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Bostan S, Johnson OA, Jaspersen LJ, Randell R. Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review. J Med Internet Res 2024; 26:e45242. [PMID: 39088815 PMCID: PMC11327637 DOI: 10.2196/45242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/29/2023] [Accepted: 02/09/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. OBJECTIVE This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. METHODS We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. RESULTS This review included 13 studies that examined open-source EHRs' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. CONCLUSIONS While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.
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Affiliation(s)
- Sarah Bostan
- Leeds University Business School, University of Leeds, Leeds, United Kingdom
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- School of Computing, University of Leeds, Leeds, United Kingdom
| | - Owen A Johnson
- School of Computing, University of Leeds, Leeds, United Kingdom
| | - Lena J Jaspersen
- Leeds University Business School, University of Leeds, Leeds, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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Anjorin S, Okolie EA, Onuegbu C, Ijaiya M, Ayorinde A, Oyebode O, Uthman O. Neighbourhood effect and inequality in access to essential health services among mother-child paired samples: a decomposition analysis of data from 58 low- and middle-income countries. Int J Equity Health 2024; 23:130. [PMID: 38943187 PMCID: PMC11212233 DOI: 10.1186/s12939-024-02194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/08/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Neighbourhood effect on health outcomes is well established, but little is known about its effect on access to essential health services (EHS). Therefore, this study aimed to assess the contributing factors to access to EHS in slum versus non-slum settings. METHODOLOGY The most recent data from 58 Demographic and Health Surveys (DHS) conducted between 2011 and 2018 were used, including a total of 157,000 pairs of currently married women aged 15-49 and their children aged 12-23 months. We used meta-analysis techniques to examine the inequality gaps in suboptimal access to EHS between mother-children pairs living in slums and non-slums. Blinder-Oaxaca decomposition technique was used to identify the factors contributing to the inequality gaps in each low- and middle-income country (LMIC) included. RESULT The percentage of mother-child pairs living in slums ranged from 0.5% in Egypt to 63.7% in Congo. Meta-analysis of proportions for the pooled sample revealed that 31.2% [27.1, 35.5] of slum residents and 20.0% [15.3, 25.2] among non-slum residents had suboptimal access to EHS. We observed significant pro-slum inequalities in suboptimal access to EHS in 28 of the 52 LMICs with sufficient data. Of the 34 African countries included, 16 showed statistically significant pro-slum inequality in suboptimal access to EHS, with the highest in Egypt and Mali (2.64 [0.84-4.44] and 1.76 [1.65, 1.87] respectively). Findings from the decomposition analysis showed that, on average, household wealth, neighbourhood education level, access to media, and neighbourhood-level illiteracy contributed mostly to slum & non-slum inequality gaps in suboptimal access to EHS. CONCLUSION The study showed evidence of inequality in access to EHS due to neighbourhood effects in 26 LMICs. This evidence suggests that increased focus on the urban poor might be a important for increasing access to EHS and achieving the universal health coverage (UHC) goals.
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Affiliation(s)
- Seun Anjorin
- Division of Health Sciences, University of Warwick, Coventry, UK.
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Elvis Anyaehiechukwu Okolie
- Department of Public Health, David Umahi Federal University of Health Sciences, Uburu, P.M.B 211, Nigeria
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | | | - Mukhtar Ijaiya
- Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT, Nigeria
| | - Abimbola Ayorinde
- NIHR Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oyinlola Oyebode
- Centre for Public Health & Policy, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Olalekan Uthman
- Division of Health Sciences, University of Warwick, Coventry, UK
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Odii A, Arize I, Agwu P, Mbachu C, Onwujekwe O. To What Extent Are Informal Healthcare Providers in Slums Linked to the Formal Health System in Providing Services in Sub-Sahara Africa? A 12-Year Scoping Review. J Urban Health 2024:10.1007/s11524-024-00885-5. [PMID: 38874863 DOI: 10.1007/s11524-024-00885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
The contributions of informal providers to the urban health system and their linkage to the formal health system require more evidence. This paper highlights the collaborations that exist between informal providers and the formal health system and examines how these collaborations have contributed to strengthening urban health systems in sub-Sahara Africa. The study is based on a scoping review of literature that was published from 2011 to 2023 with a focus on slums in sub-Sahara Africa. Electronic search for articles was performed in Google, Google Scholar, PubMed, African Journal Online (AJOL), Directory of Open Access Journals (DOAJ), ScienceDirect, Web of Science, Hinari, ResearchGate, and yippy.com. Data extraction was done using the WHO health systems building blocks. The review identified 26 publications that referred to collaborations between informal providers and formal health systems in healthcare delivery. The collaboration is manifested through formal health providers registering and standardizing the practice of informal health providers. They also participate in training informal providers and providing free medical commodities for them. Additionally, there were numerous instances of client referrals, either from informal to formal providers or from formal to informal providers. However, the review also indicates that these collaborations are unformalized, unsystematic, and largely undocumented. This undermines the potential contributions of informal providers to the urban health system.
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Affiliation(s)
- Aloysius Odii
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Sociology/Anthropology Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Ifeyinwa Arize
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Social Work Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
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Balakrishnan AK, Otieno S, Dzombo M, Plaxico L, Ukoh E, Obara LM, Brown H, Musyimi C, Lincoln C, Yang LS, Witte SS, Winter SC. Socio-ecological impacts of extreme weather events in two informal settlements in Nairobi, Kenya. Front Public Health 2024; 12:1389054. [PMID: 38887261 PMCID: PMC11180900 DOI: 10.3389/fpubh.2024.1389054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Climate change is expected to profoundly impact health and coping and widen social and environmental inequalities. People living in informal settlements are especially vulnerable to climate change as they are often located in ecologically sensitive areas more susceptible to extreme weather events (EWEs), such as floods, droughts, and heat waves. Women residing in informal settlements are especially vulnerable to climate change and related EWEs because they are more likely to experience worse health-related impacts than men but are less likely to have access to health-related services. Despite this inequality, there is a dearth of research that focuses on the impacts of EWEs on women in informal settlements. This study aims to explore the multidimensional impacts of EWEs on the daily lives of women in informal settlements through the lens of socio-ecological theory. Study data is from six monthly surveys (1 September 2022-28 February 2023) collected from a probability sample of 800 women living in two of the largest informal settlements in Nairobi, Kenya. This data is part of an ongoing longitudinal study that uses community participatory methods to investigate the effects of climate change on health and wellbeing in informal settlements by a team of 16 community health volunteers who lead data collection and provide expertise in ongoing analysis. Findings show profound impacts on women's health and wellbeing across individual, micro-, meso-, exo-, and macrosystems. These include physical and mental health, financial disruptions, property issues, social impacts, and impacts on their surrounding physical environment, such as disrupted food or water access, poor air quality, drainage issues, and safety concerns. In addition, findings highlight the critical importance of the chrono- and biosphere systems in research focused on the impacts of climate change and related EWEs among climate-vulnerable communities and marginalized populations within them.
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Affiliation(s)
| | | | | | - LaNae Plaxico
- School of Social Work, Columbia University, New York, NY, United States
| | - Ebuka Ukoh
- School of Social Work, Columbia University, New York, NY, United States
| | - Lena Moraa Obara
- Rutgers, School of Social Work, The State University of New Jersey, New Brunswick, NJ, United States
| | - Haley Brown
- School of Social Work, Columbia University, New York, NY, United States
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Chloe Lincoln
- School of Social Work, Columbia University, New York, NY, United States
| | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY, United States
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Armand A, Augsburg B, Bancalari A, Kameshwara KK. Religious proximity and misinformation: Experimental evidence from a mobile phone-based campaign in India. JOURNAL OF HEALTH ECONOMICS 2024; 96:102883. [PMID: 38805882 DOI: 10.1016/j.jhealeco.2024.102883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
We investigate how religion concordance influences the effectiveness of preventive health campaigns. Conducted during the early stages of the COVID-19 pandemic in two major Indian cities marked by Hindu-Muslim tensions, we randomly assigned a representative sample of slum residents to receive either a physician-delivered information campaign promoting health-related preventive practices, or uninformative control messages on their mobile phones. Messages, introduced by a local citizen (the sender), were cross-randomized to start with a greeting signaling either a Hindu or a Muslim identity, manipulating religion concordance between sender and receiver. We found that doctor messages increased compliance with recommended practices and beliefs in their efficacy. Our findings suggest that the campaign's impact is primarily driven by shared religion between sender and receiver, leading to increased message engagement and compliance with recommended practices. Additionally, we observe that religion concordance helps protect against misinformation.
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Affiliation(s)
- Alex Armand
- Nova School of Business and Economics, Universidade Nova de Lisboa, NOVAFRICA and CEPR, Rua da Holanda 1, 2775-405 Carcavelos, Portugal.
| | - Britta Augsburg
- Institute for Fiscal Studies, 7 Ridgmount St, WC1E 7AE, London, United Kingdom.
| | - Antonella Bancalari
- Institute for Fiscal Studies and IZA, WC1E 7AE, 7 Ridgmount St, London, United Kingdom.
| | - Kalyan Kumar Kameshwara
- Westminster Business School, University of Westminster, 35 Marylebone Rd, NW1 5LS, London, United Kingdom.
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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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7
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Morrow AJ, Sykes R, Saleh M, Zahra B, MacIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, Macfarlane PW, Mayne KJ, Mark PB, McConnachie A, McGeoch R, Nordin S, Payne A, Rankin AJ, Robertson K, Ryan N, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, Touyz RM, Veldtman G, Weeden S, Weir R, Watkins S, Welsh P, Mangion K, Berry C. Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization. COMMUNICATIONS MEDICINE 2024; 4:32. [PMID: 38418616 PMCID: PMC10901805 DOI: 10.1038/s43856-024-00455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. METHODS A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. RESULTS Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. CONCLUSIONS In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
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Affiliation(s)
- Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Baryab Zahra
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kaitlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Robertson
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robin Weir
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
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Logie CH, Okumu M, Admassu Z, MacKenzie F, Tailor L, Kortenaar JL, Perez-Brumer A, Ahmed R, Batte S, Hakiza R, Kibuuka Musoke D, Katisi B, Nakitende A, Juster RP, Marin MF, Kyambadde P. Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings. J Migr Health 2024; 9:100215. [PMID: 38375158 PMCID: PMC10875238 DOI: 10.1016/j.jmh.2024.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
- School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lauren Tailor
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy- OGERA Uganda, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Robert-Paul Juster
- Department of Psychiatry & Addiction, University of Montreal, Montreal, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Peter Kyambadde
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
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Shon H. Urbanicity and child health in 26 sub-Saharan African countries: Settlement type and its association with mortality and morbidity. Soc Sci Med 2024; 340:116401. [PMID: 38035488 DOI: 10.1016/j.socscimed.2023.116401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
Urbanization and changing settlement patterns have affected health environments in African countries. A profound understanding of the intricate association between urbanicity and health is imperative for formulating effective interventions. This study aims to classify settlement types based on urbanicity and assess their effects on child health in 26 African countries, utilizing data from the Demographic and Health Survey and the Global Human Settlements Layer. The advanced settlement classification incorporates a multidimensional urbanicity scale and globally standardized urban extents, along with identifying urban slums. This approach derives six distinct settlement types: urban center, urban cluster, deprived urban settlement, rural town, rural cluster, and rural village. A multilevel logistic regression model examines the relationship between settlement types and health outcomes, encompassing mortality, fever, anemia, diarrhea, and cough in children under five. The analysis reveals that children living in rural villages and deprived urban settlements face a high burden of adverse health conditions. However, the size and direction of urbanicity's effects vary depending on the specific outcome. These findings highlight the significance of tailored interventions acknowledging health environments within each settlement to promote health equity.
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Affiliation(s)
- Huijoo Shon
- Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University, Seoul, Republic of Korea.
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Karuga R, Kabaria C, Chumo I, Okoth L, Njoroge I, Otiso L, Muturi N, Karki J, Dean L, Tolhurst R, Steege R, Ozano K, Theobald S, Mberu B. Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches. Front Public Health 2023; 11:1175326. [PMID: 38074741 PMCID: PMC10701261 DOI: 10.3389/fpubh.2023.1175326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Caroline Kabaria
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ivy Chumo
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Linet Okoth
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Inviolata Njoroge
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Nelly Muturi
- Airbel Impact Lab, International Rescue Committee, Nairobi, Kenya
| | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rosie Steege
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kim Ozano
- The SCL Agency, Wales, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
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11
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Winter SC, Johnson L, Dzombo MN. Sanitation-related violence against women in informal settlements in Kenya: a quantitative analysis. Front Public Health 2023; 11:1191101. [PMID: 37841717 PMCID: PMC10574432 DOI: 10.3389/fpubh.2023.1191101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Approximately 3.6 billion people around the world do not have access to safe sanitation options. Those lacking access are not only at risk of diarrheal disease, other tropical diseases, and parasitic infections, they are at greater risk of experiencing violence, particularly women and girls. The burden of lack of access to safe sanitation is disproportionately experienced by women in informal settlements in lower- and middle-income countries, where violence rates tend to be higher and access to sanitation lower. Women lacking access to safe toilets often have to walk long distances to access a facility or open site or use shared toilet facilities, which increase their vulnerability to violence. Methods We explore the prevalence and multilevel factors associated with women's experiences, observations, and exposure to stories about past-year sanitation-related violence in a probability sample of 550 women in a large informal settlement in Nairobi, Kenya using chi-square tests and multivariate logistic regressions. Results Findings suggest that social/community engagement and social/cultural beliefs are important considerations for hearing about and observing sanitation-related violence, but less so experiences of sanitation-related violence. Alternatively, individual-level and technological factors may be critical factors in actual experiences of violence. Discussion Sanitation-related violence and creating an environment of safety in which women can take care of their sanitation-related needs in ways that also protect them, their families, and their communities is critical for meeting sanitation-related development agendas and goals such as Sustainable Development Goal 6.2 to achieve access to adequate and equitable sanitation and hygiene for all by 2030.
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Affiliation(s)
| | - Laura Johnson
- School of Social Work, Temple University, Philadelphia, PA, United States
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12
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Osuh ME, Oke GA, Lilford RJ, Osuh JI, Lawal FB, Gbadebo SO, Owoaje E, Omigbodun A, Adedokun B, Chen YF, Harris B. Oral health in an urban slum, Nigeria: residents' perceptions, practices and care-seeking experiences. BMC Oral Health 2023; 23:657. [PMID: 37689626 PMCID: PMC10492367 DOI: 10.1186/s12903-023-03303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/11/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND/INTRODUCTION One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. OBJECTIVES This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria. METHOD Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis. RESULTS Six FGD sessions, divided by gender and age, were conducted between September-October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes. CONCLUSION The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self-care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities.
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Affiliation(s)
- Mary E Osuh
- Division of Health Sciences, Warwick, Medical School, University of Warwick, Coventry, UK.
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria.
| | - Gbemisola A Oke
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria
| | - Richard J Lilford
- Division of Health Sciences, Warwick, Medical School, University of Warwick, Coventry, UK
- College of Medical and Dental Sciences, Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Jackson I Osuh
- Department of Psychology, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria
| | - Folake B Lawal
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria
| | - Shakeerah O Gbadebo
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria
- Department of Restorative Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Akinyinka Omigbodun
- University College Hospital (UCH), Ibadan, Oyo State, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Yen-Fu Chen
- Division of Health Sciences, Warwick, Medical School, University of Warwick, Coventry, UK
| | - Bronwyn Harris
- Division of Health Sciences, Warwick, Medical School, University of Warwick, Coventry, UK
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13
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Hughes RC, Muendo R, Bhopal SS, Onyango S, Kimani-Murage E, Kirkwood BR, Hill Z, Kitsao-Wekulo P. Parental experiences of the impacts of Covid-19 on the care of young children; qualitative interview findings from the Nairobi Early Childcare in Slums (NECS) project. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001127. [PMID: 37647351 PMCID: PMC10468034 DOI: 10.1371/journal.pgph.0001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The Covid-19 pandemic, and societal attempts to control it, have touched almost every aspect of people's lives around the world, albeit in unequal ways. In particular, there is considerable concern about the way that stringent 'lockdowns', as implemented in Kenya and many other countries, affected young children, especially those living in informal settlements. However, to date, there has been little research attempting to unpack and understand how the pandemic has impacted on the care of young children. METHODS In-depth telephone interviews were conducted with 21 parents/carers of children aged under five years living in three Nairobi slums between May and September 2021 exploring the ways in which Covid-19, and policies to control the pandemic, impacted on their household and the care of their child/children. RESULTS The impacts of Covid-19 control measures on the care of children have been widely felt, deep and multiple. The impact of economic hardship has been significant, reportedly undermining food security and access to services including healthcare and childcare. Respondents reported an associated increase in domestic and community violence. Many people relied on help from others; this was most commonly reported to be in the form of variable levels of flexibility from landlords and help from other community members. No direct harms from Covid-19 disease were reported by respondents. CONCLUSION The impacts of Covid-19 control measures on the care of young children in informal settlements have been indirect but dramatic. Given the breadth and depth of these reported impacts, and the particular vulnerability of young children, deeper consideration ought to inform decisions about approaches to implementation of stringent disease control measures in future. In addition, these findings imply a need for both short- and long-term policy responses to ameliorate the impacts described.
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Affiliation(s)
- Robert C. Hughes
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ruth Muendo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil S. Bhopal
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Silas Onyango
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Elizabeth Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty R. Kirkwood
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
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Okumu M, Logie CH, Chitwanga AS, Hakiza R, Kyambadde P. A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda: a community-based cross-sectional study. Confl Health 2023; 17:38. [PMID: 37599369 PMCID: PMC10440931 DOI: 10.1186/s13031-023-00531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Adverse socio-cultural factors compromise the implementation of HIV prevention strategies among displaced youth. While condoms are an affordable and effective HIV prevention strategy for youth, stigma and inequitable gender norms may constrain condom self-efficacy (i.e., knowledge, intentions, and relationship dynamics that facilitate condom negotiation) and use. Further, knowledge of contextually appropriate HIV prevention approaches are constrained by limited understanding of the socio-cultural conditions that affect condom self-efficacy and use among displaced youth. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among displaced youth living in urban slums in Kampala, Uganda. METHODS We conducted a community-based cross-sectional survey of displaced youth aged 16-24 years living in five slums in Kampala. We used multivariable logistic regression and multivariate linear regression to assess independent and two-way interactions among adverse socio-cultural factors (adolescent sexual and reproductive health-related stigma [A-SRH stigma], perceived HIV-related stigma, and beliefs in harmful inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural factors; conducted regression analyses to create unique profiles of adverse socio-cultural factors; and then assessed joint effects of adverse socio-cultural factors on condom self-efficacy and practices. RESULTS Among participants (mean age: 19.59 years; SD: 2.59; women: n = 333, men: n = 112), 62.5% were sexually active. Of these, only 53.3% reported recent consistent condom use. Overall, 42.73% of participants reported two co-occurring adverse socio-cultural factors, and 16.63% reported three co-occurring exposures. We found a joint effect of beliefs in harmful inequitable gender norms with high A-SRH stigma (β = - 0.20; p < 0.05) and high A-SRH stigma with high perceived HIV stigma (β = - 0.31; p < 0.001) on reduced condom self-efficacy. We found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR = 0.52; 95% CI 0.28, 0.96) on recent consistent condom use. Additionally, we found that condom self-efficacy (aOR = 1.01; 95% CI 1.05, 1.16) and safer sexual communication (aOR = 2.12; 95% CI 1.54, 2.91) acted as protective factors on inconsistent condom use. CONCLUSIONS Displaced youth living in urban slums exhibited low consistent condom use. Intersecting stigmas were associated with lower condom self-efficacy-a protective factor linked with increased consistent condom use. Findings highlight the importance of gender transformative and intersectional stigma reduction approaches to increase sexual agency and safer sex practices among Kampala's slum-dwelling displaced youth.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA.
- School of Social Sciences, Uganda Christian University, Mukono, Uganda.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
- United Nations University Institute for Water, Environment, and Health (UNU-INWEH), 204-175 Longwood Rd S, Hamilton, ON, L8P 0A1, Canada
| | - Anissa S Chitwanga
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | - Peter Kyambadde
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most at Risk Population Initiative, Mulago Hospital, Kampala, Uganda
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15
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Oduro JK, Oduro MA, Ameyaw EK. Social Determinants of Health and Happiness of Older Adults in Ghana: Secondary Analysis of Ghana SAGE Wave 2 Longitudinal Data. RESEARCH SQUARE 2023:rs.3.rs-3224059. [PMID: 37609136 PMCID: PMC10441449 DOI: 10.21203/rs.3.rs-3224059/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Social determinants of health [SDOH] and happiness have received meaningful consideration as foundational concepts in the field of public health. However, the relationship between the SDOH and happiness of older adults have not received the requisite recognition in Ghana. This study examined the relationship between the SDOH and happiness of older adults in Ghana. Methods The study used data from the 2014/2015 Ghana Study on Global Ageing and Adult Health (SAGE) Wave 2. Data was analysed using the Structural Equation Modeling (SEM) technique to investigate the direct, indirect and covariances of the SDOH and happiness of older adults. Results The results showed positive relationship between the SDOH and happiness among older adults. The economic stability (β = 0.07), neighbourhood and built environment (β = 0.02, P < 0.001), access to quality education (β = 0.56, P < 0.01), access to healthy food (β = 0.48, P < 0.001) social and community context (β = 0.41, P < 0.05), and access to quality healthcare (β = 0.80, P < 0.001) had direct relationship with happiness of the older adults in Ghana. Conclusion This study shows that the conditions in which older adults were born, live, learn, work, play, worship, and age (SDOH) positively impact their happiness in later life. Neighbourhood and physical environment influence the effect of quality education on happiness of older adults. Social policies and interventions aiming at happiness of older adults should consider the social determinants of health and the mediating effects of food on happiness through quality education, and quality of healthcare system.
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Affiliation(s)
| | | | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
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16
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Cai YS, Mustapha A. Editorial: Environmental health in informal settlements: current progress, challenges and perspectives. Front Public Health 2023; 11:1200422. [PMID: 37601222 PMCID: PMC10434244 DOI: 10.3389/fpubh.2023.1200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Yutong Samuel Cai
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, United Kingdom
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Dev S, Duval J, Galivanche A, Shitole T, Sawant K, Shitole S, Patil-Deshmukh A, Lincoln A, Subbaraman R, Weinstein L. Spatializing stigma-power: Mental health impacts of spatial stigma in a legally-excluded settlement in Mumbai, India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001026. [PMID: 37471352 PMCID: PMC10358916 DOI: 10.1371/journal.pgph.0001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/08/2023] [Indexed: 07/22/2023]
Abstract
In disadvantaged neighborhoods such as informal settlements (or "slums" in the Indian context), infrastructural deficits and social conditions have been associated with residents' poor mental health. Within social determinants of health framework, spatial stigma, or negative portrayal and stereotyping of particular neighborhoods, has been identified as a contributor to health deficits, but remains under-examined in public health research and may adversely impact the mental health of slum residents through pathways including disinvestment in infrastructure, internalization, weakened community relations, and discrimination. Based on analyses of individual interviews (n = 40) and focus groups (n = 6) in Kaula Bandar (KB), an informal settlement in Mumbai with a previously described high rate of probable common mental disorders (CMD), this study investigates the association between spatial stigma and mental health. The findings suggest that KB's high rate of CMDs stems, in part, from residents' internalization of spatial stigma, which negatively impacts their self-perceptions and community relations. Employing the concept of stigma-power, this study also reveals that spatial stigma in KB is produced through willful government neglect and disinvestment, including the denial of basic services (e.g., water and sanitation infrastructure, solid waste removal). These findings expand the scope of stigma-power from an individual-level to a community-level process by revealing its enactment through the actions (and inactions) of bureaucratic agencies. This study provides empirical evidence for the mental health impacts of spatial stigma and contributes to understanding a key symbolic pathway by which living in a disadvantaged neighborhood may adversely affect health.
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Affiliation(s)
- Saloni Dev
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States of America
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Jasper Duval
- Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, United States of America
| | - Amith Galivanche
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Tejal Shitole
- PUKAR (Partners of Urban Knowledge, Action and Research), Mumbai, MH, India
| | - Kiran Sawant
- PUKAR (Partners of Urban Knowledge, Action and Research), Mumbai, MH, India
| | - Shrutika Shitole
- PUKAR (Partners of Urban Knowledge, Action and Research), Mumbai, MH, India
| | | | - Alisa Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, United States of America
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
- PUKAR (Partners of Urban Knowledge, Action and Research), Mumbai, MH, India
- Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
| | - Liza Weinstein
- Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, United States of America
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18
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Nejad FN, Ghamari MR, Kamal SHM, Tabatabaee SS. Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents. J Prev Med Public Health 2023; 56:327-337. [PMID: 37551071 PMCID: PMC10415645 DOI: 10.3961/jpmph.23.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran. METHODS Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority. RESULTS Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources. CONCLUSIONS Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.
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Affiliation(s)
- Farhad Nosrati Nejad
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Mohammad Reza Ghamari
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad,
Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad,
Iran
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Dickson-Gomez J, Nyabigambo A, Rudd A, Ssentongo J, Kiconco A, Mayega RW. Water, Sanitation, and Hygiene Challenges in Informal Settlements in Kampala, Uganda: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6181. [PMID: 37372767 DOI: 10.3390/ijerph20126181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Diarrhea causes 1.6 million deaths annually, including 525,000 children. Further, chronic diarrhea puts children at risk for mineral deficiencies, malnutrition, and stunting which, in turn, can result in cognitive deficits, poor performance in school, and decreased disease immunity in adulthood. Most diarrhea is caused by water contaminated by fecal matter. Interventions to improve clean water and sanitation can save lives; however, challenges persist in informal settlements. In this study, we explored the views of residents of informal settlements regarding water and sanitation in their communities. Focus group interviews were conducted with residents of 6 informal settlements in Kampala, Uganda (n = 165 people), and 6 key informant interviews were conducted with governmental and nongovernmental organizations that work to improve informal settlements or provide services to them. The results from this study demonstrate that, although these informal settlements had many infrastructure "upgrades" such as latrines and toilets, water taps, wells, and garbage collection and drainage systems, the water, sanitation, and hygiene (WASH) system and its components largely failed due to point-of-use charges of water taps and toilets and the difficulty of emptying cesspits. Our results suggest that WASH must be considered a system and that multiple upgrading efforts are needed for WASH systems to work, including road construction and better oversight of fecal sludge disposal.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Abigail Rudd
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Arthur Kiconco
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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20
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Hone T, Been JV, Saraceni V, Coeli CM, Trajman A, Rasella D, Durovni B, Millett C. Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100519. [PMID: 37274550 PMCID: PMC10238835 DOI: 10.1016/j.lana.2023.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
Background Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality. Methods A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms. Results A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth. Interpretation Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits. Funding DFID/MRC/Wellcome Trust/ESRC.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jasper V. Been
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Department of Obstetrics and Gynaecology, and Department of Public Health, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Valeria Saraceni
- Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Anete Trajman
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic— Universitat de Barcelona, Barcelona, Spain
| | - Betina Durovni
- Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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21
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Onuegbu C, Harlock J, Griffiths F. Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria: a cross-sectional survey. BMJ Open 2023; 13:e065152. [PMID: 37192804 DOI: 10.1136/bmjopen-2022-065152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To describe the use, characteristics and influence of lay consultants on treatment-seeking decisions of adults in slums of Nigeria. DESIGN Cross-sectional survey using a pre-piloted questionnaire. SETTINGS Two slum communities in Ibadan city, Nigeria. PARTICIPANTS 480 adults within the working age group (18-64). RESULTS Most respondents (400/480, 83.7%) spoke to at least one lay consultant during their last illness/health concern. In total, 683 lay consultants were contacted; all from personal networks such as family and friends. No respondent listed online network members or platforms. About nine in 10 persons spoke to a lay consultant about an illness/health concern without intending to seek any particular support. However, almost all (680/683, 97%) lay consultants who were contacted provided some form of support. Marital status (OR=1.92, 95% CI: 1.10 to 3.33) and perceiving that an illness or health concern had some effects on their daily activities (OR=3.25, 95% CI: 1.94 to 5.46) had a significant independent association with speaking to at least one lay consultant. Age had a significant independent association with having lay consultation networks comprising non-family members only (OR=0.95, 95% CI: 0.92 to 0.99) or mixed networks (family and non-family members) (OR=0.97, 95% CI: 0.95 to 0.99), rather than family-only networks. Network characteristics influenced individual treatment decisions as participants who contacted networks comprising non-family members only (OR=0.23, 95% CI: 0.08 to 0.67) and dispersed networks (combination of household, neighbourhood and distant network members) (OR=2.04, 95% CI: 1.02 to 4.09) were significantly more likely to use informal than formal healthcare, while controlling for individual characteristics. CONCLUSIONS Health programmes in urban slums should consider engaging community members so, when consulted within their networks, they are able to deliver reliable information about health and treatment-seeking.
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Affiliation(s)
- Chinwe Onuegbu
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jenny Harlock
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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22
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Ghammari F, Jalilian H, Khodayari‐zarnaq R, Gholizadeh M. Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis. Health Sci Rep 2023; 6:e1231. [PMID: 37123550 PMCID: PMC10140644 DOI: 10.1002/hsr2.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023] Open
Abstract
Background and Aims The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers. Methods A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis. Results A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors. Conclusion Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.
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Affiliation(s)
- Fawzieh Ghammari
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Rahim Khodayari‐zarnaq
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Masumeh Gholizadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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23
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Fleming GM, ElQadi MM, Taruc RR, Tela A, Duffy GA, Ramsay EE, Faber PA, Chown SL. Classification and ecological relevance of soundscapes in urban informal settlements. PEOPLE AND NATURE 2023. [DOI: 10.1002/pan3.10454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
- Genie M. Fleming
- School of Biological Sciences Monash University Melbourne Victoria Australia
| | | | - Ruzka R. Taruc
- Public Health Faculty Hasanuddin University Makassar Indonesia
| | - Autiko Tela
- School of Public Health and Primary Care Fiji National University, College of Medicine, Nursing and Health Sciences Suva Fiji
| | - Grant A. Duffy
- School of Biological Sciences Monash University Melbourne Victoria Australia
| | - Emma E. Ramsay
- School of Biological Sciences Monash University Melbourne Victoria Australia
| | - Peter A. Faber
- School of Biological Sciences Monash University Melbourne Victoria Australia
| | - Steven L. Chown
- School of Biological Sciences Monash University Melbourne Victoria Australia
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24
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Chumo I, Kabaria C, Shankland A, Igonya E, Mberu B. Complementarity of formal and informal actors and their networks in support of vulnerable populations in informal settlements: Governance diaries approach. Front Public Health 2023; 10:1043602. [PMID: 36777785 PMCID: PMC9911518 DOI: 10.3389/fpubh.2022.1043602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Beyond several interests and speculations on the relationship between formal and informal actors and their networks in support of vulnerable populations, most studies do not conclusively establish whether the two types of support are substitutes or complements. While informal care and formal care may be substitutes in general, they are complements among the vulnerable groups. Despite how some studies have described complementarity, further insights on the synergy between formal and informal actors and networks are needed to pinpoint how to maximize policy and interventions to alleviate the challenges facing vulnerable groups in informal settlements. Methods We conducted an ethnography using governance diaries with 24 participants in Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved conducting bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used framework analysis approach. Findings Informal actors identified include family, neighbors, friends, community groups and community members, and their direct networks. Formal actors on the other hand included government institutions, individuals and authorities that make policies and rules and their desired and possible networks. Both the formal and informal actors and their networks had complementary roles that were beneficial to the vulnerable populations living and working in informal settlements. The complementarities between formal and informal actors and networks in supporting vulnerable groups were portrayed in roles and responsibilities to the vulnerable groups; rules, regulations and governance in supporting vulnerable groups; knowledge, skills and dynamic workforces among formal and informal actors and their networks; information flow on health and wellbeing to the vulnerable populations; transition of actors in supporting vulnerable groups; availability, access and involvement of formal and informal actors and networks to support vulnerable groups. The complementarities allowed for maximum support of the vulnerable populations than otherwise. Conclusion We conclude that informal social support is needed regardless of the availability of formal social support. Moreover, a combination of formal and informal actors and related networks are essential to support vulnerable persons. Formal actors should establish, support, or maintain the informal actors and related networks through goodwill and sundry incentives as a vital dimension of building with local community structures and enhancing inclusion, participation and ownership of policy and program interventions by marginalized and vulnerable groups.
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Affiliation(s)
- Ivy Chumo
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Caroline Kabaria
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Alex Shankland
- Institute of Development Studies (IDS), Brighton, United Kingdom
| | - Emmy Igonya
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center (APHRC), Nairobi, Kenya
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25
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Ramsay EE, Duffy GA, Burge K, Taruc RR, Fleming GM, Faber PA, Chown SL. Spatio-temporal development of the urban heat island in a socioeconomically diverse tropical city. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120443. [PMID: 36265725 DOI: 10.1016/j.envpol.2022.120443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Urban heat islands, where temperatures are elevated relative to non-urban surrounds, are near-ubiquitous in cities globally. Yet, the magnitude and form of urban heat islands in the tropics, where heat has a large morbidity and mortality burden, is not well understood, especially for those of urban informal settlements. We used 29 years of Landsat satellite-derived surface temperature, corroborated by in situ temperature measurements, to provide a detailed spatial and temporal assessment of urban heat islands in Makassar, Indonesia, a city that is representative of rapidly growing urban settlements across the tropics. Our analysis identified surface urban heat islands of up to 9.2 °C in long-urbanised parts of the city and 6.3 °C in informal settlements, the seasonal patterns of which were driven by change in non-urban areas rather than in urban areas themselves. In recently urbanised areas, the majority of urban heat island increase occurred before land became 50% urbanised, whereas the established heat island in long-urbanised areas remained stable in response to urban expansion. Green and blue space protected some informal settlements from the worst urban heat islands observed across the city and maintenance of such space will be essential to mitigate the growing heat burden from urban expansion and anthropogenic climate change. Settlements further than 4 km from the coast and with Normalised Difference Vegetation Index (NDVI) less than 0.2 had higher surface temperatures, with modelled effects of more than 5 °C. Surface temperature measurements were representative of in situ heat exposure, measured in a subset of 12 informal settlements, where mean indoor temperature had the strongest relationship with surface temperature (R2 = 0.413, P = 0.001). We advocate for green space to be prioritised in urban planning, redevelopment and informal settlement upgrading programs, with consideration of the unique environmental and socioeconomic context of tropical cities.
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Affiliation(s)
- Emma E Ramsay
- School of Biological Sciences, Monash University, Victoria, 3800, Australia.
| | - Grant A Duffy
- School of Biological Sciences, Monash University, Victoria, 3800, Australia; Department of Marine Science, University of Otago, Dunedin, New Zealand
| | - Kerrie Burge
- Monash Sustainable Development Institute, Monash University, Victoria, 3800, Australia
| | - Ruzka R Taruc
- RISE Program, Faculty of Public Health, Makassar, Hasanuddin University, Makassar, Indonesia
| | - Genie M Fleming
- School of Biological Sciences, Monash University, Victoria, 3800, Australia
| | - Peter A Faber
- School of Biological Sciences, Monash University, Victoria, 3800, Australia
| | - Steven L Chown
- School of Biological Sciences, Monash University, Victoria, 3800, Australia
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26
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Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MPD, Pires-Dias PRT, Marques-Portela C, Figueira I, Mendlowicz MV. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med 2023; 53:132-139. [PMID: 33849680 DOI: 10.1017/s0033291721001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
| | - Maria Luiza Garcia-Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
| | - Marcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires de Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Carla Marques-Portela
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
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27
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The prevalence and socio-demographic associations of household food insecurity in seven slum sites across Nigeria, Kenya, Pakistan, and Bangladesh. A cross-sectional study. PLoS One 2022; 17:e0278855. [PMID: 36584156 PMCID: PMC9803099 DOI: 10.1371/journal.pone.0278855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/24/2022] [Indexed: 12/31/2022] Open
Abstract
Although the proportion of people living in slums is increasing in low- and middle-income countries and food insecurity is considered a severe hazard for health, there is little research on this topic. This study investigated and compared the prevalence and socio-demographic associations of household food insecurity in seven slum settings across Nigeria, Kenya, Pakistan, and Bangladesh. Data were taken from a cross-sectional, household-based, spatially referenced survey conducted between December 2018 and June 2020. Household characteristics and the extent and distribution of food insecurity across sites was established using descriptive statistics. Multivariable logistic regression of data in a pooled model including all slums (adjusting for slum site) and site-specific analyses were conducted. In total, a sample of 6,111 households were included. Forty-one per cent (2,671) of all households reported food insecurity, with varying levels between the different slums (9-69%). Household head working status and national wealth quintiles were consistently found to be associated with household food security in the pooled analysis (OR: 0·82; CI: 0·69-0·98 & OR: 0·65; CI: 0·57-0·75) and in the individual sites. Households which owned agricultural land (OR: 0·80; CI: 0·69-0·94) were less likely to report food insecurity. The association of the household head's migration status with food insecurity varied considerably between sites. We found a high prevalence of household food insecurity which varied across slum sites and household characteristics. Food security in slum settings needs context-specific interventions and further causal clarification.
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28
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Mumin FI, Wesonga FD, Handuleh JIM, White RG, Mor SM. COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: impact on livelihood, food security and mental health. BMC Public Health 2022; 22:2414. [PMID: 36550473 PMCID: PMC9779940 DOI: 10.1186/s12889-022-14878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Somalia has over 2.6 million internally displaced people (IDP) that depend on daily wages and humanitarian assistance for their livelihoods. This study investigated the impact of COVID-19 on livelihoods, food security and mental health of Somalia's IDPs. METHODS A questionnaire was conducted with "breadwinners" (n = 585) residing in 15 randomly selected IDP camps. Mental health was assessed using the 5-item World Health Organization Wellbeing Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect of depressive symptoms on soap use and ability to pay for food/medicine/rent. RESULTS Knowledge of COVID-19 symptoms, transmission and prevention was relatively high, however only 55% reported using soap for hand washing. Around one third perceived that prohibition of public gatherings had negatively impacted weekly earnings. Participants reported difficulty buying food (85%), medicine (82%) and paying rent (51%) because of COVID-19. The majority were assessed as having low wellbeing and high depressive symptoms (mean WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they felt worse than before the pandemic. Compared to people with low depressive symptoms, people with high depressive symptoms were less likely to use soap (aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02). CONCLUSION COVID-19 and associated restrictions have negatively impacted Somalia's internally displaced population. Livelihood and mental health support is urgently needed in the recovery phase of the pandemic and should be factored into future pandemic planning.
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Affiliation(s)
- Farah I Mumin
- Faculty of Veterinary Medicine, Red Sea University, Bosaso, Somalia.
| | - Fred D Wesonga
- IGAD Sheikh Technical Veterinary School, Sheikh , Somaliland
| | - Jibril I M Handuleh
- Department of Psychiatry, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- School of Public Health, Amoud University, Borama, Somaliland
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Siobhan M Mor
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- International Livestock Research Institute, Addis Ababa, Ethiopia
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29
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Leung T, Okumu M, Kortenaar JL, Gittings L, Khan N, Hakiza R, Kibuuka Musoke D, Nakitende A, Katisi B, Kyambadde P, Khan T, Lester R, Mbuagbaw L. Mobile Health-Supported Virtual Reality and Group Problem Management Plus: Protocol for a Cluster Randomized Trial Among Urban Refugee and Displaced Youth in Kampala, Uganda (Tushirikiane4MH, Supporting Each Other for Mental Health). JMIR Res Protoc 2022; 11:e42342. [PMID: 36480274 PMCID: PMC9782374 DOI: 10.2196/42342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although mental health challenges disproportionately affect people in humanitarian contexts, most refugee youth do not receive the mental health support needed. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and to reduce mental health stigma among urban refugee adolescents and youth in low- and middle-income countries (LMICs). Virtual reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet such interventions have not yet been tested in LMICs where most forcibly displaced people reside. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for people experiencing a range of adversities, but has not been tested with adolescents and youth to date. Further, mobile health (mHealth) strategies have demonstrated promise in promoting mental health literacy. OBJECTIVE The aim of this study is to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (VR alone and VR combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda. METHODS A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 design. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately 16 weeks. Data will be collected at three time points: baseline enrollment, 8 weeks following enrollment, and 16 weeks after enrollment. Primary (depression) and secondary outcomes (mental health literacy, attitudes toward mental help-seeking, adaptive coping, mental health stigma, mental well-being, level of functioning) will be evaluated. RESULTS The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (#40965; May 12, 2021), Mildmay Uganda Research Ethics Committee (MUREC-2021-41; June 24, 2021), and Uganda National Council for Science & Technology (SS1021ES; January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semistructured key informant interviews to understand contextual factors influencing mental well-being among urban refugee and displaced youth. Qualitative findings will inform the VR intervention, SMS text check-in messages, and the adaptation of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022 and the final follow-up survey will be conducted in November 2022. CONCLUSIONS This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed publications, conference presentations, and with community dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT05187689; https://clinicaltrials.gov/ct2/show/NCT05187689. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42342.
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Affiliation(s)
| | - Moses Okumu
- School of Social Work, University of Illinois, Urban-Champaign, IL, United States.,School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lesley Gittings
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada.,Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Naimul Khan
- Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | | | | | - Brenda Katisi
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS and STI Control Programme, Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative, Mulago Hospital, Kampala, Uganda
| | - Torsum Khan
- Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Richard Lester
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.,Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Winter SC, Obara LM, Aguilar NJ, Johnson L. Breaking the Cycle: Women's Perceptions of the Causes of Violence and Crime in Informal Settlements in Nairobi, Kenya, and Their Strategies for Response and Prevention. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP17394-NP17428. [PMID: 34210192 DOI: 10.1177/08862605211028013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Crime and violence are serious issues in informal settlements around the world. To date, there is a dearth of evidence about the causes of and effective strategies for reducing and preventing violence and crime in informal settlements in cities in the Global South. Additionally, women's voices are often absent from research focused on violence and crime prevention and reduction in informal settlements. The purpose of this study, therefore, was (1) to identify potential causes of violence and crime in informal settlements, as perceived by women living in Mathare informal settlement in Nairobi, Kenya and (2) to highlight residents' strategies for response and prevention. Fifty-five in-depth and walk-along interviews were conducted with women living in Mathare in 2015-2016. A modified grounded theory approach was used to guide data collection and analysis. The most common contributor to violence and crime identified by women in Mathare was idle youth, but leadership and government challenges, corruption and/or inadequacy of police, community barriers, tribalism, and lack of protective infrastructure also emerged as contributing factors. Despite facing many economic, environmental, and day-to-day challenges, women in Mathare identified violence and crime as predominant issues; thus, developing effective response and prevention strategies to these issues is paramount. Women discussed many strategies and initiatives to reduce and prevent violence and crime in informal settlements, but also identified barriers to implementing them. Findings suggest there is a need for trust-building between formal and informal sectors of the community, systems of accountability, and long-term investment to foster sustainable and effective violence and crime response and prevention in these settlements.
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Affiliation(s)
| | - Lena Moraa Obara
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Belt RV, Rahimi K, Cai S. Researching the hard-to-reach: a scoping review protocol of digital health research in hidden, marginal and excluded populations. BMJ Open 2022; 12:e061361. [PMID: 36171043 PMCID: PMC9528575 DOI: 10.1136/bmjopen-2022-061361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a significant growth in the use of digital technology and methods in health-related research, further driven by the COVID-19 pandemic. This has offered a potential to apply digital health research in hidden, marginalised and excluded populations who are traditionally not easily reached due to economic, societal and legal barriers. To better inform future digital health studies of these vulnerable populations, we proposed a scoping review to comprehensively map published evidence and guidelines on the applications and challenges of digital health research methods to hard-to-reach communities. METHODS AND ANALYSIS This review will follow the Arksey and O' Malley methodological framework for scoping reviews. The framework for the review will employ updated methods developed by the Joanna Briggs Institute including the Preferred Reporting Items for Systematic reviews and Meta-Analysis Scoping Review checklist. PubMed, the Cochrane Library, PsycINFO, Google Scholar and Greenfile are the identified databases for peer-reviewed quantitative and qualitative studies in-scope of the review. Grey literature focused on guidance and best practice in digital health research, and hard-to-reach populations will also be searched following published protocols. The review will focus on literature published between 1 February 2012 and 1 February 2022. Two reviewers are engaged in the review. After screening the title and abstract to determine the eligibility of each article, a thorough full-text review of eligible articles will be conducted using a data extraction framework. Key extracted information will be mapped in tabular and visualised summaries to categorise the breadth of literature and identify key digital methods, including their limitations and potential, for use in hard-to-reach populations. ETHICS AND DISSEMINATION This scoping review does not require ethical approval. The results of the scoping review will consist of peer-reviewed publications, presentations and knowledge mobilisation activities including a lay summary posted via social media channels and production of a policy brief.
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Affiliation(s)
- Rachel Victoria Belt
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Kazem Rahimi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Samuel Cai
- Centre for Environmental Health and Sustainability, Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
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Balogun FM, Bamgboye EA, Akindolire AE. Improving timeliness and completion of infant vaccination among infants in Nigerian urban slums through older women's participation. Front Public Health 2022; 10:898636. [PMID: 36159258 PMCID: PMC9494024 DOI: 10.3389/fpubh.2022.898636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/03/2022] [Indexed: 01/22/2023] Open
Abstract
Nigerian urban slums have a high population of infants with suboptimal vaccination despite previous interventions. Older women traditionally play supervisory roles in infant care in Nigeria but their influence is untapped in infant vaccination. This study sought to determine if training of older women (≥35 years) in urban slum communities in Ibadan, South west Nigeria, and involving them in infant vaccination will improve infant vaccination timeliness and completion. This was a randomized experimental community study and pregnant women in their third trimester, residing in seven urban slum communities were randomized using their antenatal clinics (ANCs) into intervention (six ANCs) and control groups (six ANCs). The older women who will supervise the care of the infants of pregnant women in the intervention group had seven sessions of training on the importance of infant vaccination timeliness and completion. The vaccinations of the infants from both groups were compared from birth till 9 months. Data were analyzed using descriptive statistics and Chi square test at α = 0.05. There were 96 older women, 198 pregnant women (105 in intervention group and 93 controls) and 202 infants (109 in intervention group and 93 controls). Infants in the intervention group (67.9%) significantly had both timely and complete vaccinations compared with those in the control group (36.6%). Vaccines given at birth were the least timely in both groups. More infants whose older women caregiver were married had timely and complete vaccinations. Also, a higher proportion of male infants, low birth weight babies and infants with older women caregiver with at most two children had timely and completed vaccinations but these were not statistically significant. Training of older women caregivers improved infant vaccination timeliness and completion in these urban slum communities. This model may improve infant vaccination in other similar urban slum settings.
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Affiliation(s)
- Folusho Mubowale Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria,Institute of Child Health, University College Hospital, Ibadan, Nigeria,*Correspondence: Folusho Mubowale Balogun
| | - Eniola Adetola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abimbola Ellen Akindolire
- Institute of Child Health, University College Hospital, Ibadan, Nigeria,Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Atangana E, Oberholster PJ. Assessment of water, sanitation, and hygiene target and theoretical modeling to determine sanitation success in sub-Saharan Africa. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 25:1-25. [PMID: 36090188 PMCID: PMC9440466 DOI: 10.1007/s10668-022-02620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Accessing the status of clean drinking water, sanitation, and hygiene remains a challenge in sub-Saharan Africa (SSA). The current article contributes to the progress made by the WASH initiatives in ten SSA countries in eliminating open defecation by 2030, using theoretical data from 2017 to 2019. The authors used regression trend estimation to observe that rural and urban population growth had a statistically significant detrimental influence on the elimination of open defecation by 2030. According to the predicted data model, by 2030-2035, the urban population of SSA would be 65, 25, and 10 million in all the three categories of income groups. An increase in the number of modern pit users (C1) shows no improvement at the annual rate of change. The unimproved toilets and open-pit latrines (C2 and C3) show a linear growth rate, which expanded over time. Population growth, higher unemployment, and teen pregnancies contribute to this increase. Under current conditions, the curve of modern pit latrine users will increase linearly. Nigeria has the most significant number of spread pit latrine users, which has decreased linearly from 25 to 20% since 2017. It was evident that the power-law trend in Nigeria would increase the usage of unimproved pit latrines and open-pit latrines. Ghana had the highest rate (50%) of open-pit latrine users, while the data show that this situation remained stable (2001-2017). In the Democratic Rep. Congo, annual rates increased linearly from 25 to 33% (2000-2017), while Burundi was one of the countries in the region with the lowest number of open-pit latrine users, although the annual rate has increased from 6.13 to 11.75% since 2017 to 2019. Supplementary Information The online version contains supplementary material available at 10.1007/s10668-022-02620-z.
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Affiliation(s)
- Ernestine Atangana
- Centre for Environmental Management, University of the Free State Bloemfontein, Bloemfontein, 9300 South Africa
| | - Paul J. Oberholster
- Centre for Environmental Management, University of the Free State Bloemfontein, Bloemfontein, 9300 South Africa
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34
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Escobar Carías MS, Johnston DW, Knott R, Sweeney R. Flood disasters and health among the urban poor. HEALTH ECONOMICS 2022; 31:2072-2089. [PMID: 35770835 PMCID: PMC9546021 DOI: 10.1002/hec.4566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/07/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Billions of people live in urban poverty, with many forced to reside in disaster-prone areas. Research suggests that such disasters harm child nutrition and increase adult morbidity. However, little is known about impacts on mental health, particularly of people living in slums. In this paper we estimate the effects of flood disasters on the mental and physical health of poor adults and children in urban Indonesia. Our data come from the Indonesia Family Life Survey and new surveys of informal settlement residents. We find that urban poor populations experience increases in acute morbidities and depressive symptoms following floods, that the negative mental health effects last longer, and that the urban wealthy show no health effects from flood exposure. Further analysis suggests that worse economic outcomes may be partly responsible. Overall, the results provide a more nuanced understanding of the morbidities experienced by populations most vulnerable to increased disaster occurrence.
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Affiliation(s)
| | - David W. Johnston
- Centre for Health EconomicsMonash UniversityCaulfield EastVictoriaAustralia
| | - Rachel Knott
- Centre for Health EconomicsMonash UniversityCaulfield EastVictoriaAustralia
| | - Rohan Sweeney
- Centre for Health EconomicsMonash UniversityCaulfield EastVictoriaAustralia
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35
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Fofana MO, Nery N, Aguilar Ticona JP, de Andrade Belitardo EMM, Victoriano R, Anjos RO, Portilho MM, de Santana MC, dos Santos LL, de Oliveira D, Cruz JS, Muenker MC, Khouri R, Wunder EA, Hitchings MDT, Johnson O, Reis MG, Ribeiro GS, Cummings DAT, Costa F, Ko AI. Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. PLoS Med 2022; 19:e1004093. [PMID: 36074784 PMCID: PMC9499230 DOI: 10.1371/journal.pmed.1004093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 09/22/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The structural environment of urban slums, including physical, demographic, and socioeconomic attributes, renders inhabitants more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Yet, little is known about the specific determinants that contribute to high transmission within these communities. We therefore aimed to investigate SARS-CoV-2 seroprevalence in an urban slum in Brazil. METHODS AND FINDINGS We performed a cross-sectional serosurvey of an established cohort of 2,041 urban slum residents from the city of Salvador, Brazil between November 2020 and February 2021, following the first Coronavirus Disease 2019 (COVID-19) pandemic wave in the country and during the onset of the second wave. The median age in this population was 29 years (interquartile range [IQR] 16 to 44); most participants reported their ethnicity as Black (51.5%) or Brown (41.7%), and 58.5% were female. The median size of participating households was 3 (IQR 2 to 4), with a median daily per capita income of 2.32 (IQR 0.33-5.15) US Dollars. The main outcome measure was presence of IgG against the SARS-CoV-2 spike protein. We implemented multilevel models with random intercepts for each household to estimate seroprevalence and associated risk factors, adjusting for the sensitivity and specificity of the assay, and the age and gender distribution of our study population. We identified high seroprevalence (47.9%, 95% confidence interval [CI] 44.2% to 52.1%), particularly among female residents (50.3% [95% CI 46.3% to 54.8%] versus 44.6% [95% CI 40.1% to 49.4%] among male residents, p < 0.01) and among children (54.4% [95% CI 49.6% to 59.3%] versus 45.4% [95% CI 41.5% to 49.7%] among adults, p < 0.01). Adults residing in households with children were more likely to be seropositive (48.6% [95% CI 44.8% to 52.3%] versus 40.7% [95% CI 37.2% to 44.3%], p < 0.01). Women who were unemployed and living below the poverty threshold (daily per capita household income <$1.25) were more likely to be seropositive compared to men with the same employment and income status (53.9% [95% CI 47.0% to 60.6%] versus 32.9% [95% CI 23.2% to 44.3%], p < 0.01). Participation in the study was voluntary, which may limit the generalizability of our findings. CONCLUSIONS Prior to the peak of the second wave of the COVID-19 pandemic, cumulative incidence as assessed by serology approached 50% in a Brazilian urban slum population. In contrast to observations from industrialized countries, SARS-CoV-2 incidence was highest among children, as well as women living in extreme poverty. These findings emphasize the need for targeted interventions that provide safe environments for children and mitigate the structural risks posed by crowding and poverty for the most vulnerable residents of urban slum communities.
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Affiliation(s)
- Mariam O. Fofana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Juan P. Aguilar Ticona
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Renato Victoriano
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Moyra M. Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | | | | | - Jaqueline S. Cruz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Ricardo Khouri
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Elsio A. Wunder
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Matt D. T. Hitchings
- Department of Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Olatunji Johnson
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Mitermayer G. Reis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Derek A. T. Cummings
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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Win H, Shafique S, Mizan S, Wallenborn J, Probst-Hensch N, Fink G. Association between mother's work status and child stunting in urban slums: a cross-sectional assessment of 346 child-mother dyads in Dhaka, Bangladesh (2020). Arch Public Health 2022; 80:192. [PMID: 35978414 PMCID: PMC9382616 DOI: 10.1186/s13690-022-00948-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing literature highlights the increased risk of stunting among children growing up in informal or slum settlements. Despite relatively high rates of female labor force participation in slums, there is limited evidence on relationship between mother's work participation and nutritional outcomes of children in these settings. METHODS We conducted a cross-sectional study in two large slums (Korail and Tongi) of Dhaka and Gazipur, Bangladesh to assess the association between maternal work and childhood stunting in a low-income urban context. Logistic regression models estimated unconditional and conditional associations between maternal work status and 1) child stunting, 2) child morbidity and dietary intake, and 3) health and hygiene behaviors. Subgroup analyses were done by type of child care support available. RESULTS After adjusting for variations in individual and household level characteristics, we found that children of working mothers had nearly twice the odds of being stunted than children of non-working mothers (OR 1.84, 95%CI 1.05-3.23). Large differences in stunting were found by available care support: compared to children of non-working mothers, children of working mothers with nuclear-type family support had 4.5 times increased odds of stunting (OR 4.49, 95%CI 1.81-11.12), while no odds differential was found for children of working mothers with an extended-type family support (OR 0.69, 95%CI 0.30-1.59). CONCLUSIONS Maternal employment is associated with a substantial increase in the odds of child stunting in the slum areas studied. Given that these effects only appear to arise in the absence of adequate family support, integrating appropriate childcare support measures for low-income urban working mothers might be an effective strategy to help reduce the prevalence of chronic undernutrition among slum children.
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Affiliation(s)
- Hayman Win
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Sohana Shafique
- International Centre for Diarrheal Disease Research, Health Systems and Population Studies Division, Dhaka, Bangladesh
| | - Sharmin Mizan
- Ministry of Local Government, Rural Development and Cooperatives, Local Government Division, Urban Primary Health Care Service Delivery Project, Dhaka, Bangladesh
| | - Jordyn Wallenborn
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Allande-Cussó R, García-Iglesias JJ, Miranda-Plata R, Pichardo-Hexamer R, Ruiz-Frutos C, Gómez-Salgado J. Social Determinants of Health in the COVID-19 Pandemic Context of the Migrant Population Living in Settlements in Spain. Int J Public Health 2022; 67:1604628. [PMID: 35990191 PMCID: PMC9385961 DOI: 10.3389/ijph.2022.1604628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: The aim of this study was to describe and evaluate the sociodemographic profile and assess the levels of anxiety and fear, work engagement, and psychological distress on a sample of migrants living in settlements in the province of Huelva (Spain) during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted on a sample of 623 migrants during the months of April to June 2021, based on the Anxiety and Fear of COVID-19 (AMICO) assessment scale, the 9-item Utrecht Work Engagement Scale to assess work engagement, and the General Health Questionnaire (GHQ-12) to analyse psychological distress. Results: A low level of education, dwelling of less than 3 m2 and the desire to return to the country of origin may be related to the presence of anxiety and fear of COVID-19 and lower levels of work engagement. Conclusion: There is a need to improve the study of the concept of health of the migrant population residing in the settlements of Huelva (Spain) and the assessment of their physical and mental health, in an official way.
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Affiliation(s)
- Regina Allande-Cussó
- Department of Nursing, Faculty of Nursing, Podiatry and Physiotherapy, University of Seville, Seville, Spain
| | - Juan Jesús García-Iglesias
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
| | | | | | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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38
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Poortaheri N, Alimohammadzadeh K, Hosseini SM, Maher A, Bahadori M. A health service package for residents of informal settlements: A developing country. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2105886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Naeimeh Poortaheri
- Department of Health Services Management, School of Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, School of Management, North Tehran Branch, Islamic Azad University, Health Economics Policy Research Center, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, School of Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ali Maher
- Department of Health Policy, School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Grazuleviciene R, Andrusaityte S, Rapalavicius A, Dėdelė A. Environmentally related gender health risks: findings from citizen science cross-sectional study. BMC Public Health 2022; 22:1426. [PMID: 35883175 PMCID: PMC9325661 DOI: 10.1186/s12889-022-13824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Public engagement in the research of environmental epidemiological problems is becoming an important measure to empower citizens to identify the local environmental and health problems and to explain different environmental exposures affect estimates for males and females. This HORIZON2020 CitieS-Health Kaunas Pilot study examines the relationship between urban built and social environment, health behaviors, and health in men and women. Methods This cross-sectional study included 1086 18–74-year-old participants residing in 11 districts of Kaunas city, Lithuania. Using GIS, we measured traffic flow, noise, NO2, PM2.5, PM10, and greenness NDVI for the participants’ home addresses, determined participants’ perceptions of environmental quality, linked this information with personal sociodemographic data, and used multivariate logistic regression to assess the associations with health issues (physician-diagnosed chronic disease and self-rated general health) in men and women. Results Men and women similar rated the quality of the neighborhood environment, except for air pollution and satisfaction with the public transport in the district. The traffic-related health associations were stronger for women than for men. The prevalence of poor health increased with the increasing age of men and women, yet no significant differences between gender health risks were found in the total sample. Perceived air pollution, irregular visits to green space, and chronic diseases were consistently associated with poor health risks in men and women, yet part-time jobs and low income had a higher impact on women’s poor health. Conclusions Quality of the built neighborhood, air pollution, irregular visits to the green space, and chronic disease had a joint effect on the magnitude of the prevalence of poor health in men and women. Our results suggest that decreasing air pollution and improving the urban built neighborhood supporting citizens’ physical activity in green spaces, might reduce health risks for all. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13824-3.
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Affiliation(s)
- Regina Grazuleviciene
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania.
| | - Sandra Andrusaityte
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania
| | - Aurimas Rapalavicius
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania.,Department of Family Medicine, Lithuanian University of Health Sciences, 48005, Kaunas, Lithuania
| | - Audrius Dėdelė
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania
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Logie CH, Okumu M, Malama K, Mwima S, Hakiza R, Kiera UM, Kyambadde P. Examining the substance use, violence, and HIV and AIDS (SAVA) syndemic among urban refugee youth in Kampala, Uganda: cross-sectional survey findings. BMJ Glob Health 2022; 7:bmjgh-2021-006583. [PMID: 35798442 PMCID: PMC9263932 DOI: 10.1136/bmjgh-2021-006583] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Interactions between substance use, violence, HIV and AIDS, known as the ‘SAVA’ syndemic, are understudied among refugee youth. We assessed the synergistic effects of frequent alcohol use, depression and violence on HIV vulnerability among urban refugee youth aged 16–24 years in Kampala, Uganda. Methods We conducted a cross-sectional survey between January and April 2018 with a convenience sample of refugee youth aged 16–24 years living in informal settlements in Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya). We assessed non-communicable health conditions (frequent [≥3 times per week] alcohol use [FAU]; depression); violence (young adulthood violence [YAV] at age ≥16 years, intimate partner violence [IPV]), and HIV vulnerability (past 12-month transactional sex; recent [past 3-month] multiple [≥2] sex partners). We calculated the prevalence and co-occurrence of non-communicable health conditions, violence and HIV vulnerability variables. We then conducted multivariable logistic regression analyses to first create unique profiles of FAU, depression, YAV and IPV exposures, and second to assess for interactions between exposures on HIV vulnerability outcomes. Results Most participants (n=445; mean age: 19.59, SD: 2.6; women: n=333, 74.8%, men: n=112, 25.2%) reported at least one non-communicable health condition or violence exposure (n=364, 81.8%), and over half (n=278, 62.4%) reported co-occurring exposures. One-fifth reported FAU (n=90; 20.2%) and one-tenth (n=49; 11%) major depression. In logistic regression models including all two-way product terms, adjusted for sociodemographics, we found (a) multiplicative interaction for joint effects of FAU and IPV (adjusted OR (aOR)=4.81, 95% CI: 1.32 to 17.52) on multiple sex partners, and (b) multiplicative interaction for joint effects of FAU and IPV (aOR=3.72, 95% CI: 1.42 to 9.74), and YAV and depression (aOR=7.13, 95% CI: 1.34 to 37.50), on transactional sex. Conclusion Findings signal the importance of addressing the SAVA syndemic among urban refugee youth in Uganda. Synergistic interactions indicate that addressing FAU, depression or violence may concomitantly reduce HIV vulnerability with urban refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada .,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,United Nations University Institute for Water, Environment & Health, Hamilton, Ontario, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,School of Social Science, Uganda Christian University, Mukono, Uganda
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Mwima
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,National AIDS Coordinating Program, Uganda Ministry of Health, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Uwase Mimy Kiera
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Coordinating Program, Uganda Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative (MARPI), Mulago National Referral Hospital, Kampala, Uganda
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Logie CH, Okumu M, Latif M, Parker S, Hakiza R, Kibuuka Musoke D, Mwima S, Batte S, Kyambadde P. Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda. AIDS Behav 2022; 26:2191-2202. [PMID: 35098391 PMCID: PMC9162965 DOI: 10.1007/s10461-021-03567-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/01/2022]
Abstract
Despite the global phenomenon of refugee urbanization, little is known of relational contexts that shape HIV testing among urban refugee youth. We explored perspectives, experiences, and preferences for social support in HIV testing among refugee youth aged 16-24 in Kampala, Uganda. We conducted five focus groups with refugee youth (n = 44) and five in-depth key informant interviews. Participant narratives signaled relational contexts shaping HIV testing included informal sources (intimate partners and family members) and formal sources (peer educators and professionals). There was heterogeneity in perspectives based on relationship dynamics. While some felt empowered to test with partners, others feared negative relationship consequences. Participant narratives reflected kinship ties that could facilitate testing with family, while others feared coercion and judgment. Peer support was widely accepted. Professional support was key for HIV testing as well as conflict-related trauma. Findings emphasize bonding and bridging social capital as salient components of enabling HIV testing environments.
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Akhter S, Bashar F, Kamruzzaman M, Mahmood N, Rahman A, Anwar I, Hawkes S. A Rapid Ethnographic Assessment of Cultural and Social Perceptions and Practices About COVID-19 in Bangladesh: What the Policy Makers and Program Planners Should Know. QUALITATIVE HEALTH RESEARCH 2022; 32:1114-1125. [PMID: 35543221 PMCID: PMC9099403 DOI: 10.1177/10497323221091516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anthropological literature on health beliefs and practices related to COVID-19 is scarce, particularly in low and middle-income countries. We conducted a qualitative research on perceptions of COVID-19 among slum residents of Dhaka, Bangladesh from November 2020 through January, 2021. Methods included in-depth interviews and photo elicitation with community residents. Interviews were transcribed and analyzed thematically. Results show scientific explanations of COVID-19 conflicted with interviewees' cultural and spiritual beliefs such as: coronavirus is a disease of rich, sinful people; the virus is a curse from Allah to punish sinners. Interviewees rejected going to hospitals in favor of home remedies, and eschewed measures such as mask-wearing or social distancing instead preferring to follow local beliefs. We have highlighted a gap between community beliefs about the pandemic and science-led interventions proposed by health professionals. For public health policy to be more effective it requires a deeper understanding of and response to community perceptions.
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Affiliation(s)
- Sadika Akhter
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Farzana Bashar
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mohammed Kamruzzaman
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nabila Mahmood
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Aminur Rahman
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Obstetrical and Gynecological Society of Bangladesh, Dhaka, Bangladesh
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK
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Urban Climate Justice, Human Health, and Citizen Science in Nairobi’s Informal Settlements. URBAN SCIENCE 2022. [DOI: 10.3390/urbansci6020036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Urban informal settlements or slums are among the most vulnerable places to climate-change-related health risks. Yet, little data exist documenting environmental and human health vulnerabilities in slums or how to move research to action. Citizen science, where residents co-define research objectives with professionals, collect and analyze data, and help translate findings into ameliorative actions, can help fill data gaps and contribute to more locally relevant climate justice interventions. This paper highlights a citizen-science, climate justice planning process in the Mukuru informal settlement of Nairobi, Kenya. We describe how residents, non-governmental organizations and academics partnered to co-create data-gathering processes and generated evidence to inform an integrated, climate justice strategy called the Mukuru Special Planning Area, Integrated Development Plan. The citizen science processes revealed that <1% of residents had access to a private in-home toilet, and 37% lacked regular access to safe and affordable drinking water. We found that 42% of households were subject to regular flooding, 39% reported fair or poor health, and 40% reported a child in the household was stunted. These and other data were used in a community planning process where thousands of residents co-designed improvement and climate change adaptation strategies, such as flood mitigation, formalizing roads and pathways with drainage, and a water and sanitation infrastructure plan for all. We describe the participatory processes used by citizen scientists to generate data and move evidence into immediate actions to protect human health and a draft a long-range, climate justice strategy. The processes used to create the Mukuru Special Planning Area redevelopment plan suggest that participatory, citizen-led urban science can inform local efforts for health equity and global goals of climate justice.
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Park JE, Kibe P, Yeboah G, Oyebode O, Harris B, Ajisola MM, Griffiths F, Aujla N, Gill P, Lilford RJ, Chen YF. Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. BMJ Open 2022; 12:e055415. [PMID: 35613790 PMCID: PMC9125718 DOI: 10.1136/bmjopen-2021-055415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify factors associated with accessing and utilisation of healthcare and provision of health services in slums. DESIGN A scoping review incorporating a conceptual framework for configuring reported factors. DATA SOURCES MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms. ELIGIBILITY CRITERIA Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries. DATA EXTRACTION AND SYNTHESIS Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised. RESULTS Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents' perspective while only 10 studies explored provision of health services from providers/planners' perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system. CONCLUSION The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums. SYSTEMATIC REVIEW REGISTRATION NUMBER: https://osf.io/694t2.
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Affiliation(s)
- Ji-Eun Park
- Warwick Medical School, University of Warwick, Coventry, UK
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Peter Kibe
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Godwin Yeboah
- Information and Digital Group, University of Warwick, Coventry, UK
| | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Navneet Aujla
- Warwick Medical School, University of Warwick, Coventry, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Warwick Medical School, University of Warwick, Coventry, UK
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McNab S, Scudder E, Syed U, Freedman LP. Maternal and newborn health for the urban poor: the need for a new mental model and implementation strategies to accelerate progress. Global Health 2022; 18:46. [PMID: 35484577 PMCID: PMC9047468 DOI: 10.1186/s12992-022-00830-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Urbanization challenges the assumptions that have traditionally influenced maternal and newborn health (MNH) programs. This landscaping outlines how current mental models for MNH programs have fallen short for urban slum populations and identifies implications for the global community. We employed a three-pronged approach, including a literature review, key informant interviews with global- and national-level experts, and a case study in Bangladesh. Main body Our findings highlight that the current mental model for MNH is inadequate to address the needs of the urban poor. Implementation challenges have arisen from using traditional methods that are not well adapted to traits inherent in slum settings. A re-thinking of implementation strategies will also need to consider a paucity of available routine data, lack of formal coordination between stakeholders and providers, and challenging municipal government structures. Innovative approaches, including with communications, outreach, and technology, will be necessary to move beyond traditional rural-centric approaches to MNH. As populations continue to urbanize, common slum dynamics will challenge conventional strategies for health service delivery. In addition, the COVID-19 pandemic has exposed weaknesses in a system that requires intersectoral collaborations to deliver quality care. Conclusion Programs will need to be iterative and adaptive, reflective of sociodemographic features. Integrating the social determinants of health into evaluations, using participatory human-centered design processes, and innovative public-private partnerships may prove beneficial in slum settings. But a willingness to rethink the roles of all actors within the delivery system overall may be needed most.
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Affiliation(s)
- Shanon McNab
- Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, New York, NY, USA.
| | | | - Uzma Syed
- Save the Children International, Washington, DC, USA
| | - Lynn P Freedman
- Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, New York, NY, USA
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Uthman OA, Ayorinde A, Oyebode O, Sartori J, Gill P, Lilford RJ. Global prevalence and trends in hypertension and type 2 diabetes mellitus among slum residents: a systematic review and meta-analysis. BMJ Open 2022; 12:e052393. [PMID: 35210339 PMCID: PMC8883228 DOI: 10.1136/bmjopen-2021-052393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE First, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Studies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or prevalence of type 2 diabetes. INFORMATION SOURCES Ovid MEDLINE, Cochrane CENTRAL and EMBASE from inception to December 2020. RISK OF BIAS Two authors extracted relevant data and assessed risk of bias independently using the Strengthening the Reporting of Observational Studies in Epidemiology guideline. SYNTHESIS OF RESULTS We used random-effects meta-analyses to pool prevalence estimates. We examined time trends in the prevalence estimates using meta-regression regression models with the prevalence estimates as the outcome variable and the calendar year of the publication as the predictor. RESULTS A total of 62 studies involving 108 110 participants met the inclusion criteria. Prevalence of hypertension and type 2 diabetes in slum populations ranged from 4.2% to 52.5% and 0.9% to 25.0%, respectively. In six studies presenting comparator data, all from the Indian subcontinent, slum residents were 35% more likely to be hypertensive than those living in comparator rural areas and 30% less likely to be hypertensive than those from comparator non-slum urban areas. LIMITATIONS OF EVIDENCE Of the included studies, only few studies from India compared the slum prevalence estimates with those living in non-slum urban and rural areas; this limits the generalisability of the finding. INTERPRETATION The burden of hypertension and type 2 diabetes varied widely between countries and regions and, to some degree, also within countries. PROSPERO REGISTRATION NUMBER CRD42017077381.
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Affiliation(s)
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oyinlola Oyebode
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Fofana MO, Nery N, Aguilar Ticona JP, Belitardo EM, Victoriano R, Anjos RO, Portilho MM, de Santana MC, dos Santos LL, de Oliveira D, Cruz JS, Muencker MC, Khouri R, Wunder EA, Hitchings MD, Johnson O, Reis MG, Ribeiro GS, Cummings DA, Costa F, Ko AI. Structural factors contributing to SARS-CoV-2 infection risk in the urban slum setting. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.13.22270856. [PMID: 35194620 PMCID: PMC8863166 DOI: 10.1101/2022.02.13.22270856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The structural environment of urban slums, including physical, demographic and socioeconomic attributes, renders inhabitants more vulnerable to SARS-CoV-2 infection. Yet, little is known about the specific determinants that contribute to high transmission within these communities. METHODS AND FINDINGS We performed a serosurvey of an established cohort of 2,035 urban slum residents from the city of Salvador, Brazil between November 2020 and February 2021, following the first COVID-19 pandemic wave in the country. We identified high SARS-CoV-2 seroprevalence (46.4%, 95% confidence interval [CI] 44.3-48.6%), particularly among female residents (48.7% [95% CI 45.9-51.6%] vs. 43.2% [95% CI 39.8-46.6%] among male residents), and among children (56.5% [95% CI 52.3-60.5%] vs. 42.4% [95% CI 39.9-45.0%] among adults). In multivariable models that accounted for household-level clustering, the odds ratio for SARS-CoV-2 seropositivity among children was 1.96 (95% CI 1.42-2.72) compared to adults aged 30-44 years. Adults residing in households with children were more likely to be seropositive; this effect was particularly prominent among individuals with age 30-44 and 60 years or more. Women living below the poverty threshold (daily per capita household income <$1.25) and those who were unemployed were more likely to be seropositive. CONCLUSIONS During a single wave of the COVID-19 pandemic, cumulative incidence as assessed by serology approached 50% in a Brazilian urban slum population. In contrast to observations from industrialized countries, SARS-CoV-2 incidence was highest among children, as well as women living in extreme poverty. These findings emphasize the need for targeted interventions that provide safe environments for children and mitigate the structural risks posed by crowding and poverty for the most vulnerable residents of urban slum communities.
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Affiliation(s)
- Mariam O. Fofana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | - Juan P. Aguilar Ticona
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | - Emilia M.M.A. Belitardo
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | | | | | | | | | | | | | | | - M. Cate Muencker
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | - Elsio A. Wunder
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
| | | | - Olatunji Johnson
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Mitermayer G. Reis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador BA, Brazil
| | - Guilherme S. Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador BA, Brazil
| | - Derek A.T. Cummings
- Department of Biology, University of Florida, Gainesville FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville FL, USA
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador BA, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador BA, Brazil
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Characterization of Healthy Housing in Africa: Method, Profiles, and Determinants. J Urban Health 2022; 99:146-163. [PMID: 35079945 PMCID: PMC8788402 DOI: 10.1007/s11524-021-00603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/02/2022]
Abstract
Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.
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Nkrumah Agyabeng A, Ahwireng PO, Bawole JN, Mickson MK, Ahenkan A. Understanding electricity nightmare and health implications among slum dwellers in Ghana. HEALTH EDUCATION 2022. [DOI: 10.1108/he-06-2021-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of the study was to examine the electricity challenges confronting slums in order to understand the health implications thereof.Design/methodology/approachThe study utilized purposive sampling techniques supported by the convenience sampling method within the context of qualitative research to select 30 interviewees of varying demographics for in-depth interviews.FindingsThe findings revealed that slums faced various forms of challenges that are attributable to lack of government support, stringent procedures and financial hardship, among others. The study also found that a lack of health education in the slums has resulted in health problems, such as skin diseases, stomach aches, cholera, typhoid and childbirth complications.Research limitations/implicationsThe outcome of this study cannot be generalized to represent the whole population of slums within context due to the qualitative approach.Practical implicationsThe study advanced the frontiers of slum literature to understand contextual issues that are important to policymakers and practitioners.Originality/valueThis study revealed a country-specific understanding of the challenges confronting slum dwellers in accessing electricity through the perspective of the two-factor theory of motivation.
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Abstract
OBJECTIVES To survey on the availability and use of primary care services in slum populations. DESIGN Retrospective, cross-sectional, household, individual and healthcare provider surveys. SETTING Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). PARTICIPANTS Residents of slums and informal settlements. PRIMARY AND SECONDARY OUTCOME MEASURES Primary care consultation rates by type of provider and facility. RESULTS We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. CONCLUSIONS People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.
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