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Alpaugh V, Ortigoza A, Braverman Bronstein A, Pérez-Ferrer C, Wagner-Gutierrez N, Pacifico N, Ezeh A, Caiaffa WT, Lovasi G, Bilal U. Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities. J Urban Health 2024; 101:629-637. [PMID: 38652338 PMCID: PMC11189882 DOI: 10.1007/s11524-024-00854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
Abstract
Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84-1.28) and 3.19 times (95% CI 1.80-5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.
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Affiliation(s)
- Victoria Alpaugh
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Ana Ortigoza
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Social and Environmental Determinants of Health Equity, Pan American Health Organization, Washington, D.C., USA
| | - Ariela Braverman Bronstein
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Institute for Community Health, Cambridge Health Alliance, Malden, MA, USA
| | - Carolina Pérez-Ferrer
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Natalia Pacifico
- Institute of Collective Health, National University of Lanús, Remedios de Escalada, Argentina
- FJ Muñiz Infectious Hospital, Buenos Aires, Argentina
| | - Alex Ezeh
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gina Lovasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA.
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Mottelson J. On the impact of urban planning in contexts with limited enforcement of building and planning regulations: A study of the urban form of planned and unplanned informal settlements in Maputo, Mozambique. PLoS One 2023; 18:e0292045. [PMID: 37768935 PMCID: PMC10538724 DOI: 10.1371/journal.pone.0292045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND More than one billion people live in informal settlements under precarious conditions. Urban planning is considered an important instrument to mitigate compromised living conditions in informal settlements. However, limited studies have investigated the long-term impact of urban planning in contexts with limited capacity to enforce building and planning regulations. The purpose of this study is to assess the long-term impact of urban planning on the development of sustainable urban form in contexts characterized by unregulated urban development. METHODS The study conducted geospatial surveys of three urban areas in Maputo, Mozambique covering adjacent planned and unplanned settlements that were established more than 40 years ago and subsequently developed with limited enforcement of building and planning regulations. High-resolution maps were produced and six urban form metrics were computed for the planned and unplanned areas respectively, providing the basis for quantitative and qualitative comparative analysis. RESULTS Although the study found signs of street encroachment and appropriation of the public space in the planned areas, the study found higher levels of built densities, higher proportions of public space, and higher average street widths in all planned areas compared to the respective neighboring unplanned areas. Furthermore, the statistical analysis consistently showed large effect sizes (Cohen's d > 0.8) of urban planning on indicators of compact city development and access conditions. CONCLUSION The results underscore that planning of street fabrics and plot layouts can enhance compact city development, improve transportation conditions, and increase the feasibility of investments in infrastructure in contexts with limited capacity to administer the urban growth.
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Affiliation(s)
- Johan Mottelson
- Institute of Architecture, Urbanism and Landscape, Royal Danish Academy, Copenhagen, Denmark
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Coelho LE, Luz PM, Pires DC, Jalil EM, Perazzo H, Torres TS, Cardoso SW, Peixoto EM, Nazer S, Massad E, Silveira MF, Barros FC, Vasconcelos AT, Costa CA, Amancio RT, Villela DA, Pereira T, Goedert GT, Santos CV, Rodrigues NC, Grinsztejn B, Veloso VG, Struchiner CJ. Prevalence and predictors of anti-SARS-CoV-2 serology in a highly vulnerable population of Rio de Janeiro: A population-based serosurvey. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 15:100338. [PMID: 35936224 PMCID: PMC9337985 DOI: 10.1016/j.lana.2022.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 serosurveys allow for the monitoring of the level of SARS-CoV-2 transmission and support data-driven decisions. We estimated the seroprevalence of anti-SARS-CoV-2 antibodies in a large favela complex in Rio de Janeiro, Brazil. Methods A population-based panel study was conducted in Complexo de Manguinhos (16 favelas) with a probabilistic sampling of participants aged ≥1 year who were randomly selected from a census of individuals registered in primary health care clinics that serve the area. Participants answered a structured interview and provided blood samples for serology. Multilevel regression models (with random intercepts to account for participants’ favela of residence) were used to assess factors associated with having anti-S IgG antibodies. Secondary analyses estimated seroprevalence using an additional anti-N IgG assay. Findings 4,033 participants were included (from Sep/2020 to Feb/2021, 22 epidemic weeks), the median age was 39·8 years (IQR:21·8-57·7), 61% were female, 41% were mixed-race (Pardo) and 23% Black. Overall prevalence was 49·0% (95%CI:46·8%-51·2%) which varied across favelas (from 68·3% to 31·4%). Lower prevalence estimates were found when using the anti-N IgG assay. Odds of having anti-S IgG antibodies were highest for young adults, and those reporting larger household size, poor adherence to social distancing and use of public transportation. Interpretation We found a significantly higher prevalence of anti-S IgG antibodies than initially anticipated. Disparities in estimates obtained using different serological assays highlight the need for cautious interpretation of serosurveys estimates given the heterogeneity of exposure in communities, loss of immunological biomarkers, serological antigen target, and variant-specific test affinity. Funding Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), the European Union's Horizon 2020 research and innovation programme, Royal Society, Serrapilheira Institute, and FAPESP.
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[From lifestyle to stimulation for dementia prevention in Brazil] - Authors' reply. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100308. [PMID: 36778935 PMCID: PMC9903602 DOI: 10.1016/j.lana.2022.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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The Potential to Address Disease Vectors in Favelas in Brazil Using Sustainable Drainage Systems: Zika, Drainage and Greywater Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052860. [PMID: 35270552 PMCID: PMC8910237 DOI: 10.3390/ijerph19052860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/17/2022]
Abstract
Residents of informal settlements, the world over, suffer consequences due to the lack of drainage and greywater management, impacting human and environmental health. In Brazil, the presence of the Aedes aegypti mosquito in urban areas promotes infections of the Zika virus as well as companion viruses, such as dengue, chikungunya and yellow fever. By using observation and interviews with the community, this paper shows how a simple sustainable drainage system approach could prevent the accumulation of on-street standing water, and thus reduce opportunities for the mosquito to breed and reduce infection rates. During the interview phase, it became apparent that underlying misinformation and misunderstandings prevail related to existing environmental conditions in favelas and the role of the mosquito in infecting residents. This inhibits recommendations made by professionals to reduce breeding opportunities for the disease vector. Whilst unrest is an issue in favelas, it is not the only issue preventing the human right to reliable, safe sanitation, including drainage. In "pacified" favelas which may be considered safe(r), the infrastructure is still poor and is not connected to the city-wide sanitation/treatment networks.
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Chan JJL, Tran-Nhu L, Pitcairn CFM, Laverty AA, Mrejen M, Pescarini JM, Hone TV. Inequalities in the prevalence of cardiovascular disease risk factors in Brazilian slum populations: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000990. [PMID: 36962864 PMCID: PMC10022010 DOI: 10.1371/journal.pgph.0000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Social and environmental risk factors in informal settlements and slums may contribute to increased risk of cardiovascular disease (CVD). This study assesses the socioeconomic inequalities in CVD risk factors in Brazil comparing slum and non-slum populations. METHODS Responses from 94,114 individuals from the 2019 Brazilian National Health Survey were analysed. The United Nations Human Settlements Programme definition of a slum was used to identify slum inhabitants. Six behavioural risk factors, four metabolic risk factors and doctor-diagnosed CVD were analysed using Poisson regression models adjusting for socioeconomic characteristics. RESULTS Compared to urban non-slum inhabitants, slum inhabitants were more likely to: have low (less than five days per week) consumption of fruits (APR: 1.04, 95%CI 1.01-1.07) or vegetables (APR: 1.08, 95%CI 1.05-1.12); drink four or more alcoholic drinks per day (APR: 1.05, 95%CI 1.03-1.06); and be physically active less than 150 minutes per week (APR: 1.03, 95%CI 1.01-1.04). There were no differences in the likelihoods of doctor-diagnosed metabolic risk factors or CVD between the two groups in adjusted models. There was a higher likelihood of behavioural and metabolic risk factors among those with lower education, with lower incomes, and the non-White population. CONCLUSIONS Brazilians living in slums are at higher risk of behavioural risk factors for CVD, suggesting local environments might impact access to and uptake of healthy behaviours.
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Affiliation(s)
- Jasper J L Chan
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Linh Tran-Nhu
- Division of Biosciences, University College London, London, United Kingdom
| | - Charlie F M Pitcairn
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Matías Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas V Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Pitcairn CFM, Laverty AA, Chan JJL, Oyebode O, Mrejen M, Pescarini JM, Machado DB, Hone TV. Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis. Epidemiol Psychiatr Sci 2021; 30:e66. [PMID: 34670640 PMCID: PMC8546499 DOI: 10.1017/s204579602100055x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations. METHODS Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression. RESULTS Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes. CONCLUSIONS Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.
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Affiliation(s)
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | | | - Matías Mrejen
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Julia M. Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas V. Hone
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Abstract
In the influential 1995 article “Social Conditions as Fundamental Causes of Disease,” Bruce Link and Jo Phelan described social and political factors as “fundamental causes” of death and disease. Whitney Pirtle has recently declared racial capitalism another such fundamental cause. Using the case of the water crisis in Flint, Michigan, she has argued that racial capitalism's role in that situation meets each of the criteria Link and Phelan's article outlines: racial capitalism influenced multiple disease outcomes, affected disease outcomes through multiple risk factors, involved access to flexible resources that can be used to minimize both risks and the consequences of disease, and was reproduced over time through the continual replacement of intervening mechanisms. We argue for Pirtle's conclusion using the extensive literature on racial capitalism and case studies concerning housing in the United States and Brazil and what Naomi Klein has termed “corona capitalism” in India. If races correspond to hierarchies of material security, as suggested by Ruth Wilson Gilmore, then these hierarchies and their causal effects are fundamental determinants of public health.
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COVID-19 Pandemic in Rio de Janeiro, Brazil: A Social Inequality Report. ACTA ACUST UNITED AC 2021; 57:medicina57060596. [PMID: 34200557 PMCID: PMC8229071 DOI: 10.3390/medicina57060596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives: To perform a retrospective report on the lethality of COVID-19 in different realities in the city of Rio de Janeiro (RJ). Materials and Methods: We accomplished an observational study by collecting the data about total confirmed cases and deaths due to COVID-19 in the top 10 high social developed neighborhoods and top 10 most populous favelas in RJ to determine the case-fatality rate (CFR) and compare these two different realities. Results: CFR was significatively higher in poverty areas of RJ, reaching a mean of 9.08% in the most populous favelas and a mean of 4.87% in the socially developed neighborhoods. Conclusions: The social mitigation measures adopted in RJ have benefited only smaller portions of the population, excluding needy communities.
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Miagostovich MP, Rocha MS, Dos Reis FB, Sampaio MS, de Saldanha da Gama Gracie Carrijo R, Malta FC, Rodrigues J, Genuino A, Ribeiro da Silva Assis M, Fumian TM, Barrocas PRG. Gastroenteric Viruses Detection in a Drinking Water Distribution-to-Consumption System in a Low-Income Community in Rio de Janeiro. FOOD AND ENVIRONMENTAL VIROLOGY 2020; 12:130-136. [PMID: 32152895 DOI: 10.1007/s12560-020-09423-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
The availability of drinking water is one of the main determinants of quality of life, disease prevention and the promotion of health. Viruses are important agents of waterborne diseases and have been described as important markers of human faecal contamination. This study aimed to investigate viruses' presence as an indicator of drinking water quality in low-income communities in the Manguinhos area, Rio de Janeiro, Brazil. Three hundred and four drinking water samples (2L/each) were collected along the drinking water distribution-to-consumption pathway in households, as well as healthcare and school units. Water samples were collected both directly from the water supply prior to distribution and after storage in tanks and filtration units. Using qPCR, viruses were detected 50 times in 45 water samples (15%), 19 of these being human adenovirus, 17 rotavirus A and 14 norovirus GII. Viral loads recovered ranged from 5E+10 to 8.7E+106 genome copies/Liter. Co-detection was observed in five household water samples and there was no difference regarding virus detection across sampling sites. Precarious and inadequate environmental conditions characterized by the lack of local infrastructure regarding basic sanitation and waste collection in the territory, as well as negligent hygiene habits, could explain viral detection in drinking water in regions with a water supply system.
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Affiliation(s)
- Marize Pereira Miagostovich
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil.
| | - Mônica Simões Rocha
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil.
| | - Fabiane Bertoni Dos Reis
- Departamento de Saneamento e Saúde Ambiental, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Marcelo Santos Sampaio
- Departamento de Saneamento e Saúde Ambiental, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | | | - Fabio Correia Malta
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Janaína Rodrigues
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Amanda Genuino
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Matheus Ribeiro da Silva Assis
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Tulio Machado Fumian
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Paulo Rubens Guimarães Barrocas
- Departamento de Saneamento e Saúde Ambiental, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
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Slums, Space, and State of Health-A Link between Settlement Morphology and Health Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062022. [PMID: 32204347 PMCID: PMC7143924 DOI: 10.3390/ijerph17062022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/31/2022]
Abstract
Approximately 1 billion slum dwellers worldwide are exposed to increased health risks due to their spatial environment. Recent studies have therefore called for the spatial environment to be introduced as a separate dimension in medical studies. Hence, this study investigates how and on which spatial scale relationships between the settlement morphology and the health status of the inhabitants can be identified. To this end, we summarize the current literature on the identification of slums from a geographical perspective and review the current literature on slums and health of the last five years (376 studies) focusing on the considered scales in the studies. We show that the majority of medical studies are restricted to certain geographical regions. It is desirable that the number of studies be adapted to the number of the respective population. On the basis of these studies, we develop a framework to investigate the relationship between space and health. Finally, we apply our methodology to investigate the relationship between the prevalence of slums and different health metrics using data of the global burden of diseases for different prefectures in Brazil on a subnational level.
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The Role of Earth Observation in an Integrated Deprived Area Mapping “System” for Low-to-Middle Income Countries. REMOTE SENSING 2020. [DOI: 10.3390/rs12060982] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urbanization in the global South has been accompanied by the proliferation of vast informal and marginalized urban areas that lack access to essential services and infrastructure. UN-Habitat estimates that close to a billion people currently live in these deprived and informal urban settlements, generally grouped under the term of urban slums. Two major knowledge gaps undermine the efforts to monitor progress towards the corresponding sustainable development goal (i.e., SDG 11—Sustainable Cities and Communities). First, the data available for cities worldwide is patchy and insufficient to differentiate between the diversity of urban areas with respect to their access to essential services and their specific infrastructure needs. Second, existing approaches used to map deprived areas (i.e., aggregated household data, Earth observation (EO), and community-driven data collection) are mostly siloed, and, individually, they often lack transferability and scalability and fail to include the opinions of different interest groups. In particular, EO-based-deprived area mapping approaches are mostly top-down, with very little attention given to ground information and interaction with urban communities and stakeholders. Existing top-down methods should be complemented with bottom-up approaches to produce routinely updated, accurate, and timely deprived area maps. In this review, we first assess the strengths and limitations of existing deprived area mapping methods. We then propose an Integrated Deprived Area Mapping System (IDeAMapS) framework that leverages the strengths of EO- and community-based approaches. The proposed framework offers a way forward to map deprived areas globally, routinely, and with maximum accuracy to support SDG 11 monitoring and the needs of different interest groups.
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Thomson DR, Linard C, Vanhuysse S, Steele JE, Shimoni M, Siri J, Caiaffa WT, Rosenberg M, Wolff E, Grippa T, Georganos S, Elsey H. Extending Data for Urban Health Decision-Making: a Menu of New and Potential Neighborhood-Level Health Determinants Datasets in LMICs. J Urban Health 2019; 96:514-536. [PMID: 31214975 PMCID: PMC6677870 DOI: 10.1007/s11524-019-00363-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Area-level indicators of the determinants of health are vital to plan and monitor progress toward targets such as the Sustainable Development Goals (SDGs). Tools such as the Urban Health Equity Assessment and Response Tool (Urban HEART) and UN-Habitat Urban Inequities Surveys identify dozens of area-level health determinant indicators that decision-makers can use to track and attempt to address population health burdens and inequalities. However, questions remain as to how such indicators can be measured in a cost-effective way. Area-level health determinants reflect the physical, ecological, and social environments that influence health outcomes at community and societal levels, and include, among others, access to quality health facilities, safe parks, and other urban services, traffic density, level of informality, level of air pollution, degree of social exclusion, and extent of social networks. The identification and disaggregation of indicators is necessarily constrained by which datasets are available. Typically, these include household- and individual-level survey, census, administrative, and health system data. However, continued advancements in earth observation (EO), geographical information system (GIS), and mobile technologies mean that new sources of area-level health determinant indicators derived from satellite imagery, aggregated anonymized mobile phone data, and other sources are also becoming available at granular geographic scale. Not only can these data be used to directly calculate neighborhood- and city-level indicators, they can be combined with survey, census, administrative and health system data to model household- and individual-level outcomes (e.g., population density, household wealth) with tremendous detail and accuracy. WorldPop and the Demographic and Health Surveys (DHS) have already modeled dozens of household survey indicators at country or continental scales at resolutions of 1 × 1 km or even smaller. This paper aims to broaden perceptions about which types of datasets are available for health and development decision-making. For data scientists, we flag area-level indicators at city and sub-city scales identified by health decision-makers in the SDGs, Urban HEART, and other initiatives. For local health decision-makers, we summarize a menu of new datasets that can be feasibly generated from EO, mobile phone, and other spatial data-ideally to be made free and publicly available-and offer lay descriptions of some of the difficulties in generating such data products.
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Affiliation(s)
- Dana R Thomson
- Flowminder Foundation, Stockholm, Sweden. .,Department of Geography and Environment, University of Southampton, Southampton, UK. .,Department of Social Statistics, University of Southampton, Southampton, UK.
| | - Catherine Linard
- Department of Geography and Environment, University of Southampton, Southampton, UK.,Spatial Epidemiology Lab, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Geography, Université de Namur, Namur, Belgium
| | - Sabine Vanhuysse
- Department of Geosciences, Environment and Society (DGES-IGEAT), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Jessica E Steele
- Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Michal Shimoni
- Signal and Image Centre, Faculty of Electrical engineering, Royal Military Academy, Brussels, Belgium
| | - José Siri
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Megumi Rosenberg
- Center for Health Development, World Health Organization, Kobe, Japan
| | - Eléonore Wolff
- Department of Geosciences, Environment and Society (DGES-IGEAT), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Taïs Grippa
- Department of Geosciences, Environment and Society (DGES-IGEAT), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Stefanos Georganos
- Department of Geosciences, Environment and Society (DGES-IGEAT), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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14
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Remigio RV, Zulaika G, Rabello RS, Bryan J, Sheehan DM, Galea S, Carvalho MS, Rundle A, Lovasi GS. A Local View of Informal Urban Environments: a Mobile Phone-Based Neighborhood Audit of Street-Level Factors in a Brazilian Informal Community. J Urban Health 2019; 96:537-548. [PMID: 30887375 PMCID: PMC6890882 DOI: 10.1007/s11524-019-00351-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.
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Affiliation(s)
- Richard V Remigio
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA. .,Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland-College Park, College Park, MD, USA.
| | - Garazi Zulaika
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Renata S Rabello
- Escola Nacional de Saúde Publica (ENSP)/Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - John Bryan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Daniel M Sheehan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Marilia S Carvalho
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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15
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Ross JM, Henry NJ, Dwyer-Lindgren LA, de Paula Lobo A, Marinho de Souza F, Biehl MH, Ray SE, Reiner RC, Stubbs RW, Wiens KE, Earl L, Kutz MJ, Bhattacharjee NV, Kyu HH, Naghavi M, Hay SI. Progress toward eliminating TB and HIV deaths in Brazil, 2001-2015: a spatial assessment. BMC Med 2018; 16:144. [PMID: 30185204 PMCID: PMC6125942 DOI: 10.1186/s12916-018-1131-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/17/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Brazil has high burdens of tuberculosis (TB) and HIV, as previously estimated for the 26 states and the Federal District, as well as high levels of inequality in social and health indicators. We improved the geographic detail of burden estimation by modelling deaths due to TB and HIV and TB case fatality ratios for the more than 5400 municipalities in Brazil. METHODS This ecological study used vital registration data from the national mortality information system and TB case notifications from the national communicable disease notification system from 2001 to 2015. Mortality due to TB and HIV was modelled separately by cause and sex using a Bayesian spatially explicit mixed effects regression model. TB incidence was modelled using the same approach. Results were calibrated to the Global Burden of Disease Study 2016. Case fatality ratios were calculated for TB. RESULTS There was substantial inequality in TB and HIV mortality rates within the nation and within states. National-level TB mortality in people without HIV infection declined by nearly 50% during 2001 to 2015, but HIV mortality declined by just over 20% for males and 10% for females. TB and HIV mortality rates for municipalities in the 90th percentile nationally were more than three times rates in the 10th percentile, with nearly 70% of the worst-performing municipalities for male TB mortality and more than 75% for female mortality in 2001 also in the worst decile in 2015. The same municipality ranking metric for HIV was observed to be between 55% and 61%. Within states, the TB mortality rate ratios by sex for municipalities in the worst decile versus the best decile varied from 1.4 to 2.9, and HIV varied from 1.4 to 4.2. The World Health Organization target case fatality rate for TB of less than 10% was achieved in 9.6% of municipalities for males versus 38.4% for females in 2001 and improved to 38.4% and 56.6% of municipalities for males versus females, respectively, by 2014. CONCLUSIONS Mortality rates in municipalities within the same state exhibited nearly as much relative variation as within the nation as a whole. Monitoring the mortality burden at this level of geographic detail is critical for guiding precision public health responses.
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Affiliation(s)
- Jennifer M Ross
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.,Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Laura A Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Andrea de Paula Lobo
- Department of Public Health, University of Brasilia, Distrito Federal, Brazil.,Department of Health Surveillance, Ministry of Health, Brasilia, Brazil
| | | | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Sarah E Ray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Rebecca W Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Michael J Kutz
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Natalia V Bhattacharjee
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave Suite 600, Seattle, WA, 98121, USA.
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16
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Faerstein E, da Silveira IH, Boclin KDLS, Curioni CC, Castro IRRD, Junger WL. Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study. Health Place 2018; 53:110-116. [PMID: 30098468 DOI: 10.1016/j.healthplace.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/21/2018] [Accepted: 07/30/2018] [Indexed: 11/15/2022]
Abstract
Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37-5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables.
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Affiliation(s)
- Eduardo Faerstein
- Institute of Social Medicine, State University of Rio de Janeiro, Brazil.
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17
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Brelsford C, Martin T, Hand J, Bettencourt LMA. Toward cities without slums: Topology and the spatial evolution of neighborhoods. SCIENCE ADVANCES 2018; 4:eaar4644. [PMID: 30167459 PMCID: PMC6114988 DOI: 10.1126/sciadv.aar4644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/20/2018] [Indexed: 05/20/2023]
Abstract
The world is urbanizing quickly with nearly 4 billion people presently living in urban areas, about 1 billion of them in slums. Achieving sustainable development from rapid urbanization relies critically on creating cities without slums. We show that it is possible to diagnose systematically the central physical problem of slums-the lack of spatial accesses and related services-using a topological analysis of neighborhood maps and resolved by finding solutions to a sequence of constrained optimization problems. We set up the problem by showing that the built environment of any city can be decomposed into two types of networked spaces-accesses and places-and prove that these spaces display universal topological characteristics. We then show that while the neighborhoods of developed cities express the same common topology, urban slums fall into a different topological class. We demonstrate that it is always possible to find solutions that grow a street network in existing slums, providing universal accesses at minimal disruption and cost. We then show how elaborations of this procedure that include local preferences and reduce travel distances between places result from additional access construction. These methods are presently taking effect in neighborhoods in Cape Town (South Africa) and Mumbai (India), demonstrating their practical feasibility and emphasizing their role as a platform to enable communities and local governments to combine technical knowledge with local aspirations into contextually appropriate urban sustainable development solutions.
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Affiliation(s)
- Christa Brelsford
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA
- Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Taylor Martin
- Department of Mathematics, Sam Houston State University, Huntsville, TX 77340, USA
| | - Joe Hand
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA
| | - Luís M. A. Bettencourt
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501, USA
- Mansueto Institute for Urban Innovation and Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637, USA
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18
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Lee EH, Olsen CH, Koehlmoos T, Masuoka P, Stewart A, Bennett JW, Mancuso J. A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal. Health Policy Plan 2018; 32:iii75-iii87. [PMID: 29149315 DOI: 10.1093/heapol/czx114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions.
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Affiliation(s)
- Elizabeth H Lee
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA.,Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Cara H Olsen
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Tracey Koehlmoos
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Penny Masuoka
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA.,Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Ann Stewart
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jason W Bennett
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.,Multidrug Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910, USA
| | - James Mancuso
- United States Army Medical Directorate - Kenya, Nyanza, Kenya
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19
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Neta ISS, Medeiros MSD, Gonçalves MJF. Vigilância da saúde orientada às condições de vida da população: uma revisão integrativa da literatura. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A pesquisa objetivou identificar estudos que abordem a vigilância da saúde, envolvendo intrinsecamente o conceito de desenvolvimento humano, segundo os pressupostos de Bronfenbrenner e de Max-Neef. A revisão integrativa de literatura nas bases de dados Pubmed, Scopus, Web of Science, Bireme e SciELO, com termos relacionados com a vigilância da saúde e desenvolvimento humano segundo os autores citados. Identificaram-se abordagem implícita ao desenvolvimento humano de Bronfenbrenner e distanciamento da abordagem de Max-Neff. Propõe-se à vigilância da saúde articular abordagens pós-desenvolvimentistas na identificação de problemas emergentes em saúde em populações vulneráveis.
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20
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Castiglione D, Lovasi GS, Carvalho MS. Perceptions and Uses of Public and Private Health Care in a Brazilian Favela. QUALITATIVE HEALTH RESEARCH 2018; 28:159-172. [PMID: 29134851 DOI: 10.1177/1049732317739611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Since 1988, Brazil has reorganized and expanded its public health care system, defining access to health care as a right of every citizen. In parallel, the private health care sector grew rapidly to become one of the largest in the world. We explore the use of public and private health care by a low-income population living in a favela, Rio das Pedras, in Rio de Janeiro. At the time of data collection, only part of the community was covered by the primary health care program. We conducted semistructured interviews with 14 adults, both with and without access to the public primary care program. Regardless of program coverage, participants noted barriers and negative experiences while accessing public health care. The perceived inability of health professionals to deal compassionately with a low-income population was prominent in their narratives, and in the expressed motivation for pursuing private sector health care alternatives. We explore the tension arising from the more recent rights-based health care provision and historic social control and assistentialist framing of state intervention in Brazilian favelas.
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Affiliation(s)
| | - Gina S Lovasi
- 2 Drexel University, Philadelphia, Pennsylvania, USA
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21
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Snyder RE, Rajan JV, Costa F, Lima HCAV, Calcagno JI, Couto RD, Riley LW, Reis MG, Ko AI, Ribeiro GS. Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil. Trop Med Infect Dis 2017; 2:E47. [PMID: 30270904 PMCID: PMC6082112 DOI: 10.3390/tropicalmed2030047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 12/13/2022] Open
Abstract
Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities.
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Affiliation(s)
- Robert E Snyder
- Division of Epidemiology, University of California, Berkeley, CA 94720, USA.
| | - Jayant V Rajan
- Department of Medicine, University of California, San Francisco, CA 94143, USA.
| | - Federico Costa
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Helena C A V Lima
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
| | - Juan I Calcagno
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
| | - Ricardo D Couto
- Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
- School of Medicine, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Mitermayer G Reis
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- School of Medicine, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
| | - Albert I Ko
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Department of the Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT 06510, USA.
| | - Guilherme S Ribeiro
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40170-115, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, Salvador 40170-115, Bahia, Brazil.
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22
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Khayat S, Dolatian M, Navidian A, Mahmoodi Z, Sharifi N, Kasaeian A. Lifestyles in suburban populations: A systematic review. Electron Physician 2017; 9:4791-4800. [PMID: 28894537 PMCID: PMC5586995 DOI: 10.19082/4791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/12/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lifestyle and suburban population are important issues in the field of health. The living conditions of informal settlements can lead to acquisition of an unhealthy lifestyle. OBJECTIVE This study has been designed to investigate the articles that have been published regarding lifestyle in suburban populations. METHODS The present research was a systematic review of studies in databases including Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar, Science Direct and Scopus, in 2017. All Persian and English papers written from 2000 to 2017 were evaluated by two reviewers using an advanced search of the databases with keywords related to lifestyles and suburban population. After completion of the search, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to evaluate the articles. RESULTS In total, 19 articles were found to have addressed the lifestyle in suburban populations. The results of these studies showed an unhealthy lifestyle in the most informal settlements. There was no food diversity. Malnutrition was common, especially overweight. The majority of the people did not have enough physical activity, and smoking and alcohol consumption were common, especially in men. CONCLUSION Studies showed that suburban populations are among the groups that have unfavorable environmental conditions to acquiring healthy lifestyle and maintaining appropriate health. Therefore, developing infrastructure, improving health services (environment, treatment of diseases, reduction of malnutrition and infant mortality, access to safe drinking water and sanitation, improving waste disposal and recycling it), improving education and smoking prevention programs in improving lifestyle is recommended.
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Affiliation(s)
- Samira Khayat
- Ph.D. Student in Reproductive Health, Department of Midwifery and Reproductive Health, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Navidian
- Associate Professor, Department of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohreh Mahmoodi
- Assistant Professor, Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nasibeh Sharifi
- Ph.D. Candidate of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Assistant Professor, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Janevic T, Osypuk T, Stojanovski K, Jankovic J, Gundersen D, Rogers M. Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma. Eur J Public Health 2017; 27:410-415. [PMID: 28064241 DOI: 10.1093/eurpub/ckw214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Racial discrimination may increase the risk of low birthweight (LBW), but has not been studied among Roma, the largest minority population in Europe. Moreover, few studies test both institutional and interpersonal forms of racial discrimination on health. Our objective was to examine associations between institutional and interpersonal racial discrimination with LBW, and to test potential mediation by smoking during pregnancy. In 2012-2013, Romani women interviewers surveyed 410 Romani women in Serbia and Macedonia. We measured institutional discrimination (neighborhood segregation, legal status of housing and neighborhood socioeconomic status), interpersonal discrimination [Everyday Discrimination Scale (EDS)], birthweight and smoking by self-report or interviewer report. We estimated relative risks for discrimination on LBW and separately on smoking during pregnancy using log-binomial regression, adjusting for age, parity, years at residence and wealth. The indirect effect of high EDS via smoking on LBW was estimated using inverse odds weighting mediation. Living in a low SES neighborhood showed a 2-fold risk of LBW [adjusted risk ratio (aRR) = 2.4, 95% CI = 1.2, 5.0]; aRRs for segregation and illegal housing were weaker (aRR = 1.8, 95% CI = 0.7, 4.3; aRR = 1.3, 95% CI = 0.6, 2.6, respectively). Institutional measures were not associated with smoking. High EDS was associated with LBW (aRR = 2.4, 95% CI = 1.1, 5.2) and smoking during pregnancy (aRR = 1.4, 95% CI = 1.1, 1.8); the indirect effect of EDS on LBW via smoking was not significant. Interpersonal discrimination and living in a low SES neighborhood were associated with LBW among Roma. Interventions to improve Romani health may benefit from a human rights approach.
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Affiliation(s)
- Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Theresa Osypuk
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Janko Jankovic
- Faculty of Medicine University of Belgrade, Institute of Social Medicine, Belgrade, Serbia
| | - Daniel Gundersen
- Division of Population Sciences, Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Maggie Rogers
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029
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Snyder RE, Marlow MA, Phuphanich ME, Riley LW, Maciel ELN. Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study. BMC Infect Dis 2016; 16:494. [PMID: 27647383 PMCID: PMC5029075 DOI: 10.1186/s12879-016-1835-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/14/2016] [Indexed: 12/03/2022] Open
Abstract
Background Brazil’s National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program’s differential effectiveness among urban slum and non-slum residents is not known. Methods We retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city’s limits were excluded from analysis. Results In 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT. Conclusion While DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.
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Affiliation(s)
- Robert E Snyder
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | - Mariel A Marlow
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | | | - Lee W Riley
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | - Ethel Leonor Noia Maciel
- Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468 Maruípe, Vitória, ES, Brazil.
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Marlow MA, Maciel ELN, Sales CMM, Gomes T, Snyder RE, Daumas RP, Riley LW. Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts. J Urban Health 2015; 92:622-34. [PMID: 25840553 PMCID: PMC4524851 DOI: 10.1007/s11524-015-9957-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or "DALY-gap." Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4%. DALY-gap was highest for males 40-59 years of age (501 DALYs/100,000) and in census tracts with <60% electricity (12,327 DALYs/100,000). DALY-gap comparison revealed spatial and quantitative differences in TB burden between slum vs non-slum census tracts that were not apparent using traditional measures of incidence and mortality. This metric could be applied to compare TB burden or burden for other diseases in mega-cities with large informal settlements for more targeted resource allocation and evaluation of intervention programs.
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Affiliation(s)
- Mariel A Marlow
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Health Center, Berkeley, CA, 94720, USA,
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Abstract
Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21% (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95% confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p < 0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5% were aware of their condition, and only 36.3% of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (p < 0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population.
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