Urban Health and the Prevalence of Non-Communicable Diseases in Malaysia

@#Introduction: Urbanisation is a key determinant of population health. Malaysia’s exemplary economic growth in the early 1990s and the consequent development and urbanisation led to significant changes in health, lifestyle and quality of life. Rising expectations, changing demographics and nutrition and disease transitions were challenges synonymous to an increasingly urban Malaysia. As the Government targets optimal population health, this paper aims to explore one of the many challenges of urbanisation, namely the prevalence of non-communicable diseases or NCDs. For the purpose of this paper, NCD is proxied by Diabetes Mellitus. Methods: This study is based the 2015 National Health and Morbidity Survey, which is a cross-sectional population-based survey, involving 30,000 respondents. Given the binomial nature of the survey variables, the multinomial Probit model was employed using the STATA statistical software. Results: Generally, age, gender and race are significant in determining health outcomes. Socioeconomically, all three variables of income, education and employment are significant. For lifestyle factors, findings show that only the weight and physically active status have a role in determining health outcomes. Finally, the urban variable is also positive and significant. Conclusion: Findings show that the prevalence of Diabetes Mellitus, is rising along with urbanisation and that there is a health penalty for the urban population and also for those who do not embrace healthy lifestyles. Additionally, other factors are equally important as urban health determinants, encompassing both the demographic and socioeconomic factors.

Distribution of the members of the Pipiens Assemblage in the sympatric area from Argentina: which is where and when?

Given their medical and veterinary relevance, the members of the Pipiens Assemblage are a worldwide target of ecological research. The distribution of Culex pipiens s.s. and Cx. quinquefasciatus converge in Buenos Aires, Argentina, where hybrids have been detected. Each member of the assemblage exhibits a distinct eco-physiological behaviour that can affect its efficiency in pathogen transmission. Our aim was to identify the environmental drivers for the spatio-temporal distribution of each member, focusing on latitudinal and urbanisation gradients. Immatures of mosquitoes were surveyed in artificial containers found within 11 public cemeteries, raised up to the adult stage and identified by their male genitalia. The distribution of each member was associated with the environment in a Generalized Linear Model. The variable accounting for most of the heterogeneity was latitude; Cx. quinquefasciatus was collected more frequently at northern cemeteries, whereas Cx. pipiens and hybrids were more likely at the southern extreme. The urbanisation gradient was also associated with the occurrence of Cx. quinquefasciatus and hybrids at the high and low end, respectively. Other relevant variables were cemetery total area, the proportion with graves and the presence of plastic flowers in the containers. The spatial distribution of the members of the Pipiens Assemblage within the sympatric region in South America is driven by environmental features. The information presented herein provides essential baseline data for surveillance programs and control activities.

Human and canine visceral leishmaniasis in an emerging focus in Araçuaí, Minas Gerais: spatial distribution and socio-environmental factors

This study aimed to analyse the spatial distribution of human (2007-2013) and canine (2013) visceral leishmaniasis (VL) in the city of Araçuaí, Minas Gerais, Brazil, and identify the socio-environmental factors related to their occurrence. The spatial distribution of human and canine cases was analysed by kernel density estimation (KDE) and the K function. The KDE values were analysed for correlation between human and canine LV and for normalised difference vegetation index (NDVI). Socio-environmental aspects of household structures and surroundings were evaluated. The spatial distribution of human and canine VL cases exhibited a significant aggregated pattern in distances greater than 350 and 75 m, respectively. The higher occurrence of human and canine infection occurred in the central area of the city. A positive correlation between the densities of human and canine cases was observed, as well as a negative correlation between NDVI and densities of human and canine cases. Socio-environmental analysis revealed that the large amount of animals, organic material from trees and deficiencies in environmental sanitation are possibly contributing to the continuation of the transmission cycle of Leishmania infantum in Araçuaí. These results can contribute to the planning by competent agencies to reduce the incidence of infection in the city.

How Does Your Garden Flow? The Impact of Domestic Front Gardens on Urban Flooding.

Aims: To quantify rainwater runoff from domestic front gardens as a consequence of increased impervious surface area and climate change impacts, thus allowing the runoff contribution from both newly and previously covered front gardens to be assessed in terms of the overall urban flood burden. Study Design: Numerical simulation of the runoff from a typical front garden in response to simulated rainfall events for four UK cities (Edinburgh, Manchester, London, and Exeter). Methodology: A typical front garden was simulated with varying areas of impermeable surface area (0%, 10%, 25%, 50%, 75%, and 100%) to represent observed trends in garden paving. Storm events representing current design and projected future rainfall intensities were applied to each of the four cities. The resultant runoff volumes were then quantified. Results: Runoff is shown to be directly proportional to both the impermeable surface area and the rainfall intensity. Areas of impermeable paving can generate substantial volumes of runoff during a storm event which can contribute to localized flooding or add to the urban flood burden. Increased rainfall intensities and frequencies due to climate change are likely to increase runoff further. Conclusion: Domestic front gardens play a vital role in managing surface water runoff in towns and cities. Growing trends of paving over front gardens put this role in jeopardy, while increasing rainfall intensities due to climate change make this role increasingly important. The quantification of domestic front garden runoff provides a mechanism for facilitating the protection, and enhancement, of this important asset in terms of water and urban flood management.

Spatial distribution of triatomines in domiciles of an urban area of the Brazilian Southeast Region

Reports of triatomine infestation in urban areas have increased. We analysed the spatial distribution of infestation by triatomines in the urban area of Diamantina, in the state of Minas Gerais, Brazil. Triatomines were obtained by community-based entomological surveillance. Spatial patterns of infestation were analysed by Ripley’s K function and Kernel density estimator. Normalised difference vegetation index (NDVI) and land cover derived from satellite imagery were compared between infested and uninfested areas. A total of 140 adults of four species were captured (100 Triatoma vitticeps, 25Panstrongylus geniculatus, 8 Panstrongylus megistus, and 7 Triatoma arthurneivai specimens). In total, 87.9% were captured within domiciles. Infection by trypanosomes was observed in 19.6% of 107 examined insects. The spatial distributions ofT. vitticeps, P. geniculatus, T. arthurneivai, and trypanosome-positive triatomines were clustered, occurring mainly in peripheral areas. NDVI values were statistically higher in areas infested by T. vitticeps and P. geniculatus. Buildings infested by these species were located closer to open fields, whereas infestations of P. megistus andT. arthurneivai were closer to bare soil. Human occupation and modification of natural areas may be involved in triatomine invasion, exposing the population to these vectors.

Lutzomyia longipalpis urbanisation and control

Since the description of Lutzomyia longipalpis by Lutz and Neiva more than 100 years ago, much has been written in the scientific literature about this phlebotomine species. Soares and Turco (2003) and Lainson and Rangel (2005) have written extensive reviews focused on vector-host-parasite interactions and American visceral leishmaniasis ecology. However, during the last two decades, the success of Lu. longipalpis in colonising urban environments and its simultaneous geographical spreading have led to new theoretical and operational questions. Therefore, this review updates the general information about this species and notes the more challenging topics regarding the new scenario of urbanisation-spreading and its control in America. Here, we summarise the literature on these issues and the remaining unsolved questions, which pose recommendations for operational research.

Sandfly (Diptera: Psychodidae: Phlebotominae) species diversity in an urban area of the municipality of Tapachula, Chiapas, Mexico

Monitoring phlebotomine sandflies in urban areas is key for epidemiological studies in susceptible populations. This paper describes sandfly fauna that were present in an urban area of the municipality of Tapachula, Chiapas, Mexico, and were captured with Shannon and CDC light traps. During February and March of 2014, 1,442 sandflies were captured, specifically Lutzomyia cruciata (Coquillet) (98.8%), Lutzomyia cayennensis cayennensis (Floch and Abonnenc) (0.8%), Lutzomyia chiapanensis (Dampf) (0.3%) and Lutzomyia atulapai (De León) (0.1%). Lu. cruciata was the most abundant and the most frequently trapped species. This is the first record of its remarkable ability to adapt to urban green areas. The three other species trapped represent new records of geographic distribution for the study region. These results indicate the need to establish measures for reducing both human contact with this vector and the risk of possible sites of infection.

A Cross-sectional Study on the Influence of Altitude and Urbanisation on Co-infection of Malaria and Soil-transmitted Helminths in Fako Division, South West Cameroon.

Aims: Malaria and soil-transmitted helminth (STH) infections are parasitic diseases afflicting populations that are impoverished and malnourished. The aim of this study was to assess the influence of altitude and urbanisation on Co-infection of malaria and soil-transmitted helminths in Fako Division, South West Cameroon. Study Design/Place and Duration of Study: It was a cross-sectional survey carried out from 2012 to 2014 involving 1138 children aged 4 – 15 years in Fako Division. Methodology: Structured questionnaire was administered to obtain demographic and socioeconomic data. Blood samples were collected by pricking the finger. Malaria parasite prevalence, density and species were determined from Giemsa-stained thick and thin blood smears respectively. Quantitative estimation of helminth eggs was done by Kato-Katz thick smear technique. Based on height above sea level (a.s.l.), the study sites were classified as Lowland (<200 m.a.s.l), Lower middle belt (>200 but ≤ 400 m.a.s.l), Upper middle belt (>400 but ≤600 m.a.s.l.) and Highland (>600 m.a.s.l). The study communities were also classified into rural, semiurban and urban areas. Results: The overall prevalence was 38.1% (433) for malaria, 2.5% (29) for STHs and 0.9% (10) for malaria-STH co-infection. The prevalence of malaria was significantly highest (χ2 = 84.6, P <0.001) in urban areas (52.2%, 263) than in the semi-urban (29.4%, 152) and rural areas (15.4%, 18). Malaria prevalence was significantly highest (χ2 = 123.4, P <0.001) at the lowest altitude (60.5%, 182) and decreased as altitude increased to a minimum of 15.4% (18) at highland (>600 m.a.s.l). Only two species of soil-transmitted STH [Ascaris lumbricoides (1.9%) and Trichuris trichiura (0.6%)] were found. The prevalence of STH was significantly higher (χ2= 33.8, P <0.0001) in rural (13.6%, 16) than urban (0.39%, 2) areas. The prevalence of STH was significantly highest (χ2 = 33.8, P <0.0001) at high altitude (13.6%, 16) than the upper middle-belt (2.0%, 8), lower middle-belt (1.2%, 4) and lowlands (0.7%, 2). The prevalence of co-infection varied significantly (χ2 = 72.2, P <0.0001) with level of urbanisation with the highest level of co-infection occurring in the rural areas (2.6%, 3) and the lowest level in the urban areas (0.2%, 1). Conclusion: Malaria control measures need to be intensified especially in the lowland and urban areas. Deworming campaigns are yielding positive results in Fako Division.

The peri-urban interface and house infestation with Triatoma infestans in the Argentine Chaco: an underreported process?

Peri-urban infestations with triatomine bugs, their sources and their dynamics have rarely been investigated. Here, we corroborated the reported occurrence of Triatoma infestans in a peri-urban area and in neighbouring rural houses in Pampa del Indio, in the Argentine Chaco, and identified its putative sources using spatial analysis and demographic questionnaires. Peri-urban householders reported that 10% of their premises had triatomines, whereas T. infestans was collected by timed manual searches or community-based surveillance in only nine (3%) houses. Trypanosoma cruzi-infected T. infestans and Triatoma sordida were collected indoors only in peri-urban houses and were infected with TcV and TcI, respectively. The triatomines fed on chickens, cats and humans. Peri-urban infestations were most frequent in a squatter settlement and particularly within the recently built mud houses of rural immigrants, with large-sized households, more dogs and cats and more crowding. Several of the observed infestations were most likely associated with passive bug transport from other sources and with active bug dispersal from neighbouring foci. Thus, the households in the squatter settlement were at a greater risk of bug invasion and colonisation. In sum, the incipient process of domestic colonisation and transmission, along with persistent rural-to-urban migratory flows and unplanned urbanisation, indicate the need for active vector surveillance and control actions at the peri-urban interface of the Gran Chaco.

Characterization of the microbial community in a lotic environment to assess the effect of pollution on nitrifying and potentially pathogenic bacteria / Caracterização da comunidade microbiana em um ambiente lótico para acessar o efeito da poluição em bactérias nitrificantes e potencialmente patogênicas

This study aimed to investigate microbes involved in the nitrogen cycle and potentially pathogenic bacteria from urban and rural sites of the São Pedro stream. Water samples were collected from two sites. A seasonal survey of bacterial abundance was conducted. The dissolved nutrient content was analysed. PCR and FISH analysis were performed to identify and quantify microbes involved in the nitrogen cycle and potentially pathogenic bacteria. The seasonal survey revealed that the bacterial abundance was similar along the year on the rural area but varied on the urban site. Higher concentration of dissolved nutrients in the urban area indicated a eutrophic system. Considering the nitrifying microbes, the genus Nitrobacter was found, especially in the urban area, and may act as the principal bacteria in converting nitrite into nitrate at this site. The molecular markers napA, amoA, and nfrA were more accumulated at the urban site, justifying the higher content of nutrients metabolised by these enzymes. Finally, high intensity of amplicons from Enterococcus, Streptococcus, Bacteroides/Prevotella/Porphyromonas, Salmonella, S. aureus, P. aeruginosa and the diarrheagenic lineages of E. coli were observed at the urban site. These results indicate a change in the structure of the microbial community imposed by anthrophic actions. The incidence of pathogenic bacteria in aquatic environments is of particular importance to public health, emphasising the need for sewage treatment to minimise the environmental impacts associated with urbanisation.

Este estudo objetivou investigar os micro-organismos envolvidos no ciclo do nitrogênio e bactérias potencialmente patogênicas das áreas urbanas e rurais do Córrego São Pedro. Amostras de água foram coletadas dos dois locais. Um levantamento sazonal da densidade bacteriana foi realizado. O teor de nutriente dissolvido foi avaliado. As técnicas de PCR e FISH foram realizadas para identificar e quantificar os micro-organismos envolvidos no ciclo do nitrogênio e bactérias potencialmente patogênicas. O levantamento sazonal revelou que a abundância bacteriana foi semelhante ao longo do ano na área rural, porém variou na região urbana. Altas concentrações de nutrientes dissolvidos na área urbana indicaram este como um sistema eutrófico. Considerando os micro-organismos nitrificantes, o gênero Nitrobacter foi encontrado, especialmente na região urbana, e pode estar atuando como a principal bactéria convertendo nitrito em nitrato nessa área. Os marcadores moleculares napA, amoA, e nfrA foram mais acumulados na área urbana, justificando o alto teor dos nutrientes metabolizados por essas enzimas. Finalmente, alta intensidade de amplicons para Enterococcus, Streptococcus, Bacteroides/Prevotella/Porphyromonas, Salmonella, S. aureus, P. aeruginosa e linhagens diarreagênicas de E. coli foram observados na área urbana. Estes resultados indicaram uma mudança na estrutura da comunidade microbiana imposta pelas ações antropogênicas. A incidência de bactérias patogênicas em ambientes aquáticos é de particular importância para a saúde pública, enfatizando a necessidade de tratamentos de esgoto para minimizar os impactos ambientais associados com a urbanização.

Tire-breeding mosquitoes of public health importance along an urbanisation gradient in Buenos Aires, Argentina

Used vehicle tires are a source of mosquito vectors and a means of their introduction and expansion. With the aim of assessing the effects of urbanisation on the main mosquito vectors in temperate Argentina, the infestation levels of Aedes aegypti (L.) and Culex pipiens L. were studied in used tires from highly urbanised cities to low-urbanised small towns in Buenos Aires. Immatures of both species accounted for 96 percent of the 9,722 individuals collected; the total individuals collected represented seven species. The percentage of water-filled tires containing mosquitoes [container index (CI)] was 33 percent and the percentage of infested sites [site index (SI)] was 65.2 percent. These indexes decreased significantly from low to high urbanisation levels for both mosquito species. The relative abundance (RA) of Ae. aegypti immatures was slightly higher toward large cities, but showed no difference for Cx. pipiens. The CI of shaded tires was significantly higher than the CI of exposed tires for both mosquito species. There was no difference in RA values between shaded and sunlit tires. The CI and the SI were highest during the summer across the urbanisation levels, except for Cx. pipiens, which continued to increase during the autumn in small towns. Results related to urbanisation gradient, sunlit exposure and seasonality are discussed.

Niveles de urbanización, uso de televisión y video-juegos en niños colombianos: posibles implicaciones en salud pública / Possible public health implications regarding associations between the degree of urbanisation and electronic media exposure amongst Colombian children

Objetivo Examinar la asociación entre los niveles de urbanización y el uso excesivo de televisión y videojuegos (2 horas o más) en niños colombianos de 5 a 12 años. Métodos Un análisis secundario fue realizado a partir de los datos provenientes de 13.090 niños entre 5 a 12 años de edad que fueron seleccionados en la Encuesta Nacional de la Situación Nutricional en Colombia 2005, a los cuales se les determinó el tiempo dedicado a ver televisión y jugar con video juegos, a través de la información proveniente de uno de los padres o acudientes. Cinco niveles de urbanización fueron determinados mediante una adaptación de las categorías definidas por el Departamento Nacional de Planeación. Un modelo de regresión logística fue llevado a cabo, el cual considero potenciales variables de confusión. Resultados Se observó un incremento gradual de la probabilidad de ver dos o más horas televisión o video juegos a medida que el nivel de urbanización era mayor, la cual fue estadísticamente significativa a partir del nivel de urbanización 3 (nivel 2 OR de prevalencia: 1,33 IC 95 por ciento: 0,89-1,99; nivel 3: 1,35: 1,00-1,80; nivel 4: 1,61: 1,16-2,23 y nivel 5: 1,70: 1,17-2,46). Conclusión Los hallazgos de este estudio muestran como el uso excesivo de televisión y video juegos en niños esta asociado a mayores niveles de urbanización. Debido a las implicaciones que tiene para la salud de los niños la exposición excesiva a la televisión y otras formas de entretenimiento electrónico, es importante monitorear este comportamiento y entender sus determinantes.

Objective Determining the association between the degree of urbanisation and excessive television-viewing and video-game use amongst children aged 5 to 12 years old. Methods Data from the Colombian National Nutritional Survey 2005 was used in the analysis. Television viewing and video-game use was determined through parental reports for 13,090 children and classified as being excessive (e" 2 hours/day) or suitable (<2 hours/day). Five levels of urbanisation were determined using criteria from the National Planning Department and the population size of the rural or urban settings included in the survey. Multiple logistical regression analysis was conducted while taking potential confounders into account. Results There was a gradual increase in the probability of TV or videogames being used for 2 hours or more as the degree of urbanisation increased. This association was statistically significant for urbanisation level 3 and higher (urbanisation level 2, OR=1,33: 0,89-1,99 95 percentCI; urbanisation level 3, 1,35=OR: 1,00-1,80 95 percentCI; urbanisation level 4, 1,61=OR: 1,16-2,23 95 percentCI and urbanisation level 5, 1,7=OR: 1,17-2,46 95 percentCI). Conclusion Colombian children living in areas of high-to-moderate urbanisation and population density are at a higher risk of excessive exposure to electronic media entertainment. Due to its multiple health implications (in particular obesity and cardio-metabolic health), such sedentary behaviour should be monitored and its determinants in the Colombian paediatric population must be understand for making effective public health interventions.