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This study sought to understand the determinants of household's choices for fecal sludge (FS) emptying to help fighting against unhygienic/unsafe practices and environmental pollution. A cross-sectional mixed study used in the municipality of Yopougon (Abidjan, Côte d'Ivoire), involved surveys (559 household), and 24 semi-structured interviews. Adjusted odds ratios (aORs) from logistic regressions indicated the variables significantly associated with these practices while thematic content analysis helped assessing stakeholders' perceptions. Respondents (47.6%) reported unhygienic/unsafe emptying, mainly direct FS discharge into open drains or the immediate environment via illegal toilets/pits connections (38.1% out of 47.6%). Household heads with a high monthly income (aOR = 0.59; 95% CI 0.35-0.98; p = 0.04), house ownership (aOR = 0.27; 95% CI 0.15-0.47; p < 0.001) and distance to a water body (aOR = 0.03; 95% CI 0.009-0.12; p < 0.001) were the main explanatory variables, significantly reducing the likelihood of unsafe emptying. This likelihood increases when the household is close (≤ 100 m) to gully/gutter (aOR = 1.73; 95% CI 0.99-3.03; p = 0.05). Our recommendations for improving sanitation in low-income settings include reducing environmental pollution caused by unhygienic/unsafe emptying practices requires, enhancing and enforcing current regulations and making implementing texts effective, raising public awareness focusing on the benefits associated to hygienic sanitation practices, and subsidizing sanitation interventions for the poor that includes homeowners., Competing Interests: Declarations. Ethics approval: Approval was obtained from the ethics committee of Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS). In addition, we obtained a research permit issued by the municipality of Yopougon (No. 51/MYOP/CAB/SG-2022). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Participants signed an informed consent form concerning the publication of the information. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

In West Africa, the number of people facing food crises increases each year in both rural and urban areas, due to interdependent factors. The city of Grand Lome in Togo faces an increasingly large population that must ensure access to food, which it hardly produces anymore, because of the establishment of housing and infrastructure. In addition, the increase in the price of food products in this city further weakens the purchasing power of city dwellers in the context of poverty. The objective of this article is to determine the state of food and nutritional security of households in Grand Lome. The methodology adopted is based on documentary research and field surveys. A total of 310 households were interviewed on questions allowing the construction of indicators of food and nutritional security. The results show that despite the availability of food in urban markets, the food situation of households in Grand Lome is not very good. Nearly 49% of households do not have good dietary diversity, and 48% have adopted stress and crisis strategies to access food. Similarly, in Grand Lome, the prevalence of global acute malnutrition is 2.6% of children under 59 months.

There is a pressing need for transitional water infrastructures in rapidly growing cities where conventional infrastructures lag behind human settlement expansion. In Kenya, sectoral innovations have addressed local socioeconomic challenges, but empirical evidence on their efficacy (combining quantitative indicators of safety and continuity) is lacking. We addressed this gap by comparing different water infrastructures in their ability to provide constant access to safe water in informal settlements in Nairobi, Kenya. We conducted a cross-sectional survey including 1,147 households in two informal settlements. Water infrastructures were categorized based on their distribution system: 1) piped to premises; 2) piped to a neighboring compound; 3) public tap/dispenser; and 4) street vendor. We tested associations between these systems with two outcomes: constant water availability and diarrhea (stratified by age group). We used adjusted odds ratios (AORs) to test associations between distribution systems and the selected outcomes, while accounting for confounders. Obtaining water from public taps/dispensers or street vendors was associated with service continuity (AOR = 1.45, 95% confidence interval [CI]: 1.06-1.99; AOR = 11.16, 95% CI: 2.45-50.82). Piped sources were associated with service disruption, especially when obtained from a neighboring compound (AOR = 0.45, 95% CI: 0.28-0.70). Public taps/dispensers were the only system consistently associated with lower odds of diarrhea, notably in children under the age of 5 years (AOR = 0.47, 95% CI: 0.29-0.79). Hence, in cities with a high prevalence of informal settlements and limited financial resources, public taps and dispensers hold promise as transitional water infrastructures.

In addition to individual practices and access to water, sanitation, and hygiene (WASH) facilities, housing conditions may also be associated with the risk of diarrhea. Our study embraced a broad approach to health determinants by looking at housing deprivation characteristics as exposures of interest and confronting the latter's spatial distribution to that of diarrheal cases. We tested the hypothesis that the risk of diarrhea in informal settlements is not only associated with WASH services, but also with inadequate dwelling characteristics, and that their spatial distributions follow similar patterns. We designed a cross-sectional study and collected primary data through georeferenced household surveys in two informal settlements in Abidjan, Côte d'Ivoire. We used local join count statistics to assess the spatial distribution of events and multiple logistic regressions to calculate adjusted odds ratios between diarrhea and exposures. A total of 567 households were enrolled. We found that constant access to basic WASH services, non-durable building materials, cooking outdoors, and water service discontinuity were associated with higher risks of diarrhea in the general population. The spatial distribution of diarrheal cases coincided with that of dwelling deprivation characteristics. We observed significant heterogeneity within the study sites regarding the spatial distribution of diarrheal cases and deprived dwellings. Along with WASH infrastructure, communities also need dignified housing to effectively prevent diarrhea. We recommend that decision-makers acknowledge a "spectrum" of deprivation within the heterogeneous universe of informal settlements, adopting a site-specific approach based on high-resolution data to address diarrhea and improve people's well-being., (© 2023. The Author(s).)

Background: Universal access to basic sanitation remains a global challenge, particularly in low- and middle-income countries. Efforts are underway to improve access to sanitation in informal settlements, often through shared facilities. However, access to these facilities and their potential health gains-notably, the prevention of diarrheal diseases-may be hampered by contextual aspects related to the physical environment. This study explored associations between the built environment and perceived safety to access toilets, and associations between the latter and diarrheal infections., Methods: A cross-sectional study was carried out between July 2021 and February 2022, including 1714 households in two informal settlements in Abidjan (Côte d'Ivoire) and two in Nairobi (Kenya). We employed adjusted odds ratios (aORs) obtained from multiple logistic regressions (MLRs) to test whether the location of the most frequently used toilet was associated with a perceived lack of safety to use the facility at any time, and whether this perceived insecurity was associated with a higher risk of diarrhea. The MLRs included several exposure and control variables, being stratified by city and age groups. We employed bivariate logistic regressions to test whether the perceived insecurity was associated with settlement morphology indicators derived from the built environment., Results: Using a toilet outside the premises was associated with a perceived insecurity both in Abidjan [aOR = 3.14, 95% confidence interval (CI): 1.13-8.70] and in Nairobi (aOR = 57.97, 95% CI: 35.93-93.53). Perceived insecurity to access toilets was associated with diarrheal infections in the general population (aOR = 1.90, 95% CI: 1.29-2.79 in Abidjan, aOR = 1.69, 95% CI: 1.22-2.34 in Nairobi), but not in children below the age of 5 years. Several settlement morphology features were associated with perceived insecurity, namely, buildings' compactness, the proportion of occupied land, and angular deviation between neighboring structures., Conclusions: Toilet location was a critical determinant of perceived security, and hence, must be adequately addressed when building new facilities. The sole availability of facilities may be insufficient to prevent diarrheal infections. People must also be safe to use them. Further attention should be directed toward how the built environment affects safety., (© 2023. The Author(s).)

This article unites different disciplinary debates on 'southern innovation', 'theory from the South', and 'decolonisation of knowledge' in order to discuss existing understandings around the role of Africa in the production of health-related knowledge, public health policy, and medical innovation. Arguing that high-income countries have much to learn from the global South when it comes to health-related knowledge and practices, we propose an interdisciplinary research approach to uncovering and examining African contributions to global health, drawing on an ongoing collaborative project funded by the Swiss National Science Foundation. We present four empirical case studies concerning drug development, healthcare systems, and urban planning to critically enquire into both historical and contemporary transcontinental knowledge circulation and learning potentials, as much as cases of forgetting and silencing. On this basis, we argue that 'learning from the South' must mean more than transplanting quick and cheap technological fixes to serve societies in the global North, but rather recognising the vast contributions that Africans have made to global epistemologies, without losing sight of the asymmetries inherent in South-North knowledge exchanges. Lessons learned might apply to fields other than those discussed here and go far beyond 'reverse innovation'.

Unlike water and sanitation infrastructures or socio-economic indicators, landscape features are seldomly considered as predictors of diarrhoea. In contexts of rapid urbanisation and changes in the physical environment, urban planners and public health managers could benefit from a deeper understanding of the relationship between landscape patterns and health outcomes. We conducted an ecological analysis based on a large ensemble of open-access data to identify specific landscape features associated with diarrhoea. Designed as a proof-of-concept study, our research focused on Côte d'Ivoire. This analysis aimed to (i) build a framework strictly based on open-access data and open-source software to investigate diarrhoea risk factors originating from the physical environment and (ii) understand whether different types and forms of urban settlements are associated with different prevalence rates of diarrhoea. We advanced landscape patterns as variables of exposure and tested their association with the prevalence of diarrhoea among children under the age of five years through multiple regression models. A specific urban landscape pattern was significantly associated with diarrhoea. We conclude that, while the improvement of water, sanitation, and hygiene infrastructures is crucial to prevent diarrhoeal diseases, the health benefits of such improvements may be hampered if the overall physical environment remains precarious.

Urban green infrastructure, especially trees, are widely regarded as one of the most effective ways to reduce urban temperatures in heatwaves and alleviate the adverse impacts of extreme heat events on human health and well-being. Nevertheless, urban planners and decision-makers are still lacking methods and tools to spatially evaluate the cooling effects of urban green spaces and exploit them to assess greening strategies at the urban agglomeration scale. This article introduces a novel spatially explicit approach to simulate urban greening scenarios by increasing the tree canopy cover in the existing urban fabric and evaluating their heat mitigation potential. The latter is achieved by applying the InVEST urban cooling model to the synthetic land use/land cover maps generated for the greening scenarios. A case study in the urban agglomeration of Lausanne, Switzerland, illustrates the development of tree canopy scenarios following distinct spatial distribution strategies. The spatial pattern of the tree canopy strongly influences the human exposure to the highest temperatures, and small increases in the abundance of tree canopy cover with the appropriate spatial configuration can have major impacts on human health and well-being. The proposed approach supports urban planning and the design of nature-based solutions to enhance climate resilience., (© 2021 The Authors.)

Previous studies assessed cultural ecosystem services (CES) at the local scale but often ignored them in national assessments. This paper explores CES relationships in Switzerland using web-based participatory mapping. We identified the spatial relationships between CES, the drivers of negative change and solutions to mitigate it. Results indicated that CES tend to have positive spatial relationships, although not always significant. A proxy-based approach supported the findings that the provision of heritage and inspiration services decreased along the urban-rural gradient while others increased. Participants located more CES close to their residence, but acknowledged their presence in distant alpine regions. They reported that better planning and stricter implementation of policies were necessary to refrain CES loss. According to respondents, there might be a density threshold to ensure sustainable supply of CES. Although mitigation measures were specific enough at the national scale, they remained too broad to be applicable at the local scale.