Approaches to endemic and infectious disease

As cities in the developing world grow, slums become more densely packed, exposing residents to unsanitary conditions and increasing the risk of contracting infectious disease. Endemic diseases such as dengue fever, swine flu, malaria, and tuberculosis spread quickly, overwhelming limited health services and infrastructure. With health care facilities remote or non-existent, medication unavailable or unaffordable, health knowledge shaky, and caregivers in short supply, how can informal communities keep contagion in check?

Read on for solutions from Mumbai, Nairobi, Jakarta, São Paulo, and Mexico City — then join the conversation in the comments below.

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Carlin Carr

Rainy season brings public health risks to Mumbai

Carlin Carr, Mumbai Community Manager


Monsoon clouds moved over Mumbai last week, opening up into a deluge. It's the start of the rainy season in India — a welcome relief from the summer heat and a time to recharge water levels that had dropped to drought levels. While most people celebrate the wet months ahead, the season also brings with it a number of public health and safety hazards. Malaria is among the deadly diseases that raise alarms for public health officials, and it is slum dwellers who are most widely affected.

Malaria is spread through the bite of the ubiquitous female Anopheles mosquito. These mosquitoes breed in stagnant water where drainage is often clogged. The slums areas of Mumbai are always hardest hit. While some precautions include taking anti-malarial drugs, spraying with repellent or using mosquito nets, these are rarely options for the poor. A study on malaria interventions in Mumbai slums found that in the Parel slum, a central part of the city, 90 percent of slum dwellers live below the poverty line and cannot afford preventive measures against malaria.

While malaria remains a perennial issue, city officials launched a targeted intervention in 2009 that has become a model for other Indian cities. Numbers prove its success: there were 198 deaths due to malaria in 2009; dropping to 145 in 2010; 69 in 2011; and 45 in 2012. According to a Times of India article, the city has created a booklet documenting the approach and an awareness-raising film. "The BMC [Mumbai's city government] adopted a multi-pronged approach to deal with malaria, with focus on slums and construction sites, door-to-door screening, regular fogging and keeping tabs on malaria patients to ensure they underwent the entire treatment so that there was no relapse," says the article from earlier this year.

Malaria is not the only concern; officials have seen a rise in dengue during the rainy season as well. Municipal commissioner Sitaram Kunte said that their focus will now turn to combating this other mosquito-borne illness using the malaria model: "We carried out extensive house-to-house screening programs to keep a check on malaria; similar steps will be taken for dengue. Societies who don't follow the BMC guidelines will be penalized."

In addition, the city needs to ensure that storm drains are cleaned to avoid water logging. While officials has ensured civic organizations that it has taken the necessary measures to prepare the city, experience has proven otherwise. In just the first few days of the monsoon, flooding was rampant.

Monsoon-related illnesses know no boundaries. And while slum areas are most adversely affected, the entire city is on watch. Mumbai's anti-malaria program shows that proactive interventions can not only prevent infections but can also quickly deal with cases that come in. Most importantly, the city has seen how one program can be adapted to lessen the impact of other diseases, with life-saving results.

Photo: Dinesh Bareja


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