Polymerase chain reaction for detection of endocervical Chlamydia trachomatis infection in women attending a gynecology outpatient department in India

OBJECTIVES: To detect Chlamydia trachomatis infection by polymerase chain reaction (PCR) in symptomatic women attending a gynecology clinic in a city hospital and in randomly selected slum dwellers. STUDY DESIGN: Endocervical specimens were collected from 350 women with genitourinary complaints (group I) and 53 slum dwellers (group II). Samples were analyzed by PCR, direct fluorescence assay (DFA) and Giemsa stain cytology for detection of C trachomatis and compared for their sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: The prevalence of endocervical C trachomatis infection was 43.1% and 24.5% in groups I and II, respectively. The sensitivity, specificity, PPV and NPV of PCR were 80.0%, 75.0%, 66.6% and 85.7%, respectively, when DFA was considered true positive. The percent increment in detection of C trachomatis by PCR was 15.3%. CONCLUSION: Giemsa stain cytology has low sensitivity and specificity; hence, it cannot be recommended for use as a diagnostic technique. It appears that PCR can be used routinely in Chlamydia diagnosis and in screening selected populations. The high positivity of C trachomatis infection in urban slum dwellers is cause for concern.     

Global Morbidity and Mortality of Leptospirosis: A Systematic Review

BackgroundLeptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.Conclusions/SignificanceLeptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.     

Making the Global City: Urban Citizenship at the Margins of Delhi

There is a growing scholarly interest in the spatialisation of class relations in post-industrial cities. Gentrified suburbs exclude the poor and re-work notions of public property and urban citizenship to the advantage of the rich. My study moves beyond the sanitised places of the inner city and shows how the cleaning mission affects life in the new spaces of deprivation. I analyse home making in a resettlement colony of Delhi. After being removed from the hubs of the labour market and with little state support, resettled slum dwellers struggle under harsh conditions for survival. Those who can afford this expensive venture embrace home ownership at high personal risks und by exploiting the channels of the informal economy, hoping that possessing a legal dwelling will root them more firmly in the city. In practice, the new status is an often uneasy fusion of a formal and informal status and thus remains essentially precarious in an environment that criminalises informality.     

Coping Strategies among Urban Poor: Evidence from Nairobi,Kenya

Aims

In Kenya, it is estimated that 60 to 80% of urban residents live in slum or slum-like conditions. This study investigates expenditures patterns of slum dwellers in Nairobi, their coping strategies and the determinants of those coping strategies.

Method

We use a dataset from the Indicator Development for Surveillance of Urban Emergencies (IDSUE) research study conducted in four Nairobi slums from April 2012 to September 2012. The dataset includes information related to household livelihoods, earned incomes of household members, expenditures, shocks, and coping strategies.

Results

Food spending is the single most important component, accounting for 52% of total households'' income and 42% of total expenditures. Households report a variety of coping strategies over the last four weeks preceding the interview. The most frequently used strategy is related to reduction in food consumption, followed by the use of credit, with 69% and 52% of households reporting using these strategies respectively. A substantial proportion of households also report removing children from school to manage spending shortfalls. Formal employment, owning a business, rent-free housing, belonging to the two top tiers of income brackets, and being a member of social safety net reduced the likelihood of using any coping strategy. Exposure to shocks and larger number of children under 15 years increased the probability of using a coping strategy.

Policy Implications

Policies that contain food price inflation, improve decent-paying job opportunities for the urban poor are likely to reduce the use of negative coping strategies by providing urban slum dwellers with steady and reliable sources of income. In addition, enhancing access to free primary schooling in the slums would help limit the need to use detrimental strategies like “removing” children from school.     

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala,Uganda: A Cross-Sectional Study

BackgroundThere are health risks associated with wastewater and fecal sludge management and use, but little is known about the magnitude, particularly in rapidly growing urban settings of low- and middle-income countries. We assessed the point-prevalence and risk factors of intestinal parasite infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda.MethodologyA cross-sectional survey was carried out in September and October 2013, enrolling 915 adults from five distinct population groups: workers maintaining wastewater facilities; workers managing fecal sludge; urban farmers; slum dwellers at risk of flooding; and slum dwellers without risk of flooding. Stool samples were subjected to the Kato-Katz method and a formalin-ether concentration technique for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine self-reported signs and symptoms, and risk factors for intestinal parasite infections. Univariate and multivariate analyses, adjusted for sex, age, education, socioeconomic status, water, sanitation, and hygiene behaviors, were conducted to estimate the risk of infection with intestinal parasites and self-reported health outcomes, stratified by population group.Conclusions/SignificanceUrban farmers are particularly vulnerable to infections with soil-transmitted helminths, S. mansoni, and intestinal protozoa. Hence, our findings call for public health protection measures for urban farmers and marginalized communities, going hand-in-hand with integrated sanitation safety planning at city level.     

SCUSA: integrated approaches and strategies to address the sanitation crisis in unsewered slum areas in African mega-cities

Africa, though reported to be the least urbanized continent, is recognized as one where the rate of urbanization is highest. The development and expansion of informal settlements in the suburbs of the cities is widespread, while they harbor the majority of the urban population. Slums are characterized by, among other things, poorly constructed houses, poor water supply and sanitary conditions, and lack or inadequate support services. Besides the spreading of diseases related to surface water (e.g., malaria), one of the main problems associated with sanitation and water in slum areas is related to the pollutant load entering and leaving the slum catchment, either as surface water or groundwater. This is polluting drinking water or causing eutrophication of surface water, due to the extremely high nitrogen and phosphorus fluxes discharging those slum catchments. The SCUSA research project aims at identifying the most sustainable sanitation solutions in urban slums, including the most important parameters determining and guaranteeing sustainability. Our approach is multidisciplinary, and should therefore yield answers with a financial, social, technical, and environmental view on the extremely complex field of sanitation in urban slums.     

Durbolota (weakness), chinta rog (worry illness), and poverty: explanations of white discharge among married adolescent women in an urban slum in Dhaka, Bangladesh

I carried out ethnographic fieldwork among 153 married adolescent girls, aged 15-19, in a Dhaka slum from December 2001 to January 2003, including 50 in-depth interviews and eight case studies. I also held discussions with family and community members. In this article, I focus on popular understandings of vaginal discharge being caused by durbolota (weakness) and chinta rog (worry illness), as mentioned by young women. Eighty-eight young women reported that they had experienced white discharge, blaming it on a number of factors such as stress and financial hardships, tensions in the household, marital instability, hunger anxiety, and reproductive burdens. For married adolescent women in the urban slum, white discharge has many levels of meaning linked to the broader social, political, and material inequalities in their everyday lives.     

Measuring the synanthropy of species and communities to monitor the effects of urbanization on biodiversity

Urbanization is considered as one of the most important land-use and land-cover (LULC) changes with multiple pervasive effects on biodiversity. However, the quantitative assessment of biodiversity responses to urbanization remains challenging because some species can be directly and negatively affected by the spread of human settlements, while others can benefit from this LULC change. Moreover, although species sensitivity to urban settlements (their “synanthropy”) can either correspond to the spatial segregation of individuals within urban habitats or to their positive temporal trends in these habitats, these two facets are hardly distinguished explicitly. Here, we confronted the fine-scale spatial distribution of all the buildings in France with the spatial distribution and population trends of the 119 most common French breeding birds monitored in 2124 plots from 2001 to 2012. We developed and tested two indicators of “synanthropy”. The first indicator (S1) differentiates species along a continuous gradient from urban “avoiders” (low S1) to urban “dwellers” (high S1). The second indicator measures the beneficial or detrimental effect of building densities on the temporal trends of the populations. It allows the segregation among urban “losers” having lower temporal trends with increasing buildings (low S2) from urban “winners” (high S2) having more positive trends in more urbanized areas. We then tested the relationships between S1 and S2 with a set of species and life history traits. Finally, we transposed these species indicators to communities using community weighted means to test the link between the synanthropy of communities with bird species richness, and the spatial, temporal and spatio-temporal trends of the synanthropy of bird communities. We found that 43% of the species were “urban dwellers”, and 18% “urban winners”. Both urban dwellers and winners were species widely distributed and locally abundant. Urban dwellers were mainly ground feeders but did not nest on the ground. At the community level, high species richness was associated with medium-values of community synanthropy, following the intermediate-disturbance hypothesis. We found that the average value of community synanthropy and their trend were not randomly distributed in space. These two indicators of synanthropy can be used in different taxonomic groups and areas to assess the proportion of synanthropic species within communities, to monitor their temporal trends and their spatial distribution and represent a straightforward complement to the synthetic indicators of human footprint on biodiversity.     

Prospective Study of Leptospirosis Transmission in an Urban Slum Community: Role of Poor Environment in Repeated Exposures to the Leptospira Agent

Background

Leptospirosis has emerged as an urban health problem as slum settlements have rapidly spread worldwide and created conditions for rat-borne transmission. Prospective studies have not been performed to determine the disease burden, identify risk factors for infection and provide information needed to guide interventions in these marginalized communities.

Methodology/Principal Findings

We enrolled and followed a cohort of 2,003 residents from a slum community in the city of Salvador, Brazil. Baseline and one-year serosurveys were performed to identify primary and secondary Leptospira infections, defined as respectively, seroconversion and four-fold rise in microscopic agglutination titers. We used multinomial logistic regression models to evaluate risk exposures for acquiring primary and secondary infection. A total of 51 Leptospira infections were identified among 1,585 (79%) participants who completed the one-year follow-up protocol. The crude infection rate was 37.8 per 1,000 person-years. The secondary infection rate was 2.3 times higher than that of primary infection rate (71.7 and 31.1 infections per 1,000 person-years, respectively). Male gender (OR 2.88; 95% CI 1.40–5.91) and lower per capita household income (OR 0.54; 95% CI, 0.30–0.98 for an increase of $1 per person per day) were independent risk factors for primary infection. In contrast, the 15–34 year age group (OR 10.82, 95% CI 1.38–85.08), and proximity of residence to an open sewer (OR 0.95; 0.91–0.99 for an increase of 1 m distance) were significant risk factors for secondary infection.

Conclusions/Significance

This study found that slum residents had high risk (>3% per year) for acquiring a Leptospira infection. Re-infection is a frequent event and occurs in regions of slum settlements that are in proximity to open sewers. Effective prevention of leptospirosis will therefore require interventions that address the infrastructure deficiencies that contribute to repeated exposures among slum inhabitants.     

Patterns of use and knowledge of wild edible plants in distinct ecological environments: a case study of a Mapuche community from northwestern Patagonia

The multiple use of distinct ecological environments in the search for wild resources has been practiced since ancestral times in aboriginal communities inhabiting northwestern Patagonia. This paper examines the actual use and knowledge of wild edible plants in a Mapuche community presently settled in one of the most arid areas of Patagonia, far from the temperate forests where their ancestors used to live. The difference between knowledge of and use of wild plants is analyzed emphasizing that these differences could contribute to the understanding of eroding processes believed to be occurring in the community. These objectives are studied quantitatively by utilizing ethnobotanical indices, partially derived from ecological theory. Our results indicate that the Paineo dwellers still utilize multiple ecological gathering environments and have thorough plant knowledge of both native and exotic species. The Andean forest, more than 50km away from this community, is the environment from which the Paineo dwellers know the greatest total richness and the highest diversity of wild edible plants, followed by the Monte–Steppe species and lastly, those growing around their homes. The transmission of wild edible plant knowledge in the Paineo community diminishes with age, and the forest plants are the most vulnerable to loss. Our results have shown that the knowledge and consumption of wild edible plants follows a pattern according to ecological conditions of the gathering environments, as well as the cultural heritage of the Paineo people.     

Human leptospirosis in a slum area in the city of Rio de Janeiro, Brazil--a serological and epidemiological study

A serologic survey was carried out on slum dwellers in the city of Rio de Janeiro. A total of 259 serum samples from male and female individuals of different age groups were tested for the presence of antileptospire antibodies by microagglutination. Prevalence data were analyzed in relation to the major risk factors present at the site, mainly represented by the presence of carrier animals and the occurrence of frequent floods. Of the samples tested, 25% reacted with antigens of different serogroups at titres ranging from 1:100 to 1:6400, with a predominance of titres less than or equal to 1:400; 35% of positive sera reacted with leptospirae of the Icterohaemorrhagiae serogroup. Reactions with Djasiman, Panama, Javanica, Canicola, Pyrogenes, Australis, Ballum, Sejroe, Bataviae, Grippotyphosa, Autumnalis and Cynopteri were also detected, though at lower frequencies. There was no statistically significant difference between sexes, but higher prevalence rates were found to be associated with increasing age. A focus of infection was characterized, in which social and economic factors contribute to the persistence of leptospirae by favoring the proliferation of the main reservoir.     

Household transmission of leptospira infection in urban slum communities

Background

Leptospirosis, a spirochaetal zoonotic disease, is the cause of epidemics associated with high mortality in urban slum communities. Infection with pathogenic Leptospira occurs during environmental exposures and is traditionally associated with occupational risk activities. However, slum inhabitants reside in close proximity to environmental sources of contamination, suggesting that transmission during urban epidemics occurs in the household environment.

Methods and Findings

A survey was performed to determine whether Leptospira infection clustered within households located in slum communities in the city of Salvador, Brazil. Hospital-based surveillance identified 89 confirmed cases of leptospirosis during an outbreak. Serum samples were obtained from members of 22 households with index cases of leptospirosis and 52 control households located in the same slum communities. The presence of anti-Leptospira agglutinating antibodies was used as a marker for previous infection. In households with index cases, 22 (30%) of 74 members had anti-Leptospira antibodies, whereas 16 (8%) of 195 members from control households had anti-Leptospira antibodies. Highest titres were directed against L. interrogans serovars of the Icterohaemorrhagiae serogroup in 95% and 100% of the subjects with agglutinating antibodies from case and control households, respectively. Residence in a household with an index case of leptospirosis was associated with increased risk (OR 5.29, 95% CI 2.13–13.12) of having had a Leptospira infection. Increased infection risk was found for all age groups who resided in a household with an index case, including children <15 years of age (P = 0.008).

Conclusions

This study identified significant household clustering of Leptospira infection in slum communities where recurrent epidemics of leptospirosis occur. The findings support the hypothesis that the household environment is an important transmission determinant in the urban slum setting. Prevention therefore needs to target sources of contamination and risk activities which occur in the places where slum inhabitants reside.     

The insect assemblage in water filled tree-holes in a European temperate deciduous forest: community composition reflects structural,trophic and physicochemical factors

(1) A study of the metazoan community occurring in water-filled tree-holes in southern Germany has been performed to determine the relationships among the key species of arthropods found within the community and a range of structural, physical and chemical factors, using multivariate techniques. (2) Four animal species were sufficiently common to allow identification of the preferred environments for their larvae. The aedine mosquito, Aedes geniculatus, prefers shallow open tree-holes with relatively little leaf litter even though these may represent less permanent water-bodies. The scirtid beetle, Prionocyhon serricornis, occurs in larger, deeper holes with greater amounts of leaf litter and a more predictable aquatic environment, although open water is not a requisite. Larvae of the orthocladiine chironomid, Metriocnemus cavicola, favours shallow more open tree-holes with higher litter content but with sufficient open water to ensure an adequate oxygen supply. The eristaline syrphid, Myatropa florea, favours shallow, open tree-holes with low litter content. (3) There is no evidence that interspecific interactions affect the distribution or abundance of any of these species. (4) The autecological results are discussed in light of those available for phytotelm dwellers elsewhere. The food-web overall may be interpreted as so simple that it is driven by ‘bottom-up’ environmental factors with no part played by those community-level ‘top-down’ processes that may be adduced for more complex, multi-trophic level webs occurring elsewhere. No “processing chain commensalism” could be found in the arthropod community of the temperate German deciduous tree-hole dwellers. Handling editor: K. Martens     

Tobacco Smoking and Its Association with Illicit Drug Use among Young Men Aged 15-24 Years Living in Urban Slums of Bangladesh

Background

Tobacco smoking (TS) and illicit drug use (IDU) are of public health concerns especially in developing countries, including Bangladesh. This paper aims to (i) identify the determinants of TS and IDU, and (ii) examine the association of TS with IDU among young slum dwellers in Bangladesh.

Methodology/Principal Findings

Data on a total of 1,576 young slum dwellers aged 15–24 years were extracted for analysis from the 2006 Urban Health Survey (UHS), which covered a nationally representative sample of 13,819 adult men aged 15–59 years from slums, non-slums and district municipalities of six administrative regions in Bangladesh. Methods used include frequency run, Chi-square test of association and multivariable logistic regression. The overall prevalence of TS in the target group was 42.3%, of which 41.4% smoked cigarettes and 3.1% smoked bidis. The regression model for TS showed that age, marital status, education, duration of living in slums, and those with sexually transmitted infections were significantly (p<0.001 to p<0.05) associated with TS. The overall prevalence of IDU was 9.1%, dominated by those who had drug injections (3.2%), and smoked ganja (2.8%) and tari (1.6%). In the regression model for IDU, the significant (p<0.01 to p<0.10) predictors were education, duration of living in slums, and whether infected by sexually transmitted diseases. The multivariable logistic regression (controlling for other variables) revealed significantly (p<0.001) higher likelihood of IDU (OR = 9.59, 95% CI = 5.81–15.82) among users of any form of TS. The likelihood of IDU increased significantly (p<0.001) with increased use of cigarettes.

Conclusions/Significance

Certain groups of youth are more vulnerable to TS and IDU. Therefore, tobacco and drug control efforts should target these groups to reduce the consequences of risky lifestyles through information, education and communication (IEC) programs.     

Waders in winter: long-term changes of migratory bird assemblages facing climate change

Effects of climate change on species occupying distinct areas during their life cycle are still unclear. Moreover, although effects of climate change have widely been studied at the species level, less is known about community responses. Here, we test whether and how the composition of wader (Charadrii) assemblages, breeding in high latitude and wintering from Europe to Africa, is affected by climate change over 33 years. We calculated the temporal trend in the community temperature index (CTI), which measures the balance between cold and hot dwellers present in species assemblages. We found a steep increase in the CTI, which reflects a profound change in assemblage composition in response to recent climate change. This study provides, to our knowledge, the first evidence of a strong community response of migratory species to climate change in their wintering areas.     

A faunistic approach to assess potential side-effects of genetically modified Bt-Corn on non-target arthropods under field conditions

A faunistic study investigating the potential side-effects of corn (Zea mays) genetically modified to express a truncated Cry1Ab protein derived from Bacillus thuringiensis subsp. kurstaki, on non-target arthropods was carried out under field conditions. The communities of non-target arthropods in the soil, on the leaves and flying in the crop area were monitored throughout the growing season. Water-treated, untransformed corn served as a control, and a spray application of a bacterial Bt insecticide (Delfin WG) and a synthetic insecticide (Karate Xpress) used to control the European corn borer (Ostrinia nubilalis; Lepidoptera: Pyralidae) acted as positive reference treatments. Results were analyzed using a principal response curve. Significantly lower infestations by the lepidopteran target species O. nubilalis were observed in the Bt-corn plots compared to the control. No effects of Bt-corn on the communities of soil dwelling and non-target plant dwelling arthropods were observed. A trend towards a community effect on flying arthropods was observed with lower abundance of adult Lepidoptera, flies in the families Lonchopteridae, Mycetophilidae and Syrphidae, and the hymenopteran parasitoids Ceraphronidae. Effects were weak and restricted to two sampling dates corresponding to anthesis. A short but statistically significant effect of Karate Xpress and Delfin was observed on the community of plant dwellers and a prolonged effect of Karate Xpress on the soil dwellers.     

Relationship of family income and house type to body mass index and chronic energy deficiency among urban Bengalee male slum dwellers of Kolkata, India

A cross-sectional study of 469 adult (>18 years) Bengalee male slum dwellers of Dum Dum, Kolkata, India, was undertaken to study the relationships of family income and house type with body mass index (BMI) and chronic energy deficiency. The overall frequency of chronic energy deficiency was 32.0%. Based on the World Health Organization classification, the prevalence of chronic energy deficiency among this population was high and thus the situation is serious. Overall, monthly family income was significantly positively correlated with BMI. Significant differences in mean weight, BMI and monthly family income, were observed between the two house type groups. All values were found to be significantly higher in the brick household group who also earned a comparatively higher income as evident from the mean monthly family income values. The prevalence of chronic energy deficiency was also found to be significantly higher in the bamboo-fenced household group. Subjects belonging to the lowest family income group had the lowest mean BMI and the highest rate of chronic energy deficiency while those in the highest family income group had the largest mean BMI and lowest rate of chronic energy deficiency. There was a significant family income group difference in mean BMI. There existed significant differences in chronic energy deficiency rates in family income group categories. Linear regression analyses showed that monthly family income and house type had a significant impact on BMI. Subsequent multiple regression analyses revealed that both monthly family income and house type had a significant impact on BMI, even after controlling for each other.     

Stench and sensibilities: On living with waste,animals and microbes in India

Stench is often the most immediate mark of something dirty, decaying and diseased. In India, stench and the smell of acrid smoke commonly indicate the proximity of an open dump or landfill. Frequently a slum is located in the vicinity too, housing waste‐pickers who forage in these sprawling dumps for salvageable waste. These spaces are also host to vermin, birds, stray dogs, pigs, cows and, more recently, dangerous bacteria resistant to even top‐end antibiotics, popularly known as ‘superbugs’. In this paper I examine the socio‐ecological context of neighbourhood, community open garbage dumps and larger landfills in an effort to understand these as part of a dynamic ecosystem of ‘more‐than‐human’ relations. Perceptual variations of smell as experienced in and around waste (in its solid, liquid and gas states) are intrinsically linked to symbolic and material practices across species. Additionally, I suggest that one productive way to think about the emergence of disease and pathogenicity is by considering the information stimulated by smell, which is mediated by cultural interpretations, biological capacities and wider political economies.     

Random Amplified Polymorphic DNA (RAPD) for differentiation between Thai and Myanmar strains of Wuchereria bancrofti

Background

Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka.

Methods

Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS.

Results

Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52 %) of employed patients and 26 persons reported loss of job. Approximately 25 % and 6 % reported having problems interacting with the community and family, respectively and 8.7 % felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8 % of patients. Of the married persons, 5.7 % and 6.2 % reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001).

Conclusion

Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.