The health and sanitation status of specific low-cost housing communities as contrasted with those occupying backyard dwellings in the city of Cape Town, South Africa

[摘要] ENGLISH ABSTRACT: South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying 'backyard dwellings' on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards.The study population was classified as 'young' - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment.Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health that was envisaged at its inception. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor.

[发布机构] Stellenbosch University