While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore,... Show moreWhile facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668 Show less
The substantial increase in the prevalence of non-communicable diseases in Indonesia might be driven by rapid socio-economic development through urbanization. Here, we carried out a longitudinal 1... Show moreThe substantial increase in the prevalence of non-communicable diseases in Indonesia might be driven by rapid socio-economic development through urbanization. Here, we carried out a longitudinal 1-year follow-up study to evaluate the effect of urbanization, an important determinant of health, on metabolic profiles of young Indonesian adults. University freshmen/women in Jakarta, aged 16-25 years, who either had recently migrated from rural areas or originated from urban settings were studied. Anthropometry, dietary intake, and physical activity, as well as fasting blood glucose and insulin, leptin, and adiponectin were measured at baseline and repeated at one year follow-up. At baseline, 106 urban and 83 rural subjects were recruited, of which 81 urban and 66 rural were followed up. At baseline, rural subjects had better adiposity profiles, whole-body insulin resistance, and adipokine levels compared to their urban counterparts. After 1-year, rural subjects experienced an almost twice higher increase in BMI than urban subjects (estimate (95%CI): 1.23 (0.94; 1.52) and 0.69 (0.43; 0.95) for rural and urban subjects, respectively, P-int < 0.01). Fat intake served as the major dietary component, which partially mediates the differences in BMI between urban and rural group at baseline. It also contributed to the changes in BMI over time for both groups, although it does not explain the enhanced gain of BMI in rural subjects. A significantly higher increase of leptin/adiponectin ratio was also seen in rural subjects after 1-year of living in an urban area. In conclusion, urbanization was associated with less favorable changes in adiposity and adipokine profiles in a population of young Indonesian adults. Show less
Intensified and competing claims over land are crucial to understanding current urban transformations in Africa. This paper aims to highlight the role of transnational migrants in urban land... Show moreIntensified and competing claims over land are crucial to understanding current urban transformations in Africa. This paper aims to highlight the role of transnational migrants in urban land investments and claim making on urban land. While the relationship between urbanization in Africa and migration has long been a focus of research and policy, attention had mainly focused on the intertwinement between rising urbanization and the in flux of rural migrants, internally displaced people (IDPs) and refugees struggling to survive and gain access to urban space and services. More recently, the African city has gained a more positive image as a consequence of Africa's economic boom and has come to be seen as a pillar of development, rather than a place of chaos and poverty. In this 'urban turn' in development thinking and concomitant technocratic and infrastructural policy approaches, the link between urbanization and migration has been largely overlooked. We argue, however, that transnational migrants in particular are an important category in claim-making processes over urban land and real estate and add to these in specific ways. Using case studies in Khartoum and Dakar, we investigate the ways in which transnational migrants contribute to speculation, rising land values and processes of socio-spatial inclusion and exclusion. Rather than making a comparative analysis, we use two concrete cases to gain an empirical understanding of the processes associated with these diaspora investments, including the question of whether these transnational migrants can be considered as contributing to urban 'land grabs' or not. Show less
A review of Russian and foreign approaches to analyze and assess the ecological and socioeconomic role of urban and technogenic soils is made in the context of the two popular concepts: the... Show moreA review of Russian and foreign approaches to analyze and assess the ecological and socioeconomic role of urban and technogenic soils is made in the context of the two popular concepts: the ecological functions of soils and ecosystem services. The modern definitions, classification, and evaluation of ecosystem services and their relationships with soil functions are considered both in general and in relation to urban and technogenic soils. Despite some methodological differences, the work shows that the concepts are closely related, and their joint use is highly promising. Three practical examples for the cities of Moscow, Hangzhou, and Hong Kong show a consistent transition from the analysis of soil properties and functions to the assessment of ecosystem services and decision making in engineering, urban improvement, and sustainable urban development. Show less
Africa’s rapid population growth, and even more rapid urbanisation, creates serious sustainability challenges. Like many cities in other parts of the world, African cities try to become ‘green’,... Show moreAfrica’s rapid population growth, and even more rapid urbanisation, creates serious sustainability challenges. Like many cities in other parts of the world, African cities try to become ‘green’, and promote change in urban design and lifestyles to encourage more sustainable living. Many of these initiatives are supported by international agencies and illustrated on agency websites. Studying these websites, we try to answer three related questions dealing with the inclusivity of those initiatives: the geographical coverage (which cities?), the thematic coverage (how ‘holistic’?) and the social inclusivity (how inclusive in terms of social focus?). Both scholars and practitioners should become more inclusive in their approaches to sustainable cities in Africa. Show less
Africa's rapid population growth, and even more rapid urbanisation, creates serious sustainability challenges. Like many cities in other parts of the world, African cities try to become 'green',... Show moreAfrica's rapid population growth, and even more rapid urbanisation, creates serious sustainability challenges. Like many cities in other parts of the world, African cities try to become 'green', and promote change in urban design and lifestyles to encourage more sustainable living. Many of these initiatives are supported by international agencies and illustrated on agency websites. Studying these websites, we try to answer three related questions dealing with the inclusivity of those initiatives: the geographical coverage (which cities?), the thematic coverage (how 'holistic'?) and the social inclusivity (how inclusive in terms of social focus?). Both scholars and practitioners should become more inclusive in their approaches to sustainable cities in Africa. Show less
Shannon, M.; Otsuki, K.; Zoomers, A.; Kaag, M.M.A. 2018
With this article we contribute to debates on urban land governance and sustainable urban development in Africa by providing an empirical analysis of forced displacement and resettlement associated... Show moreWith this article we contribute to debates on urban land governance and sustainable urban development in Africa by providing an empirical analysis of forced displacement and resettlement associated with infrastructure development in Beira city, Mozambique. In recent years Beira has become the recipient of numerous investment flows targeting the built environment by a range of international investors. By analyzing the micropolitical engagements associated with three different infrastructure projects, based on extensive qualitative interviews, observations, and document analysis, we demonstrate how each intervention has been associated with highly informal and divergent processes of forced displacement and resettlement. We argue that these land related impacts have been annexed from debates on sustainable infrastructure development, and that they exhibit some fundamental differences from established resettlement research. We conclude by arguing that forced displacement and resettlement should be understood as a deliberate and systematic feature of urban infrastructure development, through which new social-spatial arrangements are created. This ultimately points to the emergence of a novel mode of fragmented urbanism within the context of urban development in Africa which poses new challenges to urban sustainability. Show less
OURSUS (Our Sustainable Cities) is a flagship IGU project. The OURSUS approach and findings will be discussed in two sessions during the 33rd International Geographical Congress in Beijing: one... Show moreOURSUS (Our Sustainable Cities) is a flagship IGU project. The OURSUS approach and findings will be discussed in two sessions during the 33rd International Geographical Congress in Beijing: one session about 'Chinese and International Experiences' and one about 'The Way Forward'. This paper contributes to the first session: exploring international experiences. It examines the evidence in Africa regarding the intentions of municipalities and their leadership to develop more sustainable cities, and to mobilise business and popular support for more sustainable futures in a continent that is likely to have the fastest urbanization trends in the decades ahead. The paper also compares the approaches of various sustainable city networks in Africa with the OURSUS approach, and it looks at the input of geographers. Show less
