Childhood vaccination timeliness following maternal migration to an informal urban settlement in Kenya

INTRODUCTION

Timely receipt of recommended vaccines is a proven strategy to reduce preventable under-five deaths. Kenya has experienced impressive declines in child mortality from 111 to 43 deaths per 1000 live births between 1980 and 2019. However, considerable inequities in timely vaccination remain, which unnecessarily increases risk for serious illness and death. Maternal migration is a potentially important driver of timeliness inequities, as the social and financial stressors of moving to a new community may require a woman to delay her child's immunizations. This analysis examined how maternal migration to informal urban settlements in Nairobi, Kenya influenced childhood vaccination timeliness.

METHODS

Data came from the Nairobi Urban Health and Demographic Surveillance System, 2002-2018. Migration exposures were migrant status (migrant, non-migrant), migrant origin (rural, urban), and migrant type (first-time, circular [previously resided in settlement]). Age at vaccine receipt (vaccination timeliness) was calculated for all basic vaccinations. Accelerated failure time models were used to investigate relationships between migration exposures and vaccination timeliness. Confounding was addressed using propensity score weighting.

RESULTS

Over one-third of the children of both migrants and non-migrants received at least one dose late or not at all. Unweighted models showed the children of migrants had shorter time to OPV1 and DPT1 vaccine receipt compared to the children of non-migrants. After accounting for confounding only differences in timeliness for DPT1 remained, with the children of migrants receiving DPT1 significantly earlier than the children of non-migrants. Timeliness was comparable among migrants with rural and urban origins and among first-time and circular migrants.

CONCLUSION

Although a substantial proportion of children in Nairobi's informal urban settlements do not receive timely vaccination, this analysis found limited evidence that maternal migration and migration characteristics were associated with delays for most doses. Future research should seek to elucidate potential drivers of low vaccination timeliness in Kenya.

The Impact of Preventive Interventions on Intimate Partner Violence among Pregnant Women Resident in Hamadan City Slum Areas Using the PEN-3 Model: Control Randomized Trial Study

BACKGROUND

Intimate partner violence is a severe life-threatening criminal and public health problem affecting the well-being of individuals, families, and society. Planning interventions to reduce the burden of this persistent and criminal violence should be relevant culturally and socially.

METHODS

In this randomized control trial, 150 pregnant women residing in slum areas of Hamadan were randomly assigned to two groups (intervention group: n=50 and control group: n=100). Interventional strategies included educating the victims based on local cultural norms, culturally sensitive individual and group counseling, and educating health care providers. Data were collected via face-to-face interviews at baseline and again at 3 months after the intervention. We used a paired t-test to evaluate the effect of the intervention by comparing changes in the outcomes measured.

RESULTS

There were no statistically significant differences between the two groups at baseline in terms of sociodemographic characteristics. Post-test scores of knowledge (7.50±2.65 vs. 5.14±3.51, P=0.001), communication skills (18.38±4.25 vs. 16.2±3.83, P=0.04), and family support and social expectation of obedience (15.79±4.45 vs. 13.40±4.57, P=0.005) of the victims were statistically significantly higher in the experimental group compared to the control group. Moreover, physical (0.74±2.28 vs. 1.20±2.60, P=0.06), psychological (2.80±4.10 vs. 4.52±5.43, P=0.06), and sexual (0.11±0.58 vs. 0.61±1.22, P=0.04) violence reduced in the experimental group compared to the control group.

CONCLUSION

Culturally relevant interventions can reduce intimate partner violence.

Demographic drivers of Norway rat populations from urban slums in Brazil

The Norway rat is a globally distributed pest, known for its resilience to eradication and control programs. Efficient population control, especially in urban settings, is dependent on knowledge of rat demography and population ecology. We analyzed the relationship between four demographic outcomes, estimated by live-trapping data, and fine-scale environmental features measured at the capture site. Wounds, a proxy for agonistic interactions, were associated with mature individuals. Areas with environmental features favorable to rats, such as open sewers and unpaved earth, were associated with more mature individuals with a better body condition index. The control measures (environmental stressors) are likely to be disrupting the social structure of rat colonies, increasing the frequency and distribution of agonistic interactions, which were common in both sexes and maturity states. The relationship between the favorable environmental conditions and the demographic markers analyzed indicate possible targets for infestation control through environmental manipulation, and could be incorporated into current pest management programs to achieve long-term success. Our study indicate that urban interventions focused on removal of potential resources for rats could be potential long-term solutions by reducing the carrying capacity of the environment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11252-020-01075-2.

Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries

BACKGROUND

Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations.

METHODS

We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented.

RESULTS

We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales.

CONCLUSIONS

Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.

Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study

BACKGROUND

Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums.

METHODS

Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12-23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further six IDIs were then conducted with immunization policy-makers and policy influencers to determine strategies to address these barriers, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data.

RESULTS

The survey revealed 49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient utilization of funds, unreliable immunization and household data and interference of polio campaigns with immunization. The implementation framework's policy recommendations to address these barriers include: (1) improved human resource management; (2) staff training on counselling; (3) re-allocation of funds towards incentives, outreach, salaries and infrastructure; (4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff; (5) use of digital platform for immunization targets and generating dose reminders; and (6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programmes for improved coverage.

CONCLUSIONS

The implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programmes in limited-resource settings, with possible application at a larger scale. In particular, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use.

The extent to which the design of available reproductive health interventions fit the reproductive health needs of adolescents living in urban poor settings of Kisenyi, Kampala, Uganda

BACKGROUND

The rate at which informal urban settlements (slums) are developing in Low and Middle Income. Countries (LMICs) like Uganda is high. With this, comes the growing intersection between urbanization and the reproductive health of key populations. Currently, a number of interventions are being implemented to improve the Reproductive Health (RH) of adolescents in Kisenyi, the largest informal urban settlement in Kampala, the capital of Uganda. Despite these efforts, adolescent RH indicators have persistently remained poor in Kisenyi. This could be indicative of a gap between the provided and needed adolescent RH interventions. We assessed the fit between the available interventions and the RH needs of adolescents living in Kisenyi.

METHODS

We conducted a qualitative study in July 2019-February 2020 in Kisenyi. The methodology was guided by the Word Health Organization global standards for quality-health care services for adolescents, the "For whom? Where? By whom? and What?" Framework of sexual RH service delivery and the realist evaluation approach. Eight focus group discussions were conducted with adolescents 15-19 years to explore their RH needs. The design and implementation of the available adolescent RH interventions were assessed by conducting Key Informant interviews with 10 RH service providers in Kisenyi. Validation meetings were held with adolescents and they scored the extent to which the various design features of the existing interventions fit the adolescents' RH needs.

RESULTS

The available RH interventions focused on meeting the sexual RH needs like providing family planning services but less on social needs like livelihood and sanitation which the adolescents identified as equally important. While the providers designed intervention to target 10-24 year olds, the adolescents preferred to have interventions that specifically targeted the study population 15-19 years. Most interventions were facility-based while, the adolescents desired community based outreaches.

CONCLUSION

The packaging and mode of delivery of interventions were perceived less holistic to meet the adolescents' needs. Most interventions were designed to address the sexual and family planning needs while ignoring the wider social and livelihood needs. More holistic and outreach-based programming that addresses RH within the broader context of livelihood and sanitation requirements are more likely to be effective.

How does Covid-19 affect urban slums? Evidence from settlement leaders in India

Slum settlements have received significant attention for their vulnerabilities to the spread of Covid-19. To mitigate risks of transmission, and alleviate economic distress associated with containment measures, public health experts and international agencies are calling for community-driven solutions that harness local participation. In slum settlements, such approaches will encounter the informal slum leaders present across cities of the Global South. How are slum leaders positioned to address the health and livelihood threats of the pandemic within their neighborhoods? What problem-solving activities, if any, have they performed for residents during the pandemic? What factors shape success in those efforts? To answer these questions, we conducted a phone survey of 321 slum leaders across 79 slum settlements in two north Indian cities. The survey was conducted in April and May 2020, at the height of India's stringent national lockdown in response to the virus. Our survey reveals striking continuities with pre-pandemic politics. First, slum leaders persist in their problem-solving roles, even as they shift their efforts towards requesting urgently needed government relief (particularly food rations). Second, slum leaders vary in their reported ability to gather information about relief schemes, make claims, and command government responsiveness. The factors that inform the effectiveness of slum leaders during 'normal times', notably their education and degree of embeddedness in party networks, continue to do so during the lockdown. Slum leader reliance on partisan networks raises concerns regarding the inclusiveness of their efforts. Finally, slums are not uniformly challenged in maintaining social distancing. Pre-pandemic disparities in infrastructural development fragment the degree to which residents must depart from social distancing guidelines to secure essential services.

Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina

Objectives

In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described.

Study design

This is a cross-sectional study.

Methods

All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI.

Results

From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS.

Conclusions

Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

Social determinants of mental health of women living in slum: a systematic review

OBJECTIVE

With the rise of urbanization globally, the problem of living in slums has become a problem for the civil society. As a vulnerable segment, women make up half of the population in these regions; therefore, women's mental health has always been a concern. The purpose of this study was to review the social determinants of mental health in women living in slum areas.

METHODS

We systematically reviewed articles published between 2009 and 2019 on the social determinants of women's mental health in SID, Magiran, Google scholar, PubMed, Scopus, Science Direct, Embase, MEDLINE, PsychINFO, and PsychARTICLES databases using MeSH keywords according to PRISMA guidelines. The quality of the studies was assessed depending on the type of study using Ottawa Newcastle" scale and Joanna Briggs Institute quality assessment tools. Finally, 23 studies were analyzed.

RESULTS

Different social determinants influenced the mental health of women living in slum areas. Among the structural determinants, the socioeconomic level had the highest frequency, and gender was in the second rank with the highest correlation with poorer women's mental health status. Among the intermediate determinants, living conditions, food insecurity, social capital, and social support were most frequently associated with mental health status.

CONCLUSION

Women living in slum areas are prone to developing mental disorders and poorer mental health; therefore, supporting these women and creating job opportunities to raise their incomes and, subsequently, improve their social, economic, and living conditions should be taken into consideration. In addition, this requires careful planning and comprehensive social support.

Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

COVID-19 spreads via aerosols, droplets, fomites and faeces. The built environment that facilitates crowding increases exposure and hence transmission of COVID-19 as evidenced by outbreaks in both cool-dry and hot-humid climates, such as in the US prison system and dormitories in Singapore, respectively. This paper explores how the built environment influences crowding and COVID-19 transmission, focusing on informal urban settlements (slums). We propose policy and practice changes that could reduce COVID-19 transmission. There are several issues on how COVID-19 affects informal urban settlements. Slum populations tend to be younger than the overall population. Lower numbers of older people lessen the morbidity and mortality of the pandemic in slum areas. Second, many slum populations are highly mobile. By returning to their ancestral villages residents can avoid the risks of overcrowding and reduce the population density in a given area but may spread COVID-19 to other areas. Third, detection and registration of COVID-19 cases depends on patients presenting to health care providers. If the risk of visiting a health care centre outweighs the potential benefits patients may prefer not to seek treatment. The control and prevention of COVID-19 in informal urban settlements starts with organizing community infrastructure for diagnosis and treatment and assuring that basic needs (food, water, sanitation, health care and public transport) are met during quarantine. Next, community members at highest risk need to be identified and protected. Low-income, informal settlements need to be recognized as a reservoir and source for persistent transmission. Solutions to overcrowding must be developed for this and future pandemics. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, while avoiding stigmatization.

The impact of the livelihoods and income fortification and socio-civic transformation project on the quality of life, wellbeing, self-esteem, and quality of neighbourhood social environment among the youth in slum areas of in Kampala, Uganda

BACKGROUND

Various interventions to improve the quality of life (QoL) among slum dwellers across sub Saharan Africa have been implemented. However, the interventions impacts remain less understood. We assessed the impact of the Urban Program on Livelihoods and Income Fortification and Socio-civic Transformation (UPLIFT) project on QoL, psychological wellbeing, self-esteem, and the quality of neighbourhood social environment of young people aged 13-25 years in slum areas of Makindye and Nakawa Divisions in Kampala, Uganda.

METHODS

The study was designed as a mixed method evaluation using repeated cross-sectional survey and grounded theory in both the intervention and comparison communities. The intervention effect was estimated using the difference-in-differences Kernel propensity-score matching technique, with bootstrapping. The "rcs" option was used given that data were from repeated cross-sectional surveys. A thematic analysis was adopted for the qualitative data to triangulate and complement the quantitative data.

RESULTS

The UPLIFT project led to an improvement in QoL, psychological wellbeing, and self-esteem of young people. In terms of QoL, the project led to a six-percentage point increase in quality of living conditions scores (where higher scores reflect better living conditions; lower ones, worse living conditions). However, a negative effect was observed for personal independence whilst the project did not have any impact on social relations. In terms of self-esteem and psychological wellbeing, the project led to a 4.6-point increase in self-esteem scores, a 5.4-point increase in self-acceptance scores, a 5.3- point increase in purpose in life scores, a 5.7 - point increase in personal growth, and a 10.7-point increase in autonomy scores. However, the project had a negative effect on personal independence; and had no impact on environmental mastery and the quality of neighbourhood social environment.

CONCLUSION

Functional community-owned assets accumulation and capacity building initiatives for young people in slum areas improved their psychological wellbeing and quality of life. However, such initiatives do not appear to address social relationships and personal independence of young people in slum areas.

Violence against women in urban slums of India: A review of two decades of research

It is estimated that about one-third of women ever experienced violence in their lifetime. India has experienced steady urban growth accompanying increase of urban populations living in slums. Several studies have reported prevalence of various forms of violence in urban slums. To our knowledge, no systematic review has been conducted exclusively reporting violence against women in India's urban slums. The review aims to synthesise the studies of violence against women conducted in the last two decades (2000-2020). We searched PubMed, Scopus and other relevant search engines to identify articles published between years 2000 and 2020, which focused on Indian women slum dwellers' experiences of violence. We included 14 studies, which satisfied the inclusion criteria in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to assess the studies. The prevalence of any form of violence against women, as reported in the studies, ranged from 15% to 59.3%. The major risk factors identified were husband's alcohol abuse, women justifying the violence inflicted on then, low educational levels of both women and men, dowry issues, age difference between the spouses and termination of a previous pregnancy. It is evident from the review that urban slum women experience persistent violence.

Daily changes in household water access and quality in urban slums undermine global safe water monitoring programmes

Global drinking water monitoring programmes and studies on water quality in urban slums often overlook short-term temporal changes in water quality and health risks. The aim of this study was to quantify daily changes in household water access and quality in an urban slum in Malawi using a mixed-method approach. Household drinking water samples (n = 371) were collected and monitored for E. coli in tandem with a water access questionnaire (n = 481). E. coli concentrations in household drinking water changed daily, and no household had drinking water that was completely safe to drink every day. Seasonal changes in drinking water availability, intermittent supply, limited opening hours, and frequent breakdown of public water points contributed to poor access. Households relied on multiple water sources and regularly switched between sources to meet daily water needs. There were generally similar E. coli levels in water samples considered safe and unsafe by residents. This study provides the first empirical evidence that water quality, water access, and related health risks in urban slums change at much finer (daily) temporal scales than is conventionally monitored and reported globally. Our findings underscore that to advance progress towards Sustainable Development Goal (SDG) Target 6.1, it is necessary for global water monitoring initiatives to consider short-term changes in access and quality.

Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review

BACKGROUND

Addressing adolescents' sexual and reproductive health and rights (SRHR) requires an understanding of the socio-cultural and spatial settings within which they live. One setting of particular importance is the informal settlements or 'slums' that are gradually dominating the urban space. We undertook a scoping review and synthesis of existing evidence on adolescent SRHR in slums in sub-Saharan Africa (SSA) focusing on the characteristics and nature of existing evidence.

METHODS

The scoping review was conducted based on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and using PRISMA reporting guidelines for scoping reviews. A comprehensive search was undertaken in PubMed, POPLINE, African Journals Online (AJOL), Bioline International and Google Scholar. The search was confined to studies published in peer reviewed journals and reports published online between January 2000 and May 2019. Studies were included in the review if they addressed SRHR issues among adolescents living in urban slums in SSA.

RESULTS

The review included a total of 54 studies. The majority (79.5%) of studies were quantitative. The bulk of studies (85.2%) were observational studies with only eight intervention studies. While half (27) of the studies focused exclusively on adolescents (10-19 years), 12 studies combined adolescents with other young people (10-24 years). The studies were skewed towards sexual behavior (44%) and HIV/AIDS (43%) with very few studies focusing on other SRHR issues such as contraception, abortion, gender-based violence and sexually transmitted infections (STIs) other than HIV. Most of the studies highlighted the significantly higher risks for poor SRHR outcomes among adolescents in slums as compared to their peers in other settlements.

CONCLUSION

Young people growing up in slums face tremendous challenges in relation to their SRHR needs resulting in poor outcomes such as early and unintended pregnancy, STIs, and sexual violence. The results of this review point to several potential target areas for programming, policy, and research aimed at improved adolescent SRHR in slums in SSA.

Unmet need for family planning services among young married women (15-24 years) living in urban slums of India

BACKGROUND

NFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was conducted to assess the unmet need for FP services and its determinants among this under-privileged and under-served section of society residing in urban slums of Uttar Pradesh, India.

METHODS

Cross sectional study was conducted in the slums of Lucknow, India. One Urban-Primary Health Centre (U-PHC) was randomly selected from each of the eight Municipal Corporation zones in Lucknow and two notified slums were randomly selected from each U-PHC. All the households in the selected slums were visited for interviewing 33 young married women (YMW) in each slum, with a pre-structured and pre tested questionnaire, to achieve the sample size of 535. Analysis of the data was done using logistic regression.

RESULTS

The unmet need for family planning services among YMW was 55.3%. About 40.9% of the unmet need was for spacing methods and 14.4% for limiting methods. Important reasons cited for unmet need for family planning services were negligent attitude of the women towards family planning, opposition by husband or others, embarrassment / hesitation / shyness for contraceptive use, poor knowledge of the FP method or availability of family planning services. Among method related reasons health concerns and fear of side effects were frequently cited reasons. On multiple logistic regression: age, educational status, duration of marriage, number of pregnancies, knowledge of contraceptive methods, opposition to contraceptive use and contact with Auxiliary Nurse Midwife (ANM) showed independently significant association with unmet need for family planning services.

CONCLUSIONS

Unmet need for family planning services is very high among the YMW of urban slums. The findings stress that program managers should take into cognizance these determinants of high level of unmet need for family planning among YMW and make intense efforts for addressing these issues in a holistic manner.

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

Operationalising a One Health approach to reduce the infection and antimicrobial resistance (AMR) burden in under-5 year old urban slum dwellers: The Childhood Infections and Pollution (CHIP) Consortium

The WHO advocates the use of a One Health approach to address antimicrobial resistance (AMR), focusing on integrating human, animal and environmental health factors. Nevertheless, there is a dearth of AMR research investigating the complexity of down and upstream factors across the One Health spectrum, especially in resource-deprived settings. The Childhood Infections and Pollution Consortium (CHIP) was designed to reduce the burden of childhood infections and AMR in urban slums, particularly in low-and middle-income countries, using One Health and technology-enabled Citizen Science approaches. Currently operationalized in three countries; India, Indonesia and Chile; CHIP is composed of interdisciplinary academics, healthcare professionals, veterinarians, international and local non-governmental organisations, current and former policymakers, local artists and community champions, amongst others. The CHIP Consortium invites collaborations for evidence-driven research, targeted investment and co-development of interventions in slums. We will host our third annual consortium workshop in Hong Kong in 2021 to build on our current work and explore new avenues to tackle childhood infections and AMR.

HIV testing experiences in Nairobi slums: the good, the bad and the ugly

Background

HIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90–90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting.

Methods

The study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N = 41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method.

Results

The respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported.

Conclusion

The 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good – irrespective of whether testing is initiated by the individual or by the health provider.

Review of drivers and barriers of water and sanitation policies for urban informal settlements in low-income and middle-income countries

This study examined drivers and barriers of water, sanitation, and hygiene (WASH) policies in urban informal settlements in low and middle-income countries. We conducted a search of peer-reviewed and grey literature published between January 2000 and April 2018. We organized evidence into six domains of drivers and barriers: economic, spatial, social, institutional, political, and informational. Key drivers included donor prioritization and collective action, while key barriers included social exclusion, lack of land or dwelling tenure status, the political economy of decision-making, and insufficient data. Ensuring responsive water and sanitation policies for informal settlements will require inter-disciplinary collaboration and both top-down and bottom-up approaches.

Coverage, quality, and correlates of childhood immunization in slums under national immunization program of India: A cross-sectional study

Adequate and quality immunization coverage plays a key role in controlling the outbreaks of vaccine preventable diseases. Places where immunization coverage is low, vaccine preventable diseases contribute to worse health outcomes. This is especially true in Indian slum dwellings where 33.0% of the urban population live. The aim of the study was to explore the coverage, quality, and correlates of primary immunization under national immunization program among children aged 12–23 months, living in slums of Mumbai. A community based cross-sectional survey was conducted. Parents or caretakers of 550 eligible children aged 12–23 months were interviewed using a structured interview schedule. Regression analysis was used to detect correlates of full immunization coverage (children who received one dose each of BCG, measles, and three doses each of DPT, OPV, and HBV by his/her first birthday) and of quality immunization coverage (children who received primary vaccines at appropriate age and intervals as mentioned above and had filled immunization card). Out of total 550 children, 402 (73.1%), 131 (23.8%), and 17 (3.1%) were fully, partially, and unimmunized, respectively. Almost 86.0% children received quality immunization coverage. In the regression analysis, reminder for immunization services was found to be the single most significant correlate of full and quality immunization coverage.

In this study, full immunization coverage was found to be below the expected level. This study also revealed that the awareness regarding the importance of adequate immunization was still lacking in the slum population. Emphasizing on reminders for immunization services, encouraging institutional deliveries, and scaling up use of postnatal care services may act as keys to improving the immunization coverage in Indian slums.

Acceptability and utilization of family planning benefits cards by youth in slums in Kampala, Uganda

BACKGROUND

This study was conducted to test the acceptability and utilization of family planning benefits cards (FPBCs) as incentives to increase family planning uptake among youth living in urban slums in Uganda.

METHODS

We conducted a one-year pilot study with two sub-studies on acceptability and utilization of FPBCs. The acceptability study utilized a quantitative cross-sectional design and was part of a baseline household survey while the utilization study was a primary analysis of claims and clinic data. We performed descriptive analyses and analyses of the association between different variables using binary logistic regression.

RESULTS

The acceptability study included 280 eligible females. The majority were married (52%), Christian (87%), and aged 20 and above (84%). Acceptability of the program was high (93%). Seventy-two percent of females used the card at least once to access reproductive health services. Twenty-seven percent of female users discontinued family planning and 14% changed family planning methods during the study. Female users of short-term contraceptive methods were 11 times more likely to discontinue use of FPBCs compared to those who used long-term methods (adjusted OR = 10.9, P = 0.011). Participants in professional/managerial employment were 30 times more likely to discontinue compared to the unemployed (adjusted OR = 30.3, P = 0.015). Participants of parity equal to two were 89% less likely to discontinue use of FPBCs compared to those of parity equal to zero (adjusted OR = 0.1, P = 0.019).

CONCLUSION

Family planning benefits cards, deployed as incentives to increase uptake of family planning, exhibited high acceptability and utilization by youth in urban slums in Uganda. There was evidence that use of short-term contraception methods, professional employment, and lower parity were associated with discontinuation of modern family planning methods after initial enrolment.

TRIAL REGISTRATION

MUREC1/7 No. 10/05-17. Registered 19th, July 2017.

Analysing child linear growth trajectories among under-5 children in two Nairobi informal settlements

OBJECTIVE

We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi.

DESIGN

We used longitudinal data for the period 2007-2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child.

SETTING

Two urban informal settlements in Nairobi, Kenya.ParticipantsUnder-5 children (n 1917) and their mothers (n 1679).

RESULTS

The findings show that child weight at birth, exclusive breast-feeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother's age, marital status) and household-level factors (socio-economic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further.

CONCLUSIONS

Findings from the study point to the need to improve the targeting of child health programmes directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breast-feeding, immunization status and mother's background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings.

The Risk of Tuberculosis among Populations Living in Slum Settings: a Systematic Review and Meta-analysis

According to the WHO, half of the 10.4 million incident cases of TB in 2016 came from five countries where 20-50% of the urban population live in slums. Crowded living conditions and limited access to healthcare further contribute to the burden of TB in urban slums. This article aims to assess the odds of the burden of TB in urban slums through a systematic review and meta-analysis. Four electronic databases were searched for studies published between 1993 and 2017, with TB defined as at least one sputum smear-positive. The review followed the PRISMA protocol and information was extracted from articles for a full-text review to determine eligibility. Odds ratios were calculated for studies reporting sputum smear-positive TB cases in slum settings with national incidence as a comparison. Summary estimates were calculated using the random effects model (95% CI) and publication bias was assessed through funnel plot analysis. A quality assessment of included articles was also conducted. This meta-analysis was conducted across three categories: (1) across all 22 studies, (2) studies utilizing Active Case Finding, and (3) studies conducted in a high TB-HIV setting. The odds of sputum smear-positive TB were significantly higher across all three categories of analysis. Compared with national TB incidence rates, the combined odds ratio of smear-positive TB within slums was 2.96 (2.84, 3.09; p < 0.01). The combined odds ratio for smear-positive TB with active case finding across 15 studies was 2.85 (2.71, 2.99; p < 0.01). Among the 11 studies that reported incidence of smear-positive TB with prevalent TB-HIV coinfection in the community, the combined odds ratio for slum residents with the random effects model was 2.48 (2.34, 2.63; p < 0.01). Using Egger's funnel plot, publication bias was not detected within the three categories of analysis. The findings of this analysis indicate that the odds of developing TB are almost five times as great in urban slums. Reaching the most vulnerable and often overlooked groups in slums is crucial to achieving the SDGs and End TB Strategy by 2035.

Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study

There is substantial variability in immunization coverage trends across the globe which can be attributed to a number of factors such as demographic profile, socioeconomic characteristics and political environment. Vaccine preventable diseases contribute to severe disease burden when coverage is low, particularly, in slums. Present qualitative study explored barriers, opportunities, and key facilitators of childhood immunization. This was a community based cross-sectional study conducted in the slum areas of Mumbai, India. Data from the observations of immunization sessions and interviews of end users, healthcare service providers, and influencers were collected and analyzed. Lack of time, poor awareness, fear of adverse event, loss of daily income, and migrant population were some of the major reasons to not get immunized. Also, lack of good behavior of staff was another crucial factor perceived by caretakers as barrier in the immunization. Stakeholders agreed that immunization is a shared responsibility involving community, service providers, and policy makers. There was general consensus that immunization practices have improved over the last few years. However, its positive impact is yet to be fully seen in populations that belong to lower socioeconomic strata, thus warranting additional efforts to improve the immunization coverage in slums. Effective communication, process improvement at various levels, active involvement of communities in the immunization activities, building trust and accountability, and constructive feedback are some of the essential elements to strengthen the immunization program. Strategies to improve immunization services in such settings should be based on interactions with stakeholders and understanding their perspectives.

Cardiovascular and other risk factors among people who live in slums in Buenos Aires, Argentina

OBJECTIVES

Effective planning of health policies requires the availability of accurate data, representing the burden of disease and risks to the diverse components of society. In Argentina, health information comes from the national risk factors survey (NRFS), which characterises the distribution of different risk factors. However, the NRFS has never collected information from residents living in slums, despite slums representing 10% of the population. The objective of this survey was to characterise the prevalence of cardiovascular and other risk factors among the inhabitants of one of the largest slums in Buenos Aires (Villa 31) and compare it to data from the NRFS.

STUDY DESIGN

This was a cross-sectional study.

METHODS

A cross-sectional study was carried out in 400 slum households, using the same data structure as the NRFS. The survey obtained information about economic aspects, reproductive health, addictions and risk factors. All participants had their blood pressure, weight and height measured. A total of 406 people were interviewed and their data were compared with data from 32,365 people in the NRFS. All comparisons were made on the basis of age group.

RESULTS

A fair/poor self-perceived level of health (odds ratio [OR] 3.19, 95% confidence interval [CI]: 2.60-3.91), anxiety and moderate to severe depression (OR 5.44, 95% CI: 4.43-6.69), problem drinking (OR 10.01, 95% CI 8.08-12.40), self-reported hypertension (OR 1.26, 95% CI: 1.01-1.57), overweight (OR 1.26, 95% CI: 1.03-1.55) and obesity (OR 1.72, 95% CI: 1.38-2.15) were significantly higher in the slum population. In people aged 18-24 years, the prevalence of diabetes was triple the national average (OR 3.17, 95% CI: 1.26-7.98). For all evaluated conditions in this study, the inhabitants of the slum received significantly less treatment compared with participants from the NRFS.

CONCLUSIONS

The prevalence of cardiovascular and other risk factors in the slum population has a different distribution to that reported in the NRFS. These data suggest the need to establish specific policies for slum populations.