Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.
Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.
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DOI：
10.1371/journal.pntd.0000631
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发表时间：
2010-03-16
影响因子：
3.8
通讯作者：
Ryan ET
中科院分区：
文献类型：
--
作者：
Penrose K;de Castro MC;Werema J;Ryan ET
由于经济机会不足和负担得起的住房日益短缺，世界上许多发展最快的城市的大部分空间增长是由于非正规住区的扩大，这些住区的居民没有租住权保障，获得基本基础设施的机会有限。虽然供水和卫生设施不足、拥挤和其他恶劣的生活条件会对传染病的传播产生重大影响，但很少有分析将这些疾病与正在进行的全球城市化联系起来，特别是在非正式住区的邻里和家庭一级。为了着手解决这一不足，我们分析了坦桑尼亚达累斯萨拉姆的城市环境数据和霍乱负担。霍乱发病率与以下因素有关：一个病区非正式居民的百分比、一个病区没有改善水源的非正式居民的百分比、一个病区没有改善卫生设施的非正式居民的百分比、到最近的霍乱治疗设施的距离、人口密度、非正式地区资产指数中位数得分以及是否存在主要道路。我们发现，霍乱发病率与非正规住房、人口密度和非正规居民的收入水平密切相关。利用本研究中可用的数据，我们的模型将表明，2006年，达累斯萨拉姆每平方公里人口密度每增加1000人，霍乱发病率就会增加近1%，而在非正规居民收入水平提高最低的病房，霍乱发病率下降近50%。以平均拥有一台收音机或CD播放机来衡量，相比之下，在被问及的问题中，非正式居民没有任何物品。在这项研究中，在病房一级，获得改善的卫生设施和改善的水源的范围相当狭窄，限制了我们辨别这些变量与霍乱发病率之间关系的能力。在个别家庭一级对这些变量的分析将是有趣的。我们的研究结果表明，正在进行的全球城市化加上城市贫困将与某些传染病（如霍乱）的风险增加有关，这突出表明，随着世界城市人口的不断扩大，有必要改善基础设施和规划。2008年，人类历史上第一次有超过一半的世界人口居住在城市地区，而且这一比例预计还会增加。由于经济机会不足和负担得起的住房日益短缺，在世界上许多发展最快的城市中，很大一部分空间增长是非正式住区扩大的结果，这些住区的居民没有租住权保障，获得基本基础设施的机会有限。虽然水和卫生设施不足、拥挤和其他恶劣的生活条件可能对传染病的传播产生重大影响，但将这些疾病与正在进行的全球城市化，特别是在非正式住区的邻里和家庭一级，联系起来的分析却很少。为了着手解决这一不足，我们分析了坦桑尼亚达累斯萨拉姆的城市环境数据和霍乱负担。我们发现，霍乱发病率与非正规住房、人口密度和非正规居民的收入水平密切相关。我们的分析表明，目前发展中国家许多城市的增长和非正式住区的扩大将与人类健康风险增加有关，包括霍乱和其他传染病，并强调了随着全球城市化趋势的迅速发展，城市规划、资源分配、基础设施安置和管理的重要性。
As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world's fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania. Cholera incidence was examined in relation to the percentage of a ward's residents who were informal, the percentage of a ward's informal residents without an improved water source, the percentage of a ward's informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km2 in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest. Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world's urban population continues to expand. In 2008, for the first time in human history, more than half of the world's population was living in urban areas, and this proportion is expected to increase. As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world's fastest growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding, and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Our analysis suggests that the current growth of many cities in developing countries and expansion of informal settlements will be associated with increased risks to human health, including cholera and other infectious diseases, and underscores the importance of urban planning, resource allocation, and infrastructure placement and management, as the rapidly progressive trend of global urbanization proceeds.
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