Increasing Levels of Urban Malnutrition with Rapid Urbanization in Informal Settlements of Katutura, Windhoek: Neighbourhood Differentials and the Effect of Socio-Economic Disadvantage.

Rapid urbanization and increasing urban poverty characterize much of Southern Africa, resulting in poor urban health. This study investigates inter-urban differences and determinants of undernutrition among marginalized communities. Using the 1992, 2000 and 2006/2007 Namibia Demographic and Health Survey data, we fitted hierarchical random intercept logit models, applied at 52 enumeration areas in the capital city (Windhoek), to estimate trends in undernutrition, and investigate risk factors associated with stunting and underweight. Findings demonstrate that undernutrition among children has risen (7.4% to 25.1%, p<0.001 for stunting; and 9.7% to 17.6%, p<0.001 for underweight, between 1992 and 2006/2007). The risk was pronounced for children from socioeconomically disadvantaged households (OR=1.53, 95% CI:[1.01, 2.31] for stunting and OR=2.16, 95% CI:[1.03, 4.89]for underweight). Evidence emerged of intra-urban variation in undernutrition. We argue that with increasing urbanization, comes the challenge of food insecurity and, consequently, malnutrition. For improved child health, urban planners should have targeted interventions for poor urban households and deprived neighbourhoods.

Socioeconomic Determinants of Adult Mortality in Namibia Using an Event History Analysis.

Adult mortality remains a neglected public health issue in sub-Saharan Africa, with most policy instruments concentrated on child and maternal health. In developed countries, adult mortality is negatively associated with socioeconomic factors. A similar pattern is expected in developing countries, but has not been extensively demonstrated, because of dearth of data. Understanding the hazard and factors associated with adult mortality is crucial for informing policies and for implementation of interventions aimed at improving adult survival. This paper applied a geo-additive survival model to elucidate effects of socioeconomic factors on adult mortality in Namibia, controlling for spatial frailties. Results show a clear disadvantage for adults in rural areas, for those not married and from poor households or in female-headed households. The hazard of adult mortality was highly variable with a 1.5-fold difference between areas, with highest hazard recorded in north eastern, central west and southern west parts of the country. The analysis emphasizes that, for Namibia to achieve its national development goals, targeted interventions should be aimed at poor-resourced adults, particularly in high-risk areas.