Exploring the complex relationship between women's sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

BACKGROUND

Diarrheal disease kills over half a million people each year in sub-Saharan Africa; the majority are children under 5 years. About 58% of diarrhea cases are associated with poor water, sanitation, and hygiene-a critical issue for people living in informal settlements. In Kenya, 60% of Nairobi's population lives in informal settlements; yet, there is a paucity of research exploring the relationship between water, sanitation and hygiene (WASH) conditions in these settlements and associated health outcomes.

METHODS

The study examines characteristics of women's WASH behaviors and environments as potential factors associated with household diarrhea in Mathare Valley Informal Settlement in Nairobi using cross-sectional survey data collected from 550 women.

RESULTS

Approximately 17% of participants reported that at least one member of the household suffered from diarrhea in the previous 2 weeks-48% of the cases were children under five. Results from a logistic regression exploring factors associated with reports of household diarrhea suggest that women's sanitation management strategies are associated with recent household diarrhea. Women who use toilets for defecation during the day, but rely on bags, buckets, or open defecation (OD) for urination during the day and for urination and defecation at night have over five time the odds of recent household diarrhea than women who use a toilet for all their sanitation needs. The odds of diarrhea were also higher for participants who walk up to 2 min to reach their toilets/sites for defecation and those who rely on water from taps inside buildings and plots. Odds were 62% lower for participants with clean toilets.

CONCLUSIONS

Findings suggest that health targets to reduce the prevalence of diarrheal diseases in informal settlements may not be met unless particular attention is paid to the needs of women living in these environments.

Identifying and mapping TB hot spots in an urban slum by integratingGeographic positioning system and the local postman - A pilot study

SETTING

Mahavir DOT Centre, Hyderabad, Telangana, India INTRODUCTION: Urban slums are characterized by crowding, poverty. In such setting due to lack of infection control the transmission of tuberculosis is known to rise, thereby creating a "Hot" spot. Distribution of residences in such areas does not necessarily follow postal codes, making it difficult for health workers to locate TB patients unless accompanied by the STLS.

OBJECTIVE

To investigate the utility of integrating the help of local postman and geographic positioning system (GPS) to identify and create map of hot spots in an area under a regional DOT centre.

MATERIALS & METHODS

Retrospective and prospective demographic data of TB patients enrolled during 12 years (1999-2011) was analysed from the TB register at a ward where number of cases continued to increase despite active implementation of DOTS strategy. Non-Spatial data was generated with the local postman identifying individual house addresses. The corresponding co-ordinates were recorded with GPS and uploaded in Google Earth to identify the locations. Area map was created by software (AutoCAD, Map R3, MapInfo Pro 7.5 Trial Version and MS office Tools). Residences of Index patients were marked in different colours year wise on the map.

RESULTS

Maps displayed in the DOT centre area helped in identifying HOT SPOT and visualization of the clustering of TB cases in the area. Time interval between subsequent infections (3 months-5 years) could be calculated in the locality, within household, neighbourhood and random contacts. Average distances (<1 m) between houses indicated the probable source of infection. Risk factors included crowding, poor ventilation and sanitation contributed to TB transmission in HOT spot area.

CONCLUSION

Integrating local postman and information technology to identify HOT SPOT in RNTCP, will help in early intervention by health personnel to arrest TB transmission.

The exposure of slums to high temperature: Morphology-based local scale thermal patterns

Heat exposure has become a global threat to human health and life with increasing temperatures and frequency of extreme heat events. Considering risk as a function of both heat vulnerability and hazard intensity, this study examines whether poor urban dwellers residing in slums are exposed to higher temperature, adding to their vulnerable demographic and health conditions. Instead of being restricted by sampling size of pixels or other land surface zones, this study follows the intrinsic latent patterns of the heat phenomenon to examine the association between small clusters of slums and heat patterns. Remotely sensed land surface temperature (LST) datasets of moderate resolution are employed to derive the morphological features of the temperature patterns in the city of Ahmedabad, India at the local scale. The optimal representations of temperature pattern morphology are learnt automatically from temporally adjacent images without manually choosing model hyper-parameters. The morphological features are then evaluated to identify the local scale temperature pattern at slum locations. Results show that in particular locations with slums are exposed to a locally high temperature. More specifically, larger slums tend to be exposed to a more intense locally high temperature compared to smaller slums. Due to the small size of slums in Ahmedabad, it is hard to conclude whether slums are impacting the locally high temperature, or slums are more likely to be located in poorly built places already with a locally high temperature. This study complements the missing dimension of hazard investigation to heat-related risk analysis of slums. The study developed a workflow of exploring the temperature patterns at the local scale and examination of heat exposure of slums. It extends the conventional city scale urban temperature analysis into local scales and introduces morphological measurements as new parameters to quantify temperature patterns at a more detailed level.

Association Of Antenatal Depression And Household Food Insecurity Among Pregnant Women: A Crosssectional Study From Slums Of Lahore

BACKGROUND

Pregnant women are more likely to develop antenatal depression due to multiple factors including sickness and death of close family member, unwanted pregnancy, unplanned pregnancy, economic and relationship difficulties. Food insecurity is a major issue in low resource settings, especially in developing countries. Malnourishment in pregnant women along with antenatal depression can lead to adverse effect on growth of foetus and can lead to adverse pregnancy outcomes. The aim of this study was to determine an association between food insecurity and antenatal depression among pregnant women living in slum settlements of Lahore.

METHODS

A community based, crosssectional study was conducted in slum settlements of district Lahore, with a sample of 367 pregnant women. Antenatal depression and household food insecurity was measured using Edinburgh Postnatal Depression Scale (EPDS) and Household food insecurity access scale (HFIAS). Data was entered and analysed in SPSS-20.0. Chi-square and multivariate logistic regression analysis was used to estimate effect of food insecurity on antenatal depression among pregnant women.

RESULTS

Prevalence ofantenatal depression was 39.5% among pregnant women. Majority of the sample, i.e., 46% were food insecure. In an adjusted model, multivariate logistic regression showed existence of strong association between food insecurity and antenatal depression (AOR=2.58, 95%, CI: 1.64-4.075) in women surveyed.

CONCLUSIONS

Study results show strong association between food insecurity and antenatal depression. Findings also suggest the need of an effective intervention at community level to combat food insecurity and antenatal depression in marginalized populations.

Ensuring childhood vaccination among slums dwellers under the National Immunization Program in India - Challenges and opportunities

AIMS

Almost, one third of the world's urban population resides in slums and the number would double by 2030. Slums denotes collection of people from various communities having a meagre income and living in unhygienic conditions thus making themselves most vulnerable for outbreaks of communicable diseases. India contributes substantially to the global disease burden and under-five mortality rates i.e. 20% attributable to vaccine preventable diseases. Immunization plays a crucial role in combating high childhood mortality rates attributable to vaccine preventable diseases across the globe. This systematic review, provides insights on immunization status in slums, identifies various factors influencing it thus, exploring opportunities that may be available to improve vaccination coverage under the National Immunization Program.

METHODS

Taking into account the above aspects, a review of literature was undertaken in various databases that included studies published between 2006 and 2017.

RESULTS

In India, ~33% of the urban population lives in slums with suboptimal vaccination coverage ranging from 14% to upto 90%. Few of the important causes for low coverage included socioeconomic factors such as poor community participation, lack of awareness, frequent migration, and loss of daily income. Hence, mere presence of vaccines in the National Immunization Program doesn't do the job, there is a definite unmet need to emphasize upon the importance of immunization among slums dwellers and take necessary steps. For instance, delivering immunization services at the doorstep (e.g. pulse polio program), community-based education, text messaging as reminders and incentivized immunization services are some of the opportunities that can be explored and implemented to improve immunization status in the slums.

CONCLUSION

Thus, in addition to inclusion of more and more vaccines in the National Immunization Program, there is a definite need to focus on people living in high risk areas in order to improve coverage and healthcare indicators.

Musculoskeletal health conditions among older populations in urban slums in sub-Saharan Africa

BACKGROUND

Debate on the burden of musculoskeletal (MSK) conditions in lower and middle income countries is intensifying; yet, little knowledge so far exists on patterns and impacts of such conditions among general or older adult populations in sub-Saharan Africa (SSA). The objectives of this study are to examine the prevalence, potential predictors, and sequelae of MSK among older adults residing in two low resource informal urban settlements or "slums" in Nairobi Kenya.

METHODS

Data on older adults aged 60 years and over from two unrelated cross-sectional surveys on the older slum populations are used: a 2006/7 survey on the social, health, and overall well-being of older people (sample N = 831), and a 2016 survey on realities and impacts of long-term care and social protection for older adults (sample n = 1026). Uni and multivariate regressions on the 2006/7 data are employed to examine relationships of back pain and symptoms of arthritis with sex, age, wealth, unemployment, diagnoses of hypertension, and diabetes; and with indicators of subjective well-being and functional ability. Descriptive frequencies and chi-squared tests of association are used on 2016 data to identify the overall prevalence and locations of activity limiting MSK pain, and sex differences in these.

RESULTS

Prevalence of past month back pain and past 2 week symptoms of arthritis was 44% and 42.6%, respectively. Respective prevalence of past month activity limiting back pain and joint pain was 13.9% and 22.7%. A total of 42.6% of slum residents with a current health problem report MSK as the most severe problem. In multivariate regressions, female sex, unemployment, and diagnosis of hypertension are predictive of back pain and symptoms of arthritis. Both conditions are associated with raised odds of having lower quality of life, poorer life satisfaction, and depressive symptoms, and with mobility impairments and self-care difficulties.

CONCLUSIONS

MSK conditions are salient, and a likely key cause of impaired subjective well-being and functioning among older slum populations in SSA. Further research on determinants and consequences of such conditions in older slum populations is required to inform debate on responses to MSK as part of efforts to reorient SSA health systems to aging and to improve slum health.

Study protocol: incentives for increased access to comprehensive family planning for urban youth using a benefits card in Uganda. A quasi-experimental study

BACKGROUND

The use of contraception is one of the most cost-effective public health interventions and has the potential to prevent about 30% of maternal and 10% of child deaths in developing countries. Voucher-based initiatives for family planning are an effective and viable means of increasing contraceptive use. In this paper, we present a protocol for a pilot study of a novel incentive, a family planning benefits card (FPBC) program to increase uptake of family planning services among urban poor youth in Uganda while leveraging private sector funding.

METHODS

The study employs both impact and health economic evaluation methods to assess the effect of the FPBC program. We propose a quasi-experimental study design with two separate pre- and post-samples to measure program effectiveness. The main outcome of the impact evaluation is the percentage change in the prevalence of modern contraceptive use and unmet need for contraception. We will also conduct model-based incremental cost-effectiveness and budget impact analyses. The main outcomes of the economic evaluation are the cost per enrolled youth and cost per pregnancy averted, and cost per disability-adjusted life-year (DALY) averted. We will also pilot a corporate social responsibility model of sponsorship for the FPBC program in partnership with local corporations. Budget impact analysis will examine the potential affordability of scaling up the FPBC program and the fiscal implications of this scale up to the corporate social responsibility (CSR) budgets of partner corporations, the government, and the individual taxpayer.

DISCUSSION

In this study, we propose an impact and economic evaluation to establish the proof concept of using a FPBC program to increase uptake of family planning services among urban poor youth in Uganda. The results of this study will present stakeholders in Uganda and internationally with a potentially viable option for corporate-sponsored access to family planning in urban poor communities.

TRIAL REGISTRATION

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

Low-smoke chulha in Indian slums: study protocol for a randomised controlled trial

BACKGROUND

Biomass fuel is used as a primary cooking source by more than half of the world's population, contributing to a high burden of disease. Although cleaner fuels are available, some households continue using solid fuels because of financial constraints and absence of infrastructure, especially in non-notified slums. The present study documents a randomised controlled study investigating the efficacy of improved cookstove on the personal exposure to air pollution and the respiratory health of women and children in an Indian slum. The improved cookstove was based on co-creation of a low-smoke chulha with local communities in order to support adaption and sustained uptake.

METHODS

The study will be conducted in a non-notified slum called Ashrayanagar in Bangalore, India. The study design will be a 1:1 randomised controlled intervention trial, including 250 households. The intervention group will receive an improved cookstove (low-smoke chulha) and the control group will continue using either the traditional cookstove (chulha) or a combination of the traditional stove and the kerosene/diesel stove. Follow-up time is 1 year. Outcomes include change in lung function (FEV1/FVC), incidence of pneumonia, change in personal PM2.5 and CO exposure, incidence of respiratory symptoms (cough, phlegm, wheeze and shortness of breath), prevalence of other related symptoms (headache and burning eyes), change in behaviour and adoption of the stove. Ethical clearance was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Hyderabad- Bengaluru Campus.

DISCUSSION

The findings from this study aim to provide insight into the effects of improved cookstoves in urban slums. Results can give evidence for the decrease of indoor air pollution and the improvement of respiratory health for children and women.

TRIAL REGISTRATION

The trial was registered with clinicaltrials.gov on 21 June 2016 with the identifier NCT02821650 ; A Study to Test the Impact of an Improved Chulha on the Respiratory Health of Women and Children in Indian Slums.

Effects of individual, household and community characteristics on child nutritional status in the slums of urban Bangladesh

Background

Bangladesh urban population is expected to overtake rural population by 2040, and a significant part of the increase will be in slums. Wide disparities between urban slums and the rest of the country can potentially push country indicators off track unless the specific health and nutrition needs of the expanding slum communities are addressed. The study aims at describing the individual, household and community determinants of undernutrition status among children living in major urban strata, viz. City Corporation slums and non-slums, in order to understand the major drivers of childhood undernutrition in urban slum settings.

Methods

Data are derived from Bangladesh Urban Health Survey conducted in 2013. This survey is a large-scale, nationally representative of urban areas, household survey designed specifically to provide health and nutrition status of women and children in urban Bangladesh.

Results

Data showed that 50% of under-5 children in slums are stunted and 43% are underweight, whereas for non-slums these rates are 33 and 26% respectively. In terms of severity, proportion of under-5 children living in slums severely underweight or stunted are nearly double than the children living in non-slums. Logistic analyses indicate that mother’s education, child’s age, and household’s socio-economic status significantly affects stunting and underweight levels among children living in the urban slums. Logistic models also indicate that all individual-level characteristics, except exposure to mass media and mother’s working outside home, significantly affect undernutrition levels among children living on non-slums. Among the household- and community-level characteristics, only household’s socioeconomic status remains significant for the non-slums.

Conclusions

Poor nutritional status is a major concern in slum areas, particularly as this group is expected to grow rapidly in the next few years. The situation calls for specially designed and well targeted interventions that take into account that many of the mothers are poorer and less educated, which affects their ability to provide care to their children.

Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya

BACKGROUND

Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya's urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya.

METHODS

Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically.

RESULTS

Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as 'dirty' or 'curdled milk', a curse 'bad omen' associated with breastfeeding while engaging in extra marital affairs, a fear of the 'evil eye' (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers.

CONCLUSION

Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding.

TRIAL REGISTRATION

ISRCTN83692672: December 2013 (retrospectively registered).

Tuberculosis prevalence and socio-economic differentials in the slums of four metropolitan cities of India

AIM

To understand tuberculosis (TB) prevalence among the slum dwellers of metropolitan cities of India and the factors associated with TB prevalence.

METHODS

National Family Health Survey-III data for four metropolitan cities namely, Delhi, Mumbai, Kolkata and Chennai was used for this study.

RESULTS

Prevalence of TB is significantly (P=0.001) higher in the slums than non-slums of Mumbai, Chennai and Kolkata cities. As the living standard increases, TB prevalence decreases. Logistic regression analysis uncovers that lower standard of living is highly associated with TB followed by place of residence (slum or non-slum).

CONCLUSION

Mumbai has the highest prevalence among the four cities studied herein. Living standards, place of residence and absence of windows and electricity in the households are the factors associated with TB prevalence.

How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition

Objective

Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child’s death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya.

Design

Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis.

Setting

Two slum communities in Nairobi, Kenya.

Subjects

Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90).

Results

Participants demonstrated an understanding of undernutrition in children.

Conclusions

Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling.

Prevalence of Dog Bites in Rural and Urban Slums of Delhi: A Community-based Study

Background:

Rabies is a fatal disease of the central nervous system caused by the bites of warm-blooded animals. One of the important methods of controlling rabies is by interventions to limit the number of dog bites, the most common source of transmission of rabies to humans in the community. Community-based data on dog bites are rare from India.

Aim:

The aim of this study is to determine the prevalence of dog bites and knowledge and practices relating to its management and prevention in an urban and a rural slum of North West Delhi, India.

Subjects and Methods:

A cross-sectional house to house survey of 500 households covering a population of 2887 individuals was conducted. The families were selected by systematic random sampling. A pretested and a prevalidated questionnaire was used. Chi-square test was applied for comparing proportions related to the categorical variables and t-test was used for comparing means.

Results:

The dog bite incidence rate for the study population for the last year was 25.2/1000 population with higher rates in urban (30.1/1000) than rural (19.6/1000) slum. Two-fifths of the dog bite patients did not wash the wound with soap and water. The practice of washing the wound with soap and water was significantly higher in urban than rural slum. One-fifth of the patients did not receive anti-rabies vaccine. There was lower coverage in rural than urban slum. A majority (79.0%) of the patients did not receive anti-rabies serum.

Conclusion:

A high prevalence of dog bites coupled with poor knowledge and dog bite management practices is a worrisome trend which policy makers should take into account to make India rabies free.

Prevalence, awareness, and control of hypertension in the slums of Kolkata

BACKGROUND

Slum dwellers have poor socio-environmental conditions and less access to medical care, which make them susceptible to illnesses. Studies on urban slums have primarily focused on communicable diseases and less on lifestyle diseases, such as hypertension. Consequently, there is a paucity of prevalence studies of hypertension in slums in different parts of the country. The aim of the study was to provide estimates of the prevalence, awareness, and control of hypertension in an adult population sample of the slums of Kolkata.

METHODS

A population-based cross-sectional study was conducted in the slums of Kolkata in collaboration with Kolkata Municipality Corporation. Door-to-door survey was conducted by trained healthcare workers using a structured questionnaire. Age, sex, religion, housing conditions (house/hut), average monthly household income, education status, current use of tobacco, history of hypertension, and whether on antihypertensive treatment were recorded. Blood pressure (BP) was recorded as per standard guidelines. Hypertension was diagnosed by JNC-VII criteria. A total of 10,175 adults aged ≥20 years were enrolled in the study.

RESULTS

Overall prevalence of hypertension was 42%. Hypertension was newly detected in 19% of the population. Fifty-four percent of the hypertensive subjects were aware of their hypertension status, 38% were on antihypertensive treatment, and 12% had their BP controlled to target level. Subgroup analysis showed that the prevalence of hypertension was higher in men, above 60 years age, in the minority community, in those with a higher household income, and among the tobacco users.

CONCLUSION

There is a high prevalence of hypertension in the slums of Kolkata. Although the awareness of the condition is high, the control of hypertension is poor.

Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda

Background

The effect of seasons on health outcomes is a reflection on the status of public health and the state of development in a given society. Evidence shows that in Sub-Saharan Africa, most infectious diseases flourish during the wet months of the year; while human activities in a context of constrained choices in life exacerbate the effects of seasons on human health. The paper argues that, the wet season and when human activities are at their peak, sanitation is most dire poor slum populations.

Methods

A shared latrine cleaning observation was undertaken over a period of 6 months in the slums of Kampala city. Data was collected through facility observations, user group meetings, Focus group discussions and, key informant interviews. The photos of the observed sanitation facilities were taken and assessed for facility cleanliness or dirt. Shared latrine pictures, observations, Focus Group Discussion, community meetings and key informant interviews were analysed and subjected to an analysis over the wet, dry and human activity cycles before a facility was categorised as either ‘dirty’ or ‘clean’.

Results

Human activity cycles also referred to as socio-economic seasons were, school days, holidays, weekends and market days. These have been called ‘impure’ seasons, while the ‘pure’ seasons were the wet and dry months: improved and unimproved facilities were negatively affected by the wet seasons and the peak seasons of human activity. Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities.

Conclusion

Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.

First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project's Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh

The processes for implementing effective programs at scale in low-income countries have not been well-documented in the peer-reviewed literature. This article describes the initial steps taken by one such program--the BRAC Manoshi Project, which now reaches a population of 6.9 million. The project has achieved notable increases in facility births and reductions in maternal and neonatal mortality. The focus of the paper is on the initial steps--community engagement, social mapping, and census taking. Community engagement began with (1) engaging local leaders, (2) creating Maternal, Neonatal, and Child Health Committees for populations of approximately 10,000 people, (3) responding to advice from the community, (4) social mapping of the community, and (5) census taking. Social mapping involved community members working with BRAC staff to map all important physical features that affect how the community carries out its daily functions--such as alleys, lanes and roads, schools, mosques, markets, pharmacies, health facilities, latrine sites, and ponds. As the social mapping progressed, it became possible to conduct household censuses with maps identifying every household and listing family members by household. Again, this was a process of collaboration between BRAC staff and community members. Thus, social mapping and census taking were also instrumental for advancing community engagement. These three processes-community engagement, social mapping, and census taking--can be valuable strategies for strengthening health programs in urban slum settings of low-income countries.

Contraceptive need and use among individuals with HIV/AIDS living in the slums of Nairobi, Kenya

Objective

To understand contraceptive need and use among individuals with HIV/AIDS living in slums.

Methods

A sequential mixed-methods study was conducted in two slums in Nairobi, Kenya, from November 6th, 2009 to April 18th, 2010. Data were obtained by quantitative survey (n = 513), qualitative in-depth interviews (n = 41), and key informant interviews (n = 14).

Results

In all, 250 (55.5%) participants used contraceptives. Condoms were the most frequently reported modern method (n = 142; 60.4%), followed by injectables (n = 55; 23.4%) and dual methods (n = 38; 15.3%). Unmet need was reported by 151 (33.6%) individuals. Factors associated with contraceptive use were education, marital status, number of living children, discussion of contraception with a provider, and social support. Personal, conceptual, and structural barriers to contraceptive use were identified.

Conclusions

Individuals with HIV/AIDS wished to limit their fertility but experienced high unmet need for contraception. Multi-level interventions, including educational campaigns and integration of HIV and family planning services, are required to overcome barriers.

Resilience in the face of post-election violence in Kenya: the mediating role of social networks on wellbeing among older people in the Korogocho informal settlement, Nairobi

Older people in slum settings are a vulnerable sub-group during crises, yet have received minimal attention in the development discourse. This paper examines the protective role of different types of social networks for older slum dwellers' wellbeing during adversity by investigating the relationship between social networks, the Kenyan 2007/08 post-election violence, and dimensions of wellbeing namely self-rated health, life satisfaction and happiness amongst older people in the Korogocho slum, Nairobi. The analyses are based on conditional change logistic regression models using data from a unique longitudinal survey of the health and wellbeing of older people. The results show that maintaining or increasing formal local networks reduced the detrimental effects of the post-election violence for older people's wellbeing, whilst household environment and informal local and non-local networks did not influence the relationship. Consequently, the paper provides evidence that supporting inclusive community organisations which are accessible to older people can be valuable in promoting the resilience of this population group.

The effect of enhanced public-private partnerships on Maternal, Newborn and child Health Services and outcomes in Nairobi-Kenya: the PAMANECH quasi-experimental research protocol

INTRODUCTION

Rapid urbanisation in Kenya has resulted in growth of slums in urban centres, characterised by poverty, inadequate social services and poor health outcomes. The government's initiatives to improve access to quality healthcare for mothers and children are largely limited to public health facilities, which are few and/or inaccessible in underserved areas such as the slums. The 'Partnership for Maternal, Newborn and Child Health' (PAMANECH) project is being implemented in two Nairobi slums, Viwandani and Korogocho, to assess the impact of strengthening public-private partnerships for the delivery of healthcare on the health of mothers, newborns and young children in two informal settlements in Kenya.

METHODS AND ANALYSIS

This is a quasi-experimental study; our approach is to support private as well as public health providers and the community to enhance access to and demand for quality healthcare services. Key activities include: infrastructural upgrade of selected Private Not-For-Profit health facilities operating in the two slums, building capacity for healthcare providers as well as the Health Management Teams in Nairobi, facilitating provision of supportive supervision by the local health authorities and forming networks of Community Health Volunteers (CHVs) to create demand for health services. To assess the impact of the intervention, the study is utilising multiple data sources using a combination of qualitative and quantitative methods. A baseline survey was conducted in 2013 and an end-line survey will be conducted at least 1 year after full implementation of the intervention. Systematic monitoring and documentation of the intervention is on-going to strengthen the case for causal inference.

ETHICS AND DISSEMINATION

Ethical approval for the study was obtained from the Kenya Medical Research Institute. Key messages from the results will be packaged and widely disseminated through workshops, conference presentations, reports, factsheets and academic publications to facilitate uptake by policymakers.

PROTOCOL REGISTRATION NUMBER

KEMRI- NON-SSC-PROTOCOL No. 393.

The psychological toll of slum living in Mumbai, India: a mixed methods study

In India, "non-notified" slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than "notified" (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July-November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum's overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress-by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city.

Sexuality in Adolescents: have we Explored Enough! A Cross-sectional Study to Explore Adolescent Health in a City Slum in Northern India

CONTEXT

Adolescent health is a relatively new focus area of India's National health program. However, little evidence is available for the existing problems especially in adolescent slum population. A study was planned to explore the problems of adolescent pertaining to sexuality, physical health, tobacco and alcohol use in slums of Urban Meerut, and create evidence base for informed planning and decision making by the local health authorities.

AIMS

To study the adolescent health in the slums of Meerut City, India.

SETTINGS AND DESIGN

Entire slums of Urban Meerut, cross-sectional study.

MATERIALS AND METHODS

Study was done in the slums of Meerut city, in Northern India. WHO 30 cluster sampling technique was used. Thirty slums were selected from the list of all the slums of Meerut, 210 adolescents were selected with 7 adolescents from each slum.

STATISTICAL ANALYSIS

Proportions and Chi-square test.

RESULTS

More than one third of the (36.7%) adolescents reported to have a current health problem, however only half of these sought medical help for treatment. Tweleve percent of adolescents reported history of alcohol or tobacoo use. Nine percent adolescents complained of stressful atmosphere at home. About 10% adolescents in the surveyed population gave history of sexual activity, but only one third of them had used condom during their last sexual intercourse.

CONCLUSION

This study reflects the high morbidity and poor treatment seeking behaviour among adolescents in urban slums. A significant proportion of adolescents indulge in high risk sexual behavior, tobacco and alcohol use. There were significant gender differences with regards to treatment seeking behaviour, sexual behaviour, tobacco and alcohol use. The gender nuances must be taken into account while planning interventions for this section of population.

Understanding the fate of sanitation-related nutrients in a shallow sandy aquifer below an urban slum area

We hypothesized that wastewater leaching from on-site sanitation systems to alluvial aquifers underlying informal settlements (or slums) may end up contributing to high nutrient loads to surface water upon groundwater exfiltration. Hence, we conducted a hydro-geochemical study in a shallow sandy aquifer in Bwaise III parish, an urban slum area in Kampala, Uganda, to assess the geochemical processes controlling the transport and fate of dissolved nutrients (NO3, NH4 and PO4) released from on-site sanitation systems to groundwater. Groundwater was collected from 26 observation wells. The samples were analyzed for major ions (Ca, Mg, Na, Mg, Fe, Mn, Cl and SO4) and nutrients (o-PO4, NO3 and NH4). Data was also collected on soil characteristics, aquifer conductivity and hydraulic heads. Geochemical modeling using PHREEQC was used to determine the level of o-PO4 control by mineral solubility and sorption. Groundwater below the slum area was anoxic and had near neutral pH values, high values of EC (average of 1619μS/cm) and high concentrations of Cl (3.2mmol/L), HCO3 (11mmol/L) and nutrients indicating the influence from wastewater leachates especially from pit latrines. Nutrients were predominantly present as NH4 (1-3mmol/L; average of 2.23mmol/L). The concentrations of NO3 and o-PO4 were, however, low: average of 0.2mmol/L and 6μmol/L respectively. We observed a contaminant plume along the direction of groundwater flow (NE-SW) characterized by decreasing values of EC and Cl, and distinct redox zones. The redox zones transited from NO3-reducing in upper flow areas to Fe-reducing in the lower flow areas. Consequently, the concentrations of NO3 decreased downgradient of the flow path due to denitrification. Ammonium leached directly into the alluvial aquifer was also partially removed because the measured concentrations were less than the potential input from pit latrines (3.2mmol/L). We attributed this removal (about 30%) to anaerobic ammonium oxidation (anammox) given that the cation exchange capacity of the aquifer was low (<6meq/100g) to effectively adsorb NH4. Phosphate transport was, on the other hand, greatly retarded and our results showed that this was due to the adsorption of P to calcite and the co-precipitation of P with calcite and rhodochrosite. Our findings suggest that shallow alluvial sandy aquifers underlying urban slum areas are an important sink of excessive nutrients leaching from on-site sanitation systems.

Slums' access to and coverage of primary health care services: a cross-sectional study in shiraz, a metropolis in southern iran

BACKGROUND

The United Nations has predicted that the population of slum dwellers will have grown from one billion people worldwide to 2 billion by 2030. This trend is also predictable in Iran. In the Iranian metropolis of Shiraz, more than 10% of the residents live in slum areas. There are several problems regarding the delivery of social services in these areas. The aim of this study was to evaluate slums dwellers' access to and coverage of health care.

METHODS

This cross-sectional face-to-face study included 380 household of slum dwellers via stratified random sampling. Demographics, accessibility of health services, coverage of health care, and route of receiving health services were recorded through interviews.

RESULTS

Approximately, 21.6% of the households had no physical access to health centers. The coverage rate of family planning programs for safe methods was 51.4% (95% CI: 48.86-53.9%). Vaccination coverage among children under 5 years old was 98% (95% CI: 97-99%). Furthermore, 34% of pregnant women had not received standard health care due to a lack of access to health centers.

CONCLUSION

Limited access to health services along with inadequate knowledge of slum residents about health care facilities was the main barrier to the utilization of the health care in the slums.

Perceptions and Knowledge about Leukorrhea in a Slum Dwelling South Asian Community

OBJECTIVE

The problem of RTI/STI is of growing concern worldwide, especially in developing countries; where each year 340 million new cases curable STI occur. Out of these 151 million are in South and Southeast Asia (WHO, 2001). The present paper attempts to capture the prevalence of leukorrhea, its knowledge and perceptions among currently married women of the age-group, 15-49 years, in a south Asian urban-slum dwelling community.

MATERIALS AND METHODS

A total of 400 households were selected from an urban-slum of Delhi and 391 were interviewed in a house to house survey.

RESULTS

The results showed that the awareness about leukorrhea was almost universal (97 percent), and around 33 percent reported to have experienced the same either at the time of survey or prior to 3 months of the survey date. The perceptions about leukorrhea were varied.

CONCLUSION

The study reports a high prevalence of leukorrhea among the slum dwelling women, and it also reports that there was not a marked difference in the perception and knowledge when it comes to respondent's education, occupational status, and husbands' education.

A two-step crushed lava rock filter unit for grey water treatment at household level in an urban slum

Decentralised grey water treatment in urban slums using low-cost and robust technologies offers opportunities to minimise public health risks and to reduce environmental pollution caused by the highly polluted grey water i.e. with a COD and N concentration of 3000-6000 mg L(-1) and 30-40 mg L(-1), respectively. However, there has been very limited action research to reduce the pollution load from uncontrolled grey water discharge by households in urban slums. This study was therefore carried out to investigate the potential of a two-step filtration process to reduce the grey water pollution load in an urban slum using a crushed lava rock filter, to determine the main filter design and operation parameters and the effect of intermittent flow on the grey water effluent quality. A two-step crushed lava rock filter unit was designed and implemented for use by a household in the Bwaise III slum in Kampala city (Uganda). It was monitored at a varying hydraulic loading rate (HLR) of 0.5-1.1 m d(-1) as well as at a constant HLR of 0.39 m d(-1). The removal efficiencies of COD, TP and TKN were, respectively, 85.9%, 58% and 65.5% under a varying HLR and 90.5%, 59.5% and 69%, when operating at a constant HLR regime. In addition, the log removal of Escherichia coli, Salmonella spp. and total coliforms was, respectively, 3.8, 3.2 and 3.9 under the varying HLR and 3.9, 3.5 and 3.9 at a constant HLR. The results show that the use of a two-step filtration process as well as a lower constant HLR increased the pollutant removal efficiencies. Further research is needed to investigate the feasibility of adding a tertiary treatment step to increase the nutrients and microorganisms removal from grey water.