Studio In-Situ

This photo essay explores the possibility of radically shifting the understanding of the design studio as a spatial construct. By considering the seven-year evolution of a (socalled) design-build project known as the Imizamo Yethu Water Platforms, it recognises the possibility of dislocating the design studio from its traditionally centralised space in the academy and moving it to the site of its investigation or intervention for the duration of a project. The Imizamo Yethu Water Platforms aimed to improve water and sanitation infrastructure in a severely under-resourced informal settlement in Cape Town, South Africa, through the insertion of small permanent public spaces. Due to a number of reasons, including the physical characteristics of the sites selected for these spaces, the design studio gradually shifted its physical location to such an extent that virtually the entire design, documentation and construction process took place in-situ.

Mainstreaming Climate Adaptation in Mozambican Urban Water, Sanitation, and Drainage Sector

The Capacity Development Programme (CDP) is an agreement between the Government of Mozambique and the Nordic Development Fund, to tackle climate variability by planning and the sustainable operations and maintenance of sanitation and drainage infrastructure. The Mozambican Administration of Water and Sanitation Infrastructure (AIAS) is the agency responsible for this project. The international consortium in charge of developing the CDP provided consultancy services to AIAS and the vulnerable cities of Beira and Matola. The assignment included not only capacity building but also institutional strengthening activities, as well as specific studies, mainly based on climate modelling (dynamic downscaling) and mapping exercises. Important results and conclusions were achieved, and further adaptation strategies to increase the resilience of the Mozambican urban water, sanitation, and drainage sector were proposed.

Implications of Inadequate Water and Sanitation Infrastructure for Community Spread of COVID-19 in Remote Alaskan Communities

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human population in December 2019 and spread worldwide within a few short months. Much of the public health focus for preventing and mitigating the spread of COVID-19 has been on individual and collective behaviors, such as social distancing, mask-wearing, and hygiene. Yet it is equally important to recognize that these behaviors and health outcomes occur within broader social and environmental contexts. Factors within local communities, regional policy, race, history, personal beliefs, and natural- and built environmental characteristics affect underlying population health and the spread of disease. For example, COVID-19 has renewed attention to secure water and sanitation services and their importance in protecting human health. Many remote Alaskan communities are particularly vulnerable because of inadequate water and sanitation systems. In this paper, we describe how inadequate water and sewer services may place the inhabitants of remote Alaskan communities at higher risk of COVID spread. We argue that insufficient water security and inadequate sewer systems, along with household overcrowding, multigenerational residences, limited transportation options, limited medical facilities, and higher prevalence of chronic diseases could lead to a greater potential of COVID-19 transmission and to more severe disease outcomes in these communities.

Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: Insights from Madagascar

The COVID-19 pandemic has wreaked havoc globally, and there has been a particular concern for sub-Saharan Africa (SSA), where models suggest that the majority of the population will become infected. Conventional wisdom suggests that the continent will bear a higher burden of COVID-19 for the same reasons it suffers high burdens of other infectious diseases: ecology, socio-economic conditions, lack of water and sanitation infrastructure, and weak health systems. However, so far SSA has reported lower incidence and fatalities compared to the predictions of standard models and the experience of other regions of the world. There are three leading explanations, each with very different implications for the final epidemic burden: (1) low case detection, (2) differences in COVID-19 epidemiology (e.g. low R0), and (3) policy interventions. The low number of cases to date have led some SSA governments to relax these policy interventions. Will this result in a resurgence of cases? To understand how to interpret the lower-than-expected COVID-19 case data in Madagascar, we use a simple age-structured model to explore each of these explanations and predict the epidemic impact associated with them. We show that the current incidence of COVID-19 cases can be explained by any combination of the late introduction of first imported cases, early implementation of non-pharmaceutical interventions (NPIs), and low case detection rates. This analysis reinforces that Madagascar, along with other countries in SSA, remains at risk of an impending health crisis. If NPIs remain enforced, up to 50,000 lives may be saved. Even with NPIs, without vaccines and new therapies, COVID-19 could infect up to 30% of the population, making it the largest public health threat in Madagascar until early 2021, hence the importance of conducting clinical trials and continually improving access to healthcare.

Achieving coordinated national immunity and cholera elimination in Haiti through vaccination

SummaryBackgroundCholera was introduced into Haiti in 2010. Since, there have been over 820,000 reported cases and nearly 10,000 deaths. The year 2019 has seen the lowest reported number of cases since the epidemic began. Oral cholera vaccine (OCV) is safe and effective, but has generally not been seen as a primary tool for cholera elimination due to a limited period of protection and constrained supplies. Regionally, epidemic cholera is contained to the island of Hispaniola. Hence, Haiti may represent a unique opportunity to eliminate cholera by use of OCV.MethodsWe assess the probability of elimination and the potential health impact of OCV use in Haiti by leveraging simulations from four independent modeling teams. For a 10-year projection period, we compared the impact of five vaccination campaign scenarios, differing in geographic scope, vaccination coverage, and rollout duration to a status quo scenario without vaccination. Teams used common calibration data and assumptions for vaccine efficacy and vaccination scenarios, but all other model features and assumptions were determined independently.FindingsA two-department OCV campaign proposed in Haiti’s national plan for elimination had less than 50% probability of elimination across models, and only ambitious, nationwide campaigns had a high probability of reaching this goal. Despite their low probability of elimination, two-department campaigns averted a median of 13-58% of infections across models over the five years after the start of vaccination campaigns; a nationwide campaign implemented at the same coverage and rollout duration averted a median of 58-95% of infections across models.InterpretationDespite recent declines in cholera cases in Haiti, bold action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti offer the opportunity to synchronize nationwide immunity, providing near-term protection to the population while improvements to water and sanitation infrastructure create an environment favorable to long-term cholera elimination.Research in ContextEvidence before this studyWe searched PubMed without language or date restrictions on October 4, 2019 for all records matching (“cholera*” AND “Haiti” AND (“vaccin*” OR “elim*”)) in any field and added one known article on the probability of elimination of cholera that was not indexed by PubMed to our review. Of 94 results, four articles were not about the cholera outbreak in Haiti or the use of cholera vaccination, and 34 were not original research articles. Fourteen articles presented research on cholera biology or cholera vaccine biology, either through discussion of Vibrio cholerae genetics, immunogenicity of oral cholera vaccine (OCV), or prospective vaccine candidate antigens. Twenty articles assessed OCV vaccine effectiveness, evaluated OCV campaign implementation or attitudes and knowledge about cholera control, or presented lessons learned on outbreak response and policy as a result of the Haiti cholera outbreak. Seven articles were about general cholera outbreak epidemiology in Haiti, and six articles were related to cholera transmission models outside our research scope.Of the nine remaining articles, five examined the impact of potential OCV campaigns at an early time point when Haiti’s cholera outbreak still exhibited epidemic dynamics, and one other projected the impact of the OCV campaigns planned after Hurricane Matthew in 2016. Two of the articles considered prospects for cholera elimination in Haiti in 2013 and 2014 and found that further targeted interventions were needed. One final study from 2017 modeled the possibility for OCV campaigns to eliminate cholera transmission in the Ouest department within a few years.Added value of this studyPrevious assessments of the impact of OCV use in Haiti occurred during early points of the outbreak when OCV campaigns were unlikely to lead to cholera elimination. Our study projects cholera transmission in Haiti with multiple years of more recent data, and directly examines prospect of cholera elimination in the status quo and under various mass OCV campaign scenarios. In bringing together results from multiple modeling teams, our study provides robust evidence about the current state of cholera transmission across Haiti and the potential impact of multiple mass OCV campaign scenarios.Implications of all of the available evidenceWhile 2019 has seen the lowest number of cholera cases in Haiti since the outbreak began, model simulations suggest that it may be possible for cholera transmission to persist without additional cholera control interventions.While a single two-department vaccination campaign may avert roughly 13-58% of infections with V. cholerae over a five year period, only a nationwide campaign led to a high probability of cholera elimination. Ambitious nationwide vaccination campaigns may break the cycle of endemic cholera transmission in Haiti as long-term improvements to water and sanitation infrastructure, which will limit the effects of potential re-introductions of Vibrio cholerae, are being made.

Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs

Regular hand washing habit has potential to reduce morbidity and mortality due to diseases and improves child development and reduces absenteeism of children, teachers and workforce. Improving hand washing behavior is more cost effective than improving clean water and sanitation infrastructure. There are numbers of initiatives and interventions in place, which have gained momentum with key messages of a call to action with increasing investment in schools, engaging policy makers and demonstration them with evidence. However, change in behavior as a routine habit has not reached to an optimum level and requires institutionalizing hand washing practices in schools, from schools and by schools and develop it as a curriculum. Therefore, we are purposing principles of 5Es and 3Rs – a strategy to make hand washing a routine habit. These 5E principles are: i) Embedding in a system, ii) Enabling Environment, iii) Eliminating Friction, iv) Encouraging all, and v) Establishing intervention and 3Rs are practicing them Religiously, Routinely and Repeatedly.Numbers of interventions have well demonstrated that hand hygiene educational interventionscan help maintaining good practices. Finally, if schools and community start doing today, we canobserve behavioral change practices for hand washing as a routine habit by at least 10 years after.Keywords: Hand washing, Routine Habit, Principles of 5Es and 3Rs, Educational Interventions, School. | PubMed