Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji

Abstract

IntroductionIncreasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.Methods and analysisRISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.EthicsStudy protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.Trial registration numberACTRN12618000633280; Pre-results.

Collaborating With Communities: Citizen Science Flood Monitoring in Urban Informal Settlements

“…Using a Randomised Control Trial model, RISE selected settlements that would allow researchers to study the benefits of the infrastructure systems in both countries. The selected sites represent a diversity of characteristics with varying biophysical, socioeconomic and land tenure conditions (Leder et al 2021). Varying considerably in terms of size and physical settings, the population of the settlements ranges between 50 and 700 people each and include sites with coastal, riverine and flood plain characteristics.…”

Chronic heat stress in tropical urban informal settlements

“…We recorded in situ measurements of air temperature and relative humidity from a network of iButton data loggers (Thermochrons DS1921G and Hygrochrons DS1923; Maxim Integrated, San Jose, CA) deployed in 12 urban informal settlements in Makassar, Indonesia. Settlements were selected to be a part of the broader Revitalising Informal Settlements and their Environments (RISE) study and are geographically spread across Makassar ( Leder et al., 2021 ). These settlements comprise dense housing (30–100 houses within each settlement), experience environmental stressors, including flooding and contamination and represent the most vulnerable populations of the city ( Leder et al., 2021 ).…”

“…Settlements were selected to be a part of the broader Revitalising Informal Settlements and their Environments (RISE) study and are geographically spread across Makassar ( Leder et al., 2021 ). These settlements comprise dense housing (30–100 houses within each settlement), experience environmental stressors, including flooding and contamination and represent the most vulnerable populations of the city ( Leder et al., 2021 ). We focus here on data collected during the wet season from the 1 st November 2018 to 31 st May 2019, when year-round warm temperatures in the tropics are compounded by high humidity and are, therefore, a significant source of thermal stress.…”

“…In parallel with environmental data collection, a total of 593 households, across the 12 informal settlements, completed a baseline household survey between November 2018 and January 2019 ( Leder et al., 2021 ; French et al, 2021 ). This baseline survey was used to collect household level data, including household composition, environmental risks, housing quality, tenure, water and sanitation services, solid waste practices, and household assets.…”

One Health as a catalyst for sustainable development

“…Challenge number four is to design One Health programmes that involve everyone who has a stake in the outcome. Monash University's Revitalising Informal Settlements and their Environments (RISE) programme is a good example that shows how overcoming this challenge can pay off 4,14 . More than a billion people living in informal settlements, mostly in low-and middle-income countries, are exposed to pathogens through unsafe water and sanitation.…”