that the mortality rate of COVID-19 among the included studies ranges from a minimum of 0.39 (95% CI 0.13–1.12) to a maximum of 5.74 (95% CI 3.77–8.74). Out of the 611,522 patients, 3119 died which resulted in an overall mortality prevalence of 0.5%. Subgroup analyses indicated that patients with COVID-19 who have hypertension and male patients had slightly less risk of mortality than female patients [the percentage of men > 50%; OR 1.33: 95% CI (1.01, 1.76); the percentage of men ≤ 50%: OR 2.26; and 95% CI (1.15, 4.48)]. Meta-regression analysis results also showed a statistically significant association between hypertension and COVID-19 mortality. Conclusion This systematic review and meta-analysis suggest that hypertension may not be the only risk factor associated with the increased mortality rate during the COVID-19 pandemic. In addition, a combination of other comorbidities and old age appears to increase the risk of mortality from COVID-19.We thank Dr. Osama Amer for assistance in data cleaning. The publication of this article was funded by Qatar National Library.Scopu

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Sustainability assessment methods of urban design: a review

Cities are responsible for 70% of greenhouse gas emissions, as well as the depletion of agricultural land and natural resources. The sustainable urban design can achieve the required balance, in addition to measuring convergence with sustainable development and the possibility of dealing with long term urban problems. It also encourages community participation by involving people in the design process through its various stages, and asks them to contribute to decision-making, which represents one of the foundations of collective action in creating sustainable urban design. The vision of this paper is to clarify the concept of sustainability assessment of urban design. The analysis of current situations is based on a critical review and comparison among six assessment tools from the UK, USA, Japan, Portugal, UAE and Qatar. The study focuses on finding out the strengths, weaknesses, the content use, weighting, scoring, certificates rating and context of the assessment tools. The findings of this study suggest that the existing assessment tools focus on environmental issues; and some extent social issues of sustainable urban design, while economic indicators are not emphasized in any of the tools, with ambiguity in the mechanism of local adoptions and community participation