Abstract
Historic increase in urban population numbers in the face of shrinking urban economies and declining social services has meant that a large proportion of the urban population lives in precarious urban conditions, which provide the grounds for high urban health risks in low income countries. This study aims to identify, investigate, and contrast the spatial patterns of vulnerability and risk of two major causes of mortality, viz malaria and diarrhea mortalities, in order to optimize resource allocation for effective urban environmental management and improvement in urban health. A spatial cluster analysis of the observed urban malaria and diarrhea mortalities for the whole city of Accra was conducted. We obtained routinely reported mortality data for the period 1998–2002 from the Ghana Vital Registration System (VRS), computed the fraction of deaths due to malaria and diarrhea at the census cluster level, and analyzed and visualized the data with Geographic Information System (GIS, ArcMap 9.3.1). Regions of identified hotspots, cold spots, and excess mortalities were observed to be associated with some socioeconomic and neighborhood urban environmental conditions, suggesting uneven distribution of risk factors for both urban malaria and diarrhea in areas of rapid urban transformation. Case–control and/or longitudinal studies seeking to understand the individual level factors which mediate socioenvironmental conditions in explaining the observed excess urban mortalities and to establish the full range of risk factors might benefit from initial vulnerability mapping and excess risk analysis using geostatistical approaches. This is key to evidence-based urban health policy reforms in rapidly urbanizing areas in low income economies.
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Berkowitz AR, Nilon CH, Hollweg KS. Understanding Urban Ecosystems: a New Frontier for Science and Education. New York: Springer; 2003: 523.
Niemela J. Ecology and urban planning. Biodivers Conserv. 1999; 8: 119–131.
Rebelee F. Urban ecology and special features of urban ecosystems. Glob Ecol Biogeogr Lett. 1994; 4: 173–187.
Fobil JN, Armah NA, Hogarh JN, Carboo D. The influence of institutions and organizations on urban waste collection systems: an analysis of waste collection system 430 in Accra, Ghana (1985–2000). J Environ Manage. 2008; 86: 262–271.
Fobil JN, Atuguba RA. Ghana: changing urban environmental ills in slum communities. Int J Environ Policy Law. 2004; 34: 206–215.
Fobil JN, Atuguba RA. Ghana: migration and the African urban complex. In: Globalization and Urbanization in Africa. Trenton, NJ: Africa World; 2004.
Fobil J, May J, Kraemer A. Assessing the relationship between socioeconomic conditions and urban environmental quality in Accra, Ghana. Int J Environ Res Public Health. 2010; 7: 125–145.
Carter R, Mendis KN, Roberts D. Spatial targeting of interventions against malaria. Bull World Health Organ. 2000; 78: 1401–1411.
GSS Population and Housing Census 2000: summary of Final Results; Ghana Statistical Service: Accra; 2002.
GSS Preliminary Reports. Ghana Demographic and Health Survey 2003.; Ghana Statistical Service: Accra; 2004.
ESRI ArcGIS 9.3.1, 9.3.1; Redlands, 2009.
Anselin L. GeoDa 0.9.5-i Mesa, USA, 2004
Brunsdon C, Fotheringham AS, Charlton M. Geographically weighted regression—modelling spatial non-stationarity. Statistician. 1998; 47: 431–443.
Nakaya T, Fotheringham AS, Brunsdon C, Charlton M. Geographically weighted Poisson regression for disease association mapping. Stat Med. 2005; 24: 2695–2717.
Baragatti M, Fournet F, Henry MC, Assi S, Ouedraogo H, Rogier C, Salem G. Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso. Malar J. 2009; 8: 13.
Masendu HT, McClean D, Mushavave ST, Chinyowa D, Simbanegavi P, Chawarika C, Ndlovu F. Urban malaria transmission in Mutare City; an unlikely phenomenon. Cent Afr J Med. 2000; 46: 174–178.
Peterson I, Borrell LN, El-Sadr W, Teklehaimanot A. Individual and household level factors associated with malaria incidence in a highland region of Ethiopia: a multilevel analysis. AmJTrop Med Hyg. 2009; 80: 103–111.
Siri JG, Lindblade KA, Rosen DH, Onyango B, Vulule J, Slutsker L, Wilson ML. Quantitative urban classification for malaria epidemiology in sub-Saharan Africa. Malar J. 2008; 7: 34.
Tsai PJ, Lin ML, Chu CM, Perng CH. Spatial autocorrelation analysis of health care hotspots in Taiwan in 2006. BMC Public Health. 2009; 9.
Morrow RH, Jr. Epidemiological evidence for the role of falciparum malaria in the pathogenesis of Burkitt's lymphoma. IARC Sci Publ. 1985:177–186.
Biggar RJ, Nkrumah FK. Burkitt's lymphoma in Ghana: urban–rural distribution, time–space clustering and seasonality. Int J Cancer. 1979; 23: 330–336.
Ajjampur SS, Gladstone BP, Selvapandian D, Muliyil JP, Ward H, Kang G. Molecular and spatial epidemiology of cryptosporidiosis in children in a semiurban community in South India. J Clin Microbiol. 2007; 45: 915–920.
Biritwum RB, Asante A, Amoo PK, Gyekye AA, Amissah CR, Osei KG, Appiah-Poku YA, Welbeck JE. Community-based cluster surveys on treatment preferences for diarrhoea, severe diarrhoea, and dysentery in children aged less than five years in two districts of Ghana. J Health Popul Nutr. 2004; 22: 182–190.
Henry MC, Alary M, Desmet P, Gerniers M, Muteteke D, Nku I, Mutombo L, Piot P. Community survey of diarrhoea in children under 5 years in Kinshasa, Zaire. Ann Soc Belg Med Trop. 1995; 75: 105–114.
Kandala NB, Magadi MA, Madise NJ. An investigation of district spatial variations of childhood diarrhoea and fever morbidity in Malawi. Soc Sci Med. 2006; 62: 1138–1152.
von Schirnding YE, Yach D, Blignault R, Mathews C. Environmental determinants of acute respiratory symptoms and diarrhoea in young coloured children living in urban and peri-urban areas of South Africa. S Afr Med J. 1991; 79: 457–461.
Lawoyin TO, Ogunbodede NA, Olumide EA, Onadeko MO. Outbreak of cholera in Ibadan, Nigeria. Eur J Epidemiol. 1999; 15: 367–370.
Samore MH, Venkataraman L, DeGirolami PC, Arbeit RD, Karchmer AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med. 1996; 100: 32–40.
Ye Y, Louis VR, Simboro S, Sauerborn R. Effect of meteorological factors on clinical malaria risk among children: an assessment using village-based meteorological stations and community-based parasitological survey. BMC Publ Health. 2007; 7: 101.
Peterson I, Borrell LN, El-Sadr W, Teklehaimanot A. A temporal–spatial analysis of malaria transmission in Adama, Ethiopia. AmJTrop Med Hyg. 2009; 81: 944–949.
Macintyre K, Keating J, Sosler S, Kibe L, Mbogo CM, Githeko AK, Beier JC. Examining the determinants of mosquito-avoidance practices in two Kenyan cities. Malar J. 2002; 1: 14.
Zhang J, Liu M. [Current situation on the treatment modules of diarrhea cases in 12 counties/cities of Guangdong, Henan and Gansu provinces in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2008; 29: 989–993.
Bhandari N, Taneja S, Mazumder S, Bahl R, Fontaine O, Bhan MK. Adding zinc to supplemental iron and folic acid does not affect mortality and severe morbidity in young children. J Nutr. 2007; 137: 112–117.
Nelson KC, Palmer MA, Pizzuto JE, Moglen GE, Angermeier PL, Hilderbrand RH, Dettinger M, Hayhoe K. Forecasting the combined effects of urbanization and climate change on stream ecosystems: from impacts to management options. J Appl Ecol. 2009; 46: 154–163.
de Graaf RE, van de Giesen NC, van de Ven FH. The closed city as a strategy to reduce vulnerability of urban areas for climate change. Water Sci Technol. 2007; 56: 165–173.
Banerjee S, Wall MM, Carlin BP. Frailty modeling for spatially correlated survival data, with application to infant mortality in Minnesota. Biostatistics. 2003; 4: 123–142.
Zhao L. Mixtures of Polya trees for flexible spatial frailty survival modelling. Biometrika. 2009; 96: 263–276.
Li Y, Ryan L. Modeling spatial survival data using semiparametric frailty models. Biometrics. 2002; 58: 287–297.
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Funding sources
Funding for this study was generously provided jointly by the Government of Ghana, through the GetFund Scholarship, and the German Government, through the DAAD Scholarship.
Authors' contribution
Conception and design by JNF, AK, and JM. Data collection and analysis were done by JNF, CL, TL, and WL. Drafting and revision of the manuscript were done all by authors.
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Fobil, J.N., Levers, C., Lakes, T. et al. Mapping Urban Malaria and Diarrhea Mortality in Accra, Ghana: Evidence of Vulnerabilities and Implications for Urban Health Policy. J Urban Health 89, 977–991 (2012). https://doi.org/10.1007/s11524-012-9702-x
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DOI: https://doi.org/10.1007/s11524-012-9702-x