Supporting and strengthening research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty: scoping reviews and research gap analysis

Why urban communities from low-income and middle-income countries participate in public and global health research: protocol for a scoping review

INTRODUCTION

As the number of people living in cities increases worldwide, particularly in low-income and middle-income countries (LMICs), urban health is a growing priority of public and global health. Rapid unplanned urbanisation in LMICs has exacerbated inequalities, putting the urban poor at increased risk of ill health due to difficult living conditions in cities. Collaboration with communities in research is a key strategy for addressing the challenges they face. The objective of this scoping review is, therefore, to identify factors that influence the participation of urban communities from LMICs in public and global health research.

METHODS AND ANALYSIS

We will develop a search strategy with a health librarian to explore the following databases: MEDLINE, Embase, Web of Science, Cochrane, Global Health and CINAHL. We will use MeSH terms and keywords exploring the concepts of 'low-income and middle-income countries', 'community participation in research' and 'urban settings' to look at empirical research conducted in English or French. There will be no restriction in terms of dates of publication. Two independent reviewers will screen and select studies, first based on titles and abstracts, and then on full text. Two reviewers will extract data. We will summarise the results using tables and fuzzy cognitive mapping.

ETHICS AND DISSEMINATION

This scoping review is part of a larger project to be approved by the University of Montréal's Research Ethics Committee for Science and Health in Montréal (Canada), and the Institutional Review Board of the James P Grant School of Public Health at BRAC University in Dhaka (Bangladesh). Results from the review will contribute to a participatory process seeking to combine scientific evidence with experiential knowledge of stakeholders in Dhaka to understand how to better collaborate with communities for research. The review could contribute to a shift toward research that is more inclusive and beneficial for communities.

Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe

BACKGROUND

To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables.  METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing.

RESULTS

There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81).

CONCLUSIONS

Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.

Application of logistic differential equation models for early warning of infectious diseases in Jilin Province

Background

There is still a relatively serious disease burden of infectious diseases and the warning time for different infectious diseases before implementation of interventions is important. The logistic differential equation models can be used for predicting early warning of infectious diseases. The aim of this study is to compare the disease fitting effects of the logistic differential equation (LDE) model and the generalized logistic differential equation (GLDE) model for the first time using data on multiple infectious diseases in Jilin Province and to calculate the early warning signals for different types of infectious diseases using these two models in Jilin Province to solve the disease early warning schedule for Jilin Province throughout the year.

Methods

Collecting the incidence of 22 infectious diseases in Jilin Province, China. The LDE and GLDE models were used to calculate the recommended warning week (RWW), the epidemic acceleration week (EAW) and warning removed week (WRW) for acute infectious diseases with seasonality, respectively.

Results

Five diseases were selected for analysis based on screening principles: hemorrhagic fever with renal syndrome (HFRS), shigellosis, mumps, Hand, foot and mouth disease (HFMD), and scarlet fever. The GLDE model fitted the above diseases better (0.80 ≤ R2 ≤ 0.94, P <  0. 005) than the LDE model. The estimated warning durations (per year) of the LDE model for the above diseases were: weeks 12–23 and 40–50; weeks 20–36; weeks 15–24 and 43–52; weeks 26–34; and weeks 16–25 and 41–50. While the durations of early warning (per year) estimated by the GLDE model were: weeks 7–24 and 36–51; weeks 13–37; weeks 11–26 and 39–54; weeks 23–35; and weeks 12–26 and 40–50.

Conclusions

Compared to the LDE model, the GLDE model provides a better fit to the actual disease incidence data. The RWW appeared to be earlier when estimated with the GLDE model than the LDE model. In addition, the WRW estimated with the GLDE model were more lagged and had a longer warning time.

Participatory Systems Mapping for Municipal Prioritization and Planning

Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city's unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evidence-based information on where to invest to gain the biggest impact on specific goals. This paper is part of a collection in this issue providing a detailed accounting of BHC's systems mapping approach across four project cities.

Selected Research Issues of Urban Public Health

Health is created within the urban settings of people’s everyday lives. In this paper we define Urban Public Health and compile existing evidence regarding the spatial component of health and disease in urban environments. Although there is already a substantial body of single evidence on the links between urban environments and human health, focus is mostly on individual health behaviors. We look at Urban Public Health through a structural lens that addresses health conditions beyond individual health behaviors and identify not only health risks but also health resources associated with urban structures. Based on existing conceptual frameworks, we structured evidence in the following categories: (i) build and natural environment, (ii) social environment, (iii) governance and urban development. We focused our search to review articles and reviews of reviews for each of the keywords via database PubMed, Cochrane, and Google Scholar in order to cover the range of issues in urban environments. Our results show that linking findings from different disciplines and developing spatial thinking can overcome existing single evidence and make other correlations visible. Further research should use interdisciplinary approaches and focus on health resources and the transformation of urban structures rather than merely on health risks and behavior.

Ecotoxicity of chlorpyrifos on earthworm Eisenia fetida (Savigny, 1826): Modifications in oxidative biomarkers

Chlorpyrifos (CPF; O, O'-diethyl-3, 5, 6-trichloro-2-pyridyl phosphorothionate) as an organophosphate compound with moderate toxicity that entered the soil in 1965, is widely used as an active substance of many insecticides. CPF may affect some biochemical mechanisms, particularly through disrupting pro- and anti-oxidant balance and inducing free radical-induced oxidative stress. Expired pesticides, if present in ecosystem, may pose new issues of toxicological concern. In the current study, modifications in the oxidative stress (OS) hallmarks including the content of lipid peroxidation (LPO/MDA) and the activities of antioxidant enzymes catalase (CAT) and glutathione S-transferase (GST) in the whole body extract and total antioxidant capacity (TAC), in the coelomic fluid (CF) of earthworm Eisenia fetida were evaluated spectrophotometrically after exposure to different concentrations (1/20th, 1/10th, and 1/5th of LC₅₀) of fresh and expired CPF for 4 and 8 days. First, LC₅₀ for both fresh and expired CPF were determined by using probit method as ≤192 and ≤ 209 mg/kg dry soil, respectively. Our results also revealed that both fresh and expired CPF could be toxic to earthworms via inducing OS at higher concentrations. Here, CPF-induced OS was determined by a significant elevation (p < 0.05) in LPO content, CAT and GST activities and also a meaningful decrease (p < 0.05) in TAC value. Briefly, CPF may exhibit toxic effects in earthworms in the fresh and expired forms via changing oxidative balance and modifying some biochemical markers in the whole body. Further unraveling is needed to elucidate CPF-related impairments in soil organisms.

Sustainable, healthy cities: protocol of a mixed methods evaluation of a cluster randomized controlled trial for Aedes control in Brazil using a community mobilization approach

Background

Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil.

Methods

The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants.

Discussion

The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases.

Trial registration

ISRCTN66131315, registration date: 1 October 2018.

Neglected Urban Villages in Current Vector Surveillance System: Evidences in Guangzhou, China

Numerous urban villages (UVs) with substandard living conditions that cause people to live there with vulnerability to health impacts, including vector-borne diseases such as dengue fever (DF), are major environmental and public health concerns in highly urbanized regions, especially in developing countries. It is necessary to explore the relationship between UVs and vector for effectively dealing with these problems. In this study, land-use types, including UVs, normal construction land (NCL), unused land (UL), vegetation, and water, were retrieved from the high-resolution remotely sensed imagery in the central area of Guangzhou in 2017. The vector density from May to October in 2017, including Aedes. albopictus (Ae. albopictus)’s Breteau index (BI), standard space index (SSI), and adult density index (ADI) were obtained from the vector surveillance system implemented by the Guangzhou Center for Disease Control and Prevention (CDC). Furthermore, the spatial and temporal patterns of vector monitoring sites and vector density were analyzed on a fine scale, and then the Geodetector tool was further employed to explore the relationships between vector density and land-use types. The monitoring sites were mainly located in NCL (55.70%–56.44%) and UV (13.14%–13.92%). Among the total monitoring sites of BI (79), SSI (312), and ADI (326), the random sites accounted for about 88.61%, 97.12%, and 98.47%, respectively. The density of Ae. albopictus was temporally related to rainfall and temperature and was obviously differentiated among different land-use types. Meanwhile, the grids with higher density, which were mostly concentrated in the Pearl River fork zone that collects a large number of UVs, showed that the density of Ae. albopictus was spatially associated with the UVs. Next, the results of the Geodetector illustrated that UVs posed great impact on the density of Ae. albopictus across the central region of Guangzhou. We suggest that the number of monitoring sites in the UVs should be appropriately increased to strengthen the current vector surveillance system in Guangzhou. This study will provide targeted guidance for local authorities, making more effective control and prevention measures on the DF epidemics.

Health and immunisation services for the urban poor in selected countries of Asia

Background

Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF)  on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam.

Main body

Although overall urban coverage is higher than rural coverage in selected countries of Asia, there are also wide disparities in coverage between socio economic groups within urban areas. Consistent with these coverage gaps, there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas. In response to this elevated public health risk, there have been some promising innovations in operational strategy in urban settings, although most of these initiatives are project related and externally funded. Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy, and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments. Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required. Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority, adequate resources and institutional capabilities to implement.

Conclusions

The development of urban health systems and immunisation strategy is required regionally and nationally, to respond to rapid demographic change, social transition, and increased epidemiological risk.

Electronic supplementary material

The online version of this article (10.1186/s40249-019-0538-4) contains supplementary material, which is available to authorized users.

Establishing research priorities in prevention and control of vector-borne diseases in urban areas: a collaborative process

BACKGROUND

In 2015, following a call for proposals from the Special Programme for Research and Training in Tropical Diseases (TDR), six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted. Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps, as well as needs and opportunities for future research. Based on the research findings of the scoping reviews, a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed.

METHODS

Members of the six research teams responsible for the "VEctor boRne DiseAses Scoping reviews" (VERDAS) consortium's scoping reviews met for 2 days with decision-makers from Colombia, Brazil, Peru, Pan-American Health Organization, and World Health Organization. A total of 11 researchers and seven decision-makers (from ministries of health, city and regional vector control departments, and vector control programs) completed the concept mapping, answering the question: "In view of the knowledge synthesis and your own expertise, what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?" Participants rated each statement on two scales from 1 to 5, one relative to 'priority' and the other to 'policy relevance', and grouped statements into clusters based on their own individual criteria and expertise.

RESULTS

The final map consisted of 12 clusters. Participants considered those entitled "Equity", "Technology", and "Surveillance" to have the highest priority. The cluster considered the most important concerns equity issues, confirming that these issues are rarely addressed in research on vector-borne diseases. On the other hand, the "Population mobility" and "Collaboration" clusters were considered to be the lowest priority but remained identified by participants as research priorities. The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters. Some issues were not addressed during the brain-storming. This is the case for governance and for access and quality of care.

CONCLUSIONS

Based on this work, and adopting a participatory approach, the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.

Priorities and needs for research on urban interventions targeting vector-borne diseases: rapid review of scoping and systematic reviews

This paper highlights the critical importance of evidence on vector-borne diseases (VBD) prevention and control interventions in urban settings when assessing current and future needs, with a view to setting policy priorities that promote inclusive and equitable urban health services. Research should produce knowledge about policies and interventions that are intended to control and prevent VBDs at the population level and to reduce inequities. Such interventions include policy, program, and resource distribution approaches that address the social determinants of health and exert influence at organizational and system levels.