Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.

Domestic drinking water supplies prone to interruptions and low per capita domestic water availability have been frequently reported among African households. Despite expanded international monitoring indicators that now include metrics of water availability, the range of methods used for measuring and monitoring availability remains unclear in Africa. Few household surveys have historically assessed water continuity and per capita availability, and both pose measurement challenges. This paper aims to examine the methods used to measure availability and synthesise evidence on African domestic water availability by systematically reviewing the literature from 2000–2019. Structured searches were conducted in five databases: Web of Science Core Collection, Scopus, GEOBASE, Compendex and PubMed/Medline. A total of 47 of 2406 reports met all inclusion criteria. Included studies were based on empirical research which reported the household’s perspective on a water availability measure. Most studies had methodological problems such as small sample sizes, non-representative sampling and incomplete reporting of methods and measures of uncertainty. Measurement of drinking water availability is primarily reliant on quantifying litres/capita/day (LPCD). Only four (9%) of the included studies reported an average water availability over the international benchmark of 50 LPCD. This pattern of water insufficiency is broadly consistent with previous studies of domestic water availability in Africa. The review highlights the need for high-quality and representative studies to better understand the uncertainties and differences in household water availability across Africa, and the methods used to measure it.

Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.

Background Commercial geospatial data resources are frequently used to understand healthcare utilisation. Although there is widespread evidence of a digital divide for other digital resources and infra-structure, it is unclear how commercial geospatial data resources are distributed relative to health need. Methods To examine the distribution of commercial geospatial data resources relative to health needs, we assembled coverage and quality metrics for commercial geocoding, neighbourhood characterisation, and travel time calculation resources for 183 countries. We developed a country-level, composite index of commercial geospatial data quality/availability and examined its distribution relative to age-standardised all-cause and cause specific (for three main causes of death) mortality using two inequality metrics, the slope index of inequality and relative concentration index. In two sub-national case studies, we also examined geocoding success rates versus area deprivation by district in Eastern Region, Ghana and Lagos State, Nigeria. Results Internationally, commercial geospatial data resources were inversely related to all-cause mortality. This relationship was more pronounced when examining mortality due to communicable diseases. Commercial geospatial data resources for calculating patient travel times were more equitably distributed relative to health need than resources for characterising neighbourhoods or geocoding patient addresses. Countries such as South Africa have comparatively high commercial geospatial data availability despite high mortality, whilst countries such as South Korea have comparatively low data availability and low mortality. Sub-nationally, evidence was mixed as to whether geocoding success was lowest in more deprived districts. Conclusions To our knowledge, this is the first global analysis of commercial geospatial data resources in relation to health outcomes. In countries such as South Africa where there is high mortality but also comparatively rich commercial geospatial data, these data resources are a potential resource for examining healthcare utilisation that requires further evaluation. In countries such as Sierra Leone where there is high mortality but minimal commercial geospatial data, alternative approaches such as open data use are needed in quantifying patient travel times, geocoding patient addresses, and characterising patients’ neighbourhoods.

This article describes a single session aimed at helping participants on a family therapy foundation course to move from a position of anxiety and discomfort about completing a written assignment to a position of safe uncertainty. Evaluation from the perspectives of course participants, course facilitators and assignment markers has shown participants engaging more enthusiastically with the writing of the assignment and expressing less anxiety about the process.

The behavior of staff and persons with severe handicaps was surveyed in nine settings, including four traditional institutions, three large community-based units, and two groups of small homes. Data were collected that established the relationship among staff:client interactions, client responding, and the size of staff:client groups. The latter showed that the institutions were characterized by larger client and staff groups than the large community units. Large client and staff groups were virtually absent in the small homes. Two general conclusions could be drawn about the relationship between staff:client ratios and client behavior: (a) when one or two staff were together, improvements in the level of the staff interactions and client adaptive functioning occurred as the client group decreased in size and the staff size remained constant; (b) improvement in staff performance and client behavior arising from the addition of staff to a client group of a given size was marginal or nonexistent. The results were discussed in terms of their implications for the design of residential environments.

ABSTRACTTwo studies examined the frequency of community and family contacts of 10 adults with severe and profound mental handicaps living in small, community‐based homes, first with their previous institutional experience and second in comparison with adults with similar handicaps living in larger community units.Adults in the small homes used community amenities significantly more than they did when in institutions and also significantly more than residents of larger community units. They experienced greater family contact than when they lived in more distant institutions, but not significantly more than residents of larger community units which also served local areas. Within the small homes, people newly admitted from their family homes had significantly greater family involvement than those transferred from institutions. The results are related to the characteristics of the residential settings, such as location, staff factors, operational policy, and autonomy of management.

This study describes the systems used in planning and implementing a community‐based service for adults with severe or profound mental handicaps over a three year period. These systems were: a global method of individual programme planning; a formal structure for one‐to‐one teaching; and a more general form of opportunity planning for developing and practising skills. A content analysis of the type of goals set and the extent of their implementation and success is presented.

Turnover of staff in a small home service for adults with severe and profound mental handicaps was compared to that in a number of larger units also based in the community and serving people with similar handicaps. Turnover was higher in the two small homes studied although recruitment was able to match staff loss so that the proportion of staff in post was maintained. Reasons for staff leaving were discussed. The main difference between the settings to account for the difference in turnover was size.

A demographic sample of 28 severely and profoundly mentally handicapped adults with a mental age of four years and below were assessed on Part 1 of the Adaptive Behavior Scale (ABS) at three points 18 months apart. The Griffiths Mental Development Scales and Reynell Developmental Language Scales were also conducted at the first and last assessment points. The subjects were resident in either a small community-based home, the parental home or other residential institutions. The small-home group showed the greatest adaptive behaviour change particularly in the areas of independent functioning, domestic skills and self-direction and on the scale total. Although reservations are expressed on the accuracy of assessment, the ABS data and the comparative result received some validation from the mental age and language assessments. Gains were independent of subject characteristics. The study adds to the literature showing adaptive behaviour gains arising from transfer from institutional to more normal residential environments. However, in attributing the results found to the general characteristics of the residential settings, the explicit programming emphasis of the small-home service should not be overlooked.

The effects of transferring severely and profoundly mentally-handicapped adults from institutional to community care and the use made of the physical setting were examined. The material enrichment of two small homes in the community and six institutional settings was assessed and the use made of each type of item in the environment was observationally measured. Two comparisons were made: (a) between an experimental group of six people in a small home and a comparable control group, of which one member lived in each of the six institutions; and (b) between the latter group both when in institutions and following transfer to a small home. The inventories of the physical environment showed an increased level of opportunity in the small homes due to the considerably greater presence of and access to equipment and materials. Residents of the small homes demonstrated a greater range and extent of usage of the physical setting than the institutional group. The type of materials significant in the difference and the implications for the value of institutional adaption are discussed.