Free and simple GIS as appropriate for health mapping in a low resource setting: a case study in eastern Indonesia

Background: Despite the demonstrated utility of GIS for health applications, there are perceived problems in low resource settings: GIS software can be expensive and complex; input data are often of low quality. This study aimed to test the appropriateness of new, inexpensive and simple GIS tools in poorly resourced areas of a developing country. GIS applications were trialled in pilot studies based on mapping of health resources and health indicators at the clinic and district level in the predominantly rural province of Nusa Tenggara Timur in eastern Indonesia. The pilot applications were (i) rapid field collection of health infrastructure data using a GPSenabled PDA, (ii) mapping health indicator data using open source GIS software, and (iii) service availability mapping using a free modelling tool. Results: Through contextualised training, district and clinic staff acquired skills in spatial analysis and visualisation and, six months after the pilot studies, they were using these skills for advocacy in the planning process, to inform the allocation of some health resources, and to evaluate some public health initiatives.Conclusions: We demonstrated that GIS can be a useful and inexpensive tool for the decentralisation of health data analysis to low resource settings through the use of free and simple software, locally relevant training materials and by providing data collection tools to ensure data reliability

Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia<br />

The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC) and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season), modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes

The Vulnerability of Groundwater Resources to Climate Change in Timor-Leste. Prepared for the Australian Government Department of Climate Change and Enerfy Efficiency by B. Mayers, R. Fisher, T. Paul P. Wurm. A. Campbell, Research Institute for the Enviro

This report is part of a two part study of the vulnerability of Timor-Leste&rsquo;s ground water resources, and those who use them, to predicted climate change.In this part of the study by Charles Darwin University (CDU) we focus on potential impact and adaptive capacity to address the vulnerability of Districts to water availability, and provide recommendations for water management. The second part of the study, by Geosciences Australia and presented separately, investigates the biophysical vulnerability of Timor Leste (of the aquifers) to climate change.This report uses a mixed methods approach including:&bull; Review of current climate change predictions&bull; Review of information about aquifer characteristics, provided by the GA study&bull; Assessment of exposure of aquifers to pressure by groundwater users, by reviewing population distribution and growth&bull; Evaluation of adaptive capacity of groundwater users, using census data on indicators of wealth, and field interviews about use and management of water resources.Using these methods we identify priority areas for action in water management and current and potential adaptation options. These options link readily to the National Adaptation Programmes of Action for Timor-Leste (NAPA), and we have also ranked them broadly in terms of predicted cost of implementation.Timor-Leste is a small island developing state, located in the eastern part of the lesser Sunda Islands archipelago. Topography is rugged, with the central mountains of the island reaching altitudes of almost 3000m. The climate is monsoonal, and annual rainfall varies with elevation and aspect, from less than 1000mm in some coastal areas to over 2500mm in the wettest high altitude areas. Timor-Leste has a complex geology and much of the bedrock is sedimentary calcareous rock with shallow soils of low water holding capacity, high alkalinity and low nutrient content.According to the national census, in 2010 Timor-Leste had a population of 1.07 million. Population growth is high (2.4%), fertility rate is high (5.7 births for each fertile aged woman) and the population is relatively young (41% under 14 years, 54% between 15-66 years, and about 5% over 65 years).Already, water insecurity is widespread in Timor-Leste and is a major limitation of food security and livelihoods. Low-input agriculture is the main economic activity in Timor-Leste, with over 86% of households involved in subsistence farming. The main staple crops are rice, maize and cassava, with the limited rice production on the coastal plains fed by gravity irrigation and maize widely grown on the uplands.Geoscience Australia has classified aquifer types in Timor-Leste according to geology and &ldquo;prospectivity&rdquo;, i.e. potential flow rates or yields. The major aquifer types in Timor-Leste are:&bull; Sedimentary aquifers with intergranular porosity, which have potential to hold large amounts of groundwater. Alluvial sedimentary aquifers have potential to be high yielding aquifers, with higher yield associated with greater porosity where sediments are more well-sorted (e.g. Dili).&bull; Limestone karstic aquifers with fissured porosity are associated with many springs fed by groundwater and are sensitive to rainfall. In limestone areas, groundwater recharge, storage and yield are affected by the age of the system which determines whether fissures and channels have formed (e.g. in and around Baucau).&bull; Fractured rock aquifers with localised porosity are low yielding and usually only sufficient for household use and animal watering. There is little or no porosity and groundwater is stored in existing fractures, with new channels not becoming larger with time (e.g. Lequidoe in Aileu District).A substantial proportion (about 33%) of the population live on high yielding sedimentary aquifers, particularly on the coast, such as in Dili District, however, most of the population (44%) live on localised aquifers in the highlands (approximately equally on high yielding karst and low yielding localised fractured rock aquifers aquifers).Uncertainty in climate change projections for Timor-Leste is relatively high because Timor-Leste is a similar in size to the grid cells of the models used for projections, has variable topography and little climatic data with which to test the validity of the models that underpin the projections.The most recent climate projections for Timor-Leste have been published by the Pacific Climate Change Science Program (www.pacificclimatechangescience.org). These projections include:&bull; warming of average air and sea temperatures (by 0.4-1.0oC by 2030 under a high emissions scenario);&bull; decrease in dry season and increase in wet season rainfall;&bull; extreme rainfall events to occur more frequently;&bull; decrease in frequency and increase in high intensity cyclones;&bull; sea level rise will continue (by 6-15cm by 2030 under a high emissions scenario)&bull; ocean acidification will continue.Impacts of climate change are discussed within the following framework:Exposure of groundwater resources to climate change were derived from prospectivity of aquifers as determined by Geoscience Australia. Sensitivity of groundwater resources was mapped by overlaying relative aquifer yield and modelled annual rainfall. Areas along the central northern coast and in Oecussi are expected to be particularly sensitive. Sensitivity was also considered in terms of population pressures, both density and rate of change.Potential impacts of climate change were a function of expected exposure to climate change and sensitivity to those changes. High potential impact was identified in several areas on low yielding, localised aquifers: Liquica District, with low rainfall west of Dili; the Districts of Ainaro, Aileu, Bobonaro, and Ermera, with high and rapidly growing populations; Oecussi District, with high population growth and low rainfall. The major towns of Dili and Baucau can also be considered sites of high potential impacts because of high population densities and high population growth rates. This is despite having relatively high yielding aquifers: high yielding sedimentary aquifer in the case of Dili and high yielding fissured aquifer in the case of Baucau. In addition, the surrounding hills are underlain by low yielding fractured rock aquifers.Vulnerability to climate change is a product of potential impacts and adaptive capacity.High adaptive capacity can minimise the vulnerability of a community or nation in the face of high potential impacts. Adaptive capacity is influenced by many factors, including poverty, education, health and social capital. We derived some possible indicators of adaptive capacity using data from the national census and Demographic and Health Survey, and from field surveys at sites representing the main aquifer types. This investigation indicated higher vulnerability due to potentially low adaptive capacity in some Districts. Dili is wealthy compared with other Districts and this may represent relatively high capacity for adaptation. Other factors, such as implementation of some health programs and evidence of community management bodies, suggest high adaptive capacity in other Districts. Current adaptation strategies in some sites included cooperative management of water resources, moving temporarily when water sources became unavailable, carrying water, and collecting rainwater.In summary, the following adaptation options are recommended:1. Documentation and monitoring of ground water resources &ndash; to improve understanding of water availability;2. Integrated water harvesting and storage, and irrigation maintenance &ndash; to build local resilience and adaptive capacity;3. Agricultural diversification - to build resilience and adaptive capacity;4. Improving governance (policy and regulation) &ndash; to reduce waste and over use, to secure availability and access, and to increase adaptive capacity.The people of Timor-Leste face substantial challenges in coping with the variability of the current climate, and further challenges regarding the expected changes to climate and water availability. Options for adaptations to climate change should be considered in the context of food security and sustainable agriculture and natural resource management practices at community, landscape and national scales. The need for this broader framework is stipulated in the National Adaptation Programmes of Action for Timor-Leste (NAPA)

The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township

This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

Abstract

Experiences of Violence and Association with Decreased Drug Abstinence Among Women in Cape Town, South Africa

Drug abuse is a contributing factor in women’s HIV risk in low-income communities in Cape Town, South Africa. This study assessed whether experiencing violence is associated with reduced drug abstinence among adult women (n = 603) participating in a randomized field trial for an HIV prevention study in Cape Town. In relation to drug abstinence at 12-month follow-up, multivariable regression models were used to assess (1) baseline partner and non-partner victimization, and (2) victimization at 12-month follow-up among participants reporting baseline victimization. Baseline partner (AOR = 0.6; 95 % CI 0.4–0.9) and non-partner victimization (AOR = 0.6; 95 % CI 0.4–0.9) were associated with a reduced likelihood of drug abstinence at follow-up. Among participants who reported victimization at baseline, those no longer reporting victimization at follow-up did not differ significantly in drug abstinence compared with those who reported victimization at follow-up. The study findings highlight the lasting impact of victimization on women’s drug use outcomes, persisting regardless of whether violence was no longer reported at follow-up. Overall, the findings support the need for the primary prevention of violence to address the cycle of violence, drug use, and HIV among women in this setting

Pregnant and Nonpregnant Women in Cape Town, South Africa: Drug Use, Sexual Behavior, and the Need for Comprehensive Services

The multiple risks associated with methamphetamine use are of serious concern for women. These risks and consequences are magnified during pregnancy. This secondary analysis of a parent study compared 26 pregnant to 356 nonpregnant women in Cape Town, South Africa, on selected demographic, psychosocial, and HIV-risk domains to identify their treatment service needs. Proportionally, more pregnant than nonpregnant women are using methamphetamine, P = .01, although a very high rate of women used methamphetamine. Women reported similar monthly rates of sexual intercourse, but pregnant women were significantly less likely to report condom use, P < .0001, maintaining their risky behavior. Both groups reported elevated Center for Epidemiological Studies Depression Scale CES-D means, suggesting a need for depression treatment. Results demonstrate a pervasive need for women's comprehensive treatment, regardless of pregnancy status. Moreover, findings support the urgent need for women-focused and pregnancy-specific treatment services for methamphetamine use. Finally, a job-skills training/employment component focus is suggested