"Making it": Understanding adolescent resilience in two informal settlements (slums) in Nairobi, Kenya

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15-19 years) than younger (12-14 years) adolescents. Models for pro-social behavior and models for anti-social behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.

Antenatal Care Seeking Behaviour among Slum Mothers: A Study of Rajshahi City Corporation, Bangladesh

OBJECTIVES

The study aimed to identify the important effects of some selected variables in antenatal care (ANC) seeking behaviour among slum mothers.

METHODS

The data for the study were collected in 2006 from 700 mothers in the slum areas of Rajshahi City Corporation (RCC), Bangladesh.

RESULTS

The results indicate that tetanus toxoid (TT) is relatively widespread in slum areas of RCC. Serious health implications were observed for the mothers and their children who lived in the study areas because more than half of the respondents (56.1%) were not assisted at their last childbirth by any health professional. The respondents were too poor to buy iron tablets/syrup and vitamin tablets/syrup during their last pregnancy. The application of a logistic regression model suggested that demographic and socio-economic factors were associated with ANC seeking behaviour among slum mothers.

CONCLUSION

Respondents' education, place of treatment, husband's occupation, family's income, and exposure to mass media had highly significant effects on mothers seeking medical checkups during their last pregnancy.

The sanitation environment in urban slums: implications for child health

I examine the effect of improved sanitation on child health in urban Bangladesh to assess the relative importance of household versus neighborhood characteristics and of adult latrine usage versus safe disposal of children's feces. Using fixed-effects regression, I calculate the change in weight-for-height in 153 children as a function of changes in latrine usage in the surrounding community. The use of longitudinal data allows children to act as their own controls, a stumbling point of many other sanitation evaluation studies using cross-sectional or case-control methods. Results provide strong evidence that children's toileting matters more than adult toileting behavior in creating a safe, hygienic environment and reducing diarrheal disease. I conclude that investments in sanitation improvements offer important externalities, and that sanitation programs must encourage the safe disposal of children's feces in order to produce maximum health gains.

Developing an interactive STD-prevention program for youth: lessons from a north Indian slum

An intervention developed to teach young men in the urban slums of Lucknow, India, about sexually transmitted diseases is described in detail. This community-based intervention was designed to impart core educational messages and to address preexisting ideas about sexual health and STD-prevention practices among participants. Indicators of knowledge recorded before and after the intervention are presented and evaluated against the scores of a control group. Levels of sexual activity and factors associated with risky sex are discussed. The intervention was successful in raising the young men's awareness of STDs significantly in all areas except for the length of time that symptoms take to manifest following risky sex and the ineffectiveness of washing one's genitals after sex to avoid acquiring STDs. Lessons learned during the intervention are described as a means of informing future STD-education programs, and issues requiring prompt attention are identified.

Diphtheria in urban slums in north India

We recorded a reappearance of cases of microbiologically confirmed diphtheria in a tertiary care hospital in north India. Poor immunisation coverage, population migrations, and overcrowded urban slums may be contributory factors.

Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord

OBJECTIVE

To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord.

DESIGN

Cross-sectional survey.

SUBJECTS

Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya.

RESULTS

Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching.

CONCLUSION

Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated.

Vitamin A intake and xerophthalmia among Indian children

OBJECTIVE

To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y.

DESIGN

Cross sectional study.

STUDY SETTING

Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India.

PARTICIPANTS

The study included 1094 all children under 6 y of age, from two randomly selected urban slums.

METHODS

Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group.

RESULTS

Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased.

CONCLUSIONS

Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.

Difficulties in conducting participatory action research to prevent diarrhoea in a slum area of Bangkok

Childhood diarrhoea is a major cause of childhood morbidity and mortality in Thailand. During April 1988-April 1990, a study was conducted to evaluate participatory action research as a method of intervening on unhygienic practices in two communities in the Klong Toey slum of Bangkok (intervention group) and compared these practices in two other communities of the same slum where there was no intervention (control group). The following variables were compared in two groups: hygiene behaviour and factors associated with participation of community leaders and mothers with children aged less than five years. Two hundred and twenty-one mothers of the original 606 (36%) were still available at the end of the study. It was found that the mothers in the intervention groups were more likely to wash their hands before feeding and use cupboards and covered containers for keeping food. Several factors negatively affected community participation: matters concerning the slum culture and organization, community leadership, family problems, occupational problems, and physical environment of the community. The conclusions of the study are limited because of the considerable proportion of the subjects that was lost to follow-up. The study points at some of the methodological issues when conducting research in challenging and difficult to reach communities that have important health problems.

Hyperendemic pulmonary tuberculosis in a Peruvian shantytown

Estimates of the incidence of pulmonary tuberculosis in developing countries are based on case reporting from local health laboratories or the annual risk of tuberculin skin test conversion. Because these methods are problematic, the authors used a multiple case ascertainment method to estimate the incidence of pulmonary tuberculosis from 1989 to 1993 in a Peruvian shantytown of 34,000 inhabitants. Two methods, face-to-face interview of all local inhabitants and examination of local laboratory smear records, were used for case gathering. The number of missed cases was estimated by capture-recapture analysis. Survey cases with positive smears were matched to age- and sex-matched controls and interviewed about socioeconomic conditions. The average annual incidence per 100,000 population was 364 (95% confidence interval 293-528) by capture-recapture methods. For the city encompassing the shantytown, the Peruvian Ministry of Heath reported an average annual incidence of 134 cases per 100,000 population. The authors conclude that, in Peru, alarming clusters of pulmonary tuberculosis are masked by government reports that pool zones of disparate incidence. Existing estimators of pulmonary tuberculosis incidence based on tuberculin conversion rates may be invalid in such areas. Within these hyperendemic areas, persons suitable for intensive prophylaxis efforts cannot be reliably identified by housing and socioeconomic risk factors.