Healthier, more resilient cities are a global priority. Yet findings from a TDR-supported set of research reviews now published in Infectious Diseases of Poverty reveal severe gaps in urban health knowledge and actions to control infectious diseases and protect the most vulnerable city dwellers.
Abidjan, Cote d’Ivoire
WHO/TDR Bernadette Ramirez
About 70% of the world’s population will live in cities by 2050, mainly in low- and middle-income countries.
This special issue of the journal reviews available evidence on urban health – commissioned by TDR and conducted by scientists from Brazil, Burkina Faso, Canada, Colombia, France and Spain – to analyse the state of public health response to the rising risk of vector-borne and other infectious diseases of poverty in urban settings.
About 80% of the world’s population is at risk of one or more vector-borne diseases (VBDs).
“Unplanned growth in many cities is exploding, disease transmission patterns may be influenced by a number of factors, including climate change and poor living conditions in cities, and there is a lack of research and action being taken,” says TDR scientist and journal commentary author Mariam Otmani del Barrio.
“Before we recommend priorities for next steps we need to identify what we know, what we don’t know, and the most effective solutions to the evolving public health challenges,” explains Otmani del Barrio.
Study authors make a joint call for implementation research in urban settings to generate evidence on the tools, approaches and delivery measures to respond to the growing risk of vector-borne diseases – such as dengue, urban malaria and Zika virus disease.
The urban disease burden disproportionally affects people who live in poor conditions in low- and middle-income countries.
“TDR works with countries and communities to generate evidence that contributes to the global goals for health. In the world we live in today, and for future generations, that means turning our attention to cities and how to fight infectious diseases in the urban context,” says TDR Director John Reeder.
A worldwide call to review urban health research
To identify key research gaps and their policy and practice implications, TDR launched a worldwide call in 2015 to build a research consortium to analyse available knowledge and public health measures in place to combat the spread of VBDs and other infectious diseases in urban settings.
A series of global consultations and research gap and prioritization activities identified six top priority topics of research to review: rapid diagnostics; surveillance systems; impact, economic evaluation and sustainability of integrated vector management; transmission dynamics, vector capacity and coinfection; containment of emerging diseases; and, housing and hygiene interventions.
Key findings
Research analyses on each topic generated detailed findings. Highlights include:
- Rapid diagnostics: Results of this scoping review will be useful to health care providers having to choose among several different rapid diagnostic options and may contribute to improve clinical management and diagnosis of VBDs. More evidence on the performance or implementation of current tests or alternative tools to detect a range of other infectious diseases is needed.
- Surveillance systems: Findings of an extensive literature review on disease surveillance systems report such top research and practice priorities as: innovative research for new disease control tools; more use of cost-effective technologies for surveillance, including mobile phones which can speed up detection and disease control actions; and, more cross-sector collaboration between public health and urban services.
- Impact, economic evaluation and sustainability of integrated vector management: Scoping review authors report a lack of robust studies on the economic evaluation of interventions, and a scarcity of countries with operational integrated vector management (IVM). Community involvement was highlighted as key to vector control success.
- Transmission dynamics, vector capacity and coinfection of infectious diseases: This review focuses mainly on dengue transmission in Asia and the Americas, and malaria in Africa. Authors recommend policies and practices that target the most at-risk populations through stronger disease surveillance measures, including early warning tools. Key knowledge gaps on the role of asymptomatic individuals, the impact of coinfections and other environmental and social factors were identified.
- Containment of emerging diseases: Most available evidence from this review focuses on Ebola virus and dengue outbreak response and containment experiences. Authors report that studies should extend beyond reporting on the effectiveness of detection and control actions. They urge scientists, policy makers and health practitioners to take into account the complexity of real-world settings and how these conditions affect policies, practice and outcomes.
- Housing and hygiene interventions: Authors also identify waste management and sanitation, integration of ecological and sustainable vector control strategies and implementation research as research priorities. Community involvement in risk management of VBDs is particularly promising at the household level, they report.
The commentary and articles in this special issue provide detailed findings to inform scientists, public health practitioners and policy makers on next steps to build an optimal response to the pressing threat of VBDs on urban health.
For more information, contact TDR scientist Mariam Otmani del Barrio