Division of Family Medicine, Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, 2000, South Africa.
COPC Research Unit, School of Medicine, Faculty of Health Science, University of Pretoria, Pretoria, 0028, South Africa.
J Urban Health. 2022 Jun;99(3):571-581. doi: 10.1007/s11524-022-00625-7. Epub 2022 Apr 20.
COVID-19 has highlighted the importance of household infrastructure in containing the spread of SARS-CoV-2, with Global South urban settlements particularly vulnerable. Targeted interventions have used area or dwelling type as proxies for infrastructural vulnerability, potentially missing vulnerable households. We use infrastructural determinants of COVID-19 (crowding, water source, toilet facilities, and indoor pollution) to create an Infrastructural Vulnerability Index using cross-sectional household data (2018-2019) from Mamelodi, a low-income urban settlement in South Africa. Households were stratified into vulnerability groups by index results; sociodemographic variables were assessed as predictors of index scores; and inequality analysis and decomposition were conducted. Thirty-three percent of households fell in the lowest risk group, 32% in the second, 21% in the third, and 14% in the highest. Dwelling type and geographical ward were associated with changes in index scores, with a shack (adjusted β (aβ) = 3.45, CI = 3.39-3.51) associated with highest increase compared to a house. Wards in more developed areas were not consistently associated with lower index scores in the final regression model. The infrastructural vulnerability of the top 10% of households was greater than the bottom 40%, and inequality was predominantly within (80%) rather than between (20%) wards, and more between (60%) than within (40%) dwelling types. Our results show a minority of households account for the majority of infrastructural vulnerability, with its distribution only partially explained by area and dwelling type. Efforts to contain COVID-19 can be improved by using local-level data, and a vulnerability index, to target infrastructural support to households in greatest need.
COVID-19 凸显了家庭基础设施在遏制 SARS-CoV-2 传播方面的重要性，而全球南方的城市住区尤其脆弱。有针对性的干预措施使用区域或住宅类型作为基础设施脆弱性的替代指标，可能会遗漏脆弱家庭。我们使用 COVID-19 的基础设施决定因素（拥挤、水源、厕所设施和室内污染），利用来自南非低收入城市住区马梅洛迪的横截面家庭数据（2018-2019 年）创建基础设施脆弱性指数。根据指数结果将家庭分层为脆弱性群体；评估社会人口变量作为指数得分的预测指标；并进行不平等分析和分解。33%的家庭属于低风险组，32%的家庭属于第二组，21%的家庭属于第三组，14%的家庭属于最高组。住宅类型和地理区是与指数得分变化相关的因素，与房屋相比，棚屋（调整后的 β (aβ) = 3.45，CI = 3.39-3.51）的指数得分增加幅度最大。在最终回归模型中，较发达地区的区并不总是与较低的指数得分相关。前 10%的家庭的基础设施脆弱性大于后 40%的家庭，不平等主要存在于（80%）区内，而不是（20%）区之间，在住宅类型内（40%）的不平等程度大于区之间（60%）的不平等程度。我们的研究结果表明，少数家庭占基础设施脆弱性的大部分，其分布仅部分由区域和住宅类型来解释。通过使用本地数据和脆弱性指数，努力遏制 COVID-19 可以将基础设施支持的目标对准最需要的家庭，从而得到改善。
