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Abdel-Rahman S, Khater E, Abdel Fattah MN, Hussein WA. Social determinants of chronic diseases reporting among slum dwellers in Egypt. J Biosoc Sci 2024; 56:590-608. [PMID: 38347812 DOI: 10.1017/s0021932024000014] [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] [Indexed: 04/19/2024]
Abstract
The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents' health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.
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Affiliation(s)
- Suzan Abdel-Rahman
- Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
| | - Elsayed Khater
- Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
| | - Mohamed N Abdel Fattah
- Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
| | - Wafaa A Hussein
- Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
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Kumar P, Abhishek K, Shukla R, Sarkar M, Kaushal GP, Gharde P, Shah U, Panchawagh S, Srikumar S. Prevalence and Assessment of Factors Associated With Malnutrition in Children Residing in Slums of Mumbai: A Cross-Sectional Study. Cureus 2024; 16:e58619. [PMID: 38770452 PMCID: PMC11103267 DOI: 10.7759/cureus.58619] [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: 10/24/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background Malnutrition in children continues to be a serious public health problem in India. Therefore, this study aims to evaluate the prevalence of malnutrition and assess factors contributing to it in children of the marginalized slum population of India, masked in the metropolitan cities. Methods A retrospective data analysis with a cross-sectional model was conducted by medical volunteers affiliated with the Rotaract Club of Medicrew who had organized a free pediatric health check-up camp in the Dharavi village of Mumbai, India for children under five. Children under five years of age group of either sex residing in the slums of Dharavi and whose parents consented are included in the study. Neonates, children older than five years of age, and children whose parents did not consent for them to be included in the study were excluded. A pretested, pre-validated questionnaire was administered, and statistical analysis was done with p-values <0.05 considered to be statistically significant. Results A total of 126 children were included. Out of these children, 109 of them (86.50%) had a mid-arm circumference of more than 12.5 cm (normal), 11 (8.73%) were between 11.5 cm and 12.5 cm (moderate acute malnutrition), and five (4.77%) were less than 11.5 cm (severe acute malnutrition). Among the 126 kids, 86 kids were above the age of two and their BMI was assessed, 36 (44.19%) were found to be underweight (<5th percentile) while 14 (16.3%) were obese (>95th percentile), and four (4.65%) were overweight (85th-95th percentile). For 106 (84.13%) of these children, the caregivers were mothers while others were fathers (n=4; 3.18%), grandmothers (n=5; 3.97%), sisters (n=5; 3.97%), and aunts (n=6; 4.76%). Out of those who had commenced receiving formal education, only 39 (55.71%) were in an appropriate grade for their age. The mean expenditure on food as a proportion of the total household income was 36.40% (standard deviation (SD) 15.0%). On the single-item sleep quality scale, the sleep of only 36 kids (28.58%) was reported by their caregivers as excellent. A high proportion of other medical problems were reported in the children. Conclusion Our study reports a substantial burden of malnutrition among children residing in the slums of Dharavi. Rigorous strengthening and conceptualization of on-ground nutritional programs targeted toward slum children should be done by Indian healthcare policymakers.
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Affiliation(s)
- Pratyush Kumar
- Department of Medicine, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Kumar Abhishek
- Department of Medicine, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Rushikesh Shukla
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali Sarkar
- Department of Internal Medicine, MGM Medical College, Navi Mumbai, IND
| | - G P Kaushal
- Department of Pediatrics, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Pankaj Gharde
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Urmil Shah
- Department of Medicine, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Mumbai, IND
| | - Suhrud Panchawagh
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Shabarini Srikumar
- Department of Internal Medicine, Tirunelveli Medical College, Tirunelveli, IND
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Patil M, Qureshi A, Naydenova E, Bang A, Halbert J, De Vos M, Nair P, Patil M, Medvedev MM. Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework. PLOS DIGITAL HEALTH 2023; 2:e0000363. [PMID: 37910483 PMCID: PMC10619782 DOI: 10.1371/journal.pdig.0000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023]
Abstract
An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbai's population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery.
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Affiliation(s)
| | - Athar Qureshi
- Chetana’s Institute of Management and Research, Bandra East, Mumbai, India
| | | | - Anand Bang
- Society for Education, Action and Research in Community Health, Shodhgram, Chatgaon, Dhanora, Gadchiroli, Maharashtra, India
| | - Jay Halbert
- Department of Pediatrics, Maidstone and Tunbridge Wells NHS Trust, Royal Tunbridge Wells, Tunbridge Wells, United Kingdom
| | - Maarten De Vos
- Kellogg College, University of Oxford, Park Town, Oxford, United Kingdom
- Stadius, Dept. of Electrical Engineering & Dept. Of Development & Regeneration, KU Leuven, Belgium
| | - Poornima Nair
- Apnalaya, B/9–103 New Jaiphalwadi SRA Co-op Hsg Society, Tardeo, Mumbai, India
| | - Madhumita Patil
- Chetana’s Institute of Management and Research, Bandra East, Mumbai, India
| | - Melissa M. Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Kalyanasundaram M, Krishnan K, Singh S, Sahoo KC, Soni R, Parashar V, Mathankar N, Pathak A, Sabde Y, Stålsby Lundborg C, Atkins S, Rousta K, Diwan V. Composition analysis (pick analysis) of waste generated from household: A pilot study in Ujjain city, India. Heliyon 2023; 9:e19902. [PMID: 37809475 PMCID: PMC10559268 DOI: 10.1016/j.heliyon.2023.e19902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Waste segregation is an essential function in improving waste management. Waste segregation not only facilitates recycling and reduces waste going to landfills, rather it can benefit our environment and human in various ways. A pick analysis of waste composition is used to characterize the household waste stream and thus can analyze the segregation rate among the residents. In addition, it can measure the actual waste sorting behaviour at the household/community level. The objective of the study was to assess feasibility of a large-scale waste composition study, identify methodological and operational challenges, and estimate the resources needed to conduct the main waste composition study in order to obtain and get indicative figures about waste generation, composition, and miss-sorted proportions. The study team went door-to-door to collect waste in colour coded bags. We also collected the socio-demographic data of the households. The collected waste was weighed and segregated to analyze the waste composition. The analysis was done among 45 households, and it was found that the per capita waste generation per day is 0.25 kg (0.24 kg from slum and 0.27 kg from non-slum). Challenges identified in conducting waste composition study were lack of standard waste fraction classifications, difficulty in recruitment of personnel to conduct study due to social taboo around waste, challenge in co-coordinating with Ujjain Municipal Corporation waste collection vehicle for collection of waste. 53 household activities were completed in 5 and half hours with INR 24685 (USD 300.5). Pick analysis could be adopted by the Ujjain Municipal Corporation after cost effective analysis to generate precise estimate of waste generation, resource recovery, efficient resource allocation and will help in future interventions and informed policy decision making to improve segregation.
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Affiliation(s)
| | - Kavya Krishnan
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR – National Institute for Research in Environmental Health, Bhopal, 462030, Madhya Pradesh, India
| | - Surya Singh
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR – National Institute for Research in Environmental Health, Bhopal, 462030, Madhya Pradesh, India
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India Regional Hub, ICMR- Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India
| | - Rachna Soni
- Ruxmaniben Deepchand Gardi Medical College, Ujjain, 456006, Madhya Pradesh, India
| | - Vivek Parashar
- Ruxmaniben Deepchand Gardi Medical College, Ujjain, 456006, Madhya Pradesh, India
| | - Namrata Mathankar
- Ruxmaniben Deepchand Gardi Medical College, Ujjain, 456006, Madhya Pradesh, India
| | - Ashish Pathak
- Ruxmaniben Deepchand Gardi Medical College, Ujjain, 456006, Madhya Pradesh, India
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Yogesh Sabde
- Division of Environemtnal Health and Epidemiology, ICMR – National Institute for Research in Environmental Health, Bhopal, 462030, Madhya Pradesh, India
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Salla Atkins
- Department of Global Public Health, Social Medicine Infectious Disease and Migration, Karolinska Institutet, 171 77, Stockholm, Sweden
- Global Health and Development, Health Sciences, Faculty of Social Sciences, Tampere University, 33100, Tampere, Finland
| | - Kamran Rousta
- Swedish Centre for Resource Recovery, University of Borås, 50332, Borås, Sweden
| | - Vishal Diwan
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR – National Institute for Research in Environmental Health, Bhopal, 462030, Madhya Pradesh, India
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
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Akter S, Banna MHA, Brazendale K, Sultana MS, Kundu S, Disu TR, Alshahrani NZ, Tareq MA, Hassan MN, Islam Khan MS. Determinants of health care seeking behavior for childhood infectious diseases and malnutrition: A slum-based survey from Bangladesh. J Child Health Care 2023; 27:395-409. [PMID: 35164525 DOI: 10.1177/13674935211057714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to explore the magnitude and determinants of health care seeking behaviors for common infectious disease and malnutrition among Bangladeshi under-five children living in slum areas. A cross-sectional study of 300 children-caregiver dyads was conducted in an urban slum of Bangladesh. Data were collected via a structured questionnaire with accompanying anthropometric assessments of children administered by research staff. Multiple logistic regression was employed to identify associated factors of health care seeking behaviors. Only 44.7% and 13.0% of respondents sought care for childhood infectious diseases and malnutrition, respectively. Being a male child, 2-5 years old, having ≤5 family members, monthly family income >125$, and living in close proximity to a health facility were found to be potential determinants of health care seeking behavior for childhood infectious diseases. Mother/caregivers with poor nutritional information knowledge and who had a child 2-5 years old reported engaging in less care seeking behaviors regarding their child's malnutrition compared to their counterparts. Caregivers of children under the age of 5 years old reported low participation in health care seeking behaviors in relation to childhood infectious disease and malnutrition. Families living in slums require additional support targeting health and nutritional educational programs.
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Affiliation(s)
- Sumaiya Akter
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Hasan Al Banna
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando, FL, US
| | - Mst Sadia Sultana
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Satyajit Kundu
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | | | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Md Abu Tareq
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Nazmul Hassan
- Department of Environmental Sanitation, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Gupta A, Sengar M, Manar M, Bansal U, Singh SK. Tracking Water, Sanitation, and Hygiene Practices: Waste Management and Environmental Cleaning in the Slums of North India. Cureus 2023; 15:e42067. [PMID: 37602103 PMCID: PMC10434291 DOI: 10.7759/cureus.42067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background One or more of the following five amenities is lacking in slum communities: durable housing, sufficient living area, access to clean water, access to improved sanitation facilities, and secure tenure. This study aimed to identify the gaps in water, sanitation, and hygiene conditions in the urban slums of Lucknow. Methodology A community-based, cross-sectional study was conducted among families residing in the urban slums of Lucknow, Uttar Pradesh, India for 18 months starting from April 2020. Results A total of 747 heads of families were interviewed and their families were surveyed. The proportion of kaccha slums was 37.25% and of pakka slums was 62.74%. About 98.3% of families residing in kaccha slums used indiscriminate throwing as a method of solid waste disposal. About 96.5% of families residing in kaccha slums practiced open-field defecation while those residing in pakka slums used a toilet within the premises. Kaccha slum dwellers were practicing open-field defecation 12.8 times more than pakka slum dwellers. This study showed that sanitary conditions in kaccha slums were mainly responsible for the overall burden of excreta disposal, solid waste disposal, and access to water supply for drinking and other household purposes. Conclusions Water supply and housing conditions such as dampness, floor, and the non-availability of electricity are the primary predictors of the preference for open-field defecation among slum dwellers.
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Affiliation(s)
- Abhishek Gupta
- Community Medicine, Government Medical College, Kannauj, Kannauj, IND
| | - Mili Sengar
- Community Medicine, T.S. Misra Medical College, Lucknow, IND
| | - Manish Manar
- Community Medicine, King George's Medical University, Lucknow, IND
| | - Utkarsh Bansal
- Pediatrics, Hind Institute of Medical Sciences, Barabanki, IND
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Chatterjee S, Das P, Shikhule A, Munje R, Vassall A. Journey of the tuberculosis patients in India from onset of symptom till one-year post-treatment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001564. [PMID: 36811090 PMCID: PMC7614204 DOI: 10.1371/journal.pgph.0001564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/14/2023] [Indexed: 02/12/2023]
Abstract
Historically, economic studies on tuberculosis estimated out-of-pocket expenses related to tuberculosis treatment and catastrophic cost, however, no study has yet been conducted to understand the post-treatment economic conditions of the tuberculosis patients in India. In this paper, we add to this body of knowledge by examining the experiences of the tuberculosis patients from the onset of symptoms till one-year post-treatment. 829 adult drug-susceptible tuberculosis patients from general population and from two high risk groups: urban slum dwellers and tea garden families were interviewed during February 2019 to February 2021 at their intensive and continuation phases of treatment and about one-year post-treatment using adapted World Health Organization tuberculosis patient cost survey instrument. Interviews covered socio-economic conditions, employment status, income, out-of-pocket expenses and time spent for outpatient visits, hospitalization, drug-pick up, medical follow-ups, additional food, coping strategies, treatment outcome, identification of post-treatment symptoms and treatment for post-treatment sequalae/recurrent cases. All costs were calculated in 2020 Indian rupee (INR) and converted into US dollar (US$) (1 US$ = INR 74.132). Total cost of tuberculosis treatment since the onset of symptom till one-year post-treatment ranged from US$359 (Standard Deviation (SD) 744) to US$413 (SD 500) of which 32%-44% of costs incurred in pre-treatment phase and 7% in post-treatment phase. 29%-43% study participants reported having outstanding loan with average amount ranged from US $103 to US$261 during the post-treatment period. 20%-28% participants borrowed during post-treatment period and 7%-16% sold/mortgaged personal belongings. Therefore, economic impact of tuberculosis persists way beyond treatment completion. Major reasons of continued hardship were costs associated with initial tuberculosis treatment, unemployment, and reduced income. Therefore, policy priorities to reduce treatment cost and to protect patients from the economic consequences of the disease by ensuring job security, additional food support, better management of direct benefit transfer and improving coverage through medical insurances need consideration.
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Affiliation(s)
- Susmita Chatterjee
- Research Department, George Institute for Global Health, New Delhi, India
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Palash Das
- Research Department, George Institute for Global Health, New Delhi, India
| | - Aaron Shikhule
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Radha Munje
- Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sharif H, Jan SS, Sharif S, Seemi T, Naeem H, Rehman J. Respiratory Diseases' Burden in children and adolescents of marginalized population: A retrospective study in slum area of Karachi, Pakistan. FRONTIERS IN EPIDEMIOLOGY 2023; 2:1031666. [PMID: 38455318 PMCID: PMC10911041 DOI: 10.3389/fepid.2022.1031666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 03/09/2024]
Abstract
Background Worldwide, the burden of respiratory disease has dramatically increased, endangering public health. To our knowledge, there have been no reported cases of respiratory illness among children and adolescents living in the slums of Karachi, Pakistan. This study aimed to assess the burden of respiratory disease in marginalized slum populations and the factors causing such an increase in disease burden. Methods This study was conducted in 35 slums of Karachi, Pakistan, to determine the prevalence of respiratory disease in children and adolescents. Data on pneumonia, bronchitis, bronchiolitis, tuberculosis, and asthma from August 2019 to July 2022 were analyzed and inferences were drawn. Results Among the studied diseases, pneumonia was more prevalent among females (39,864, 44.9%), followed by males (19,006, 21.4%). Most of the children (59,988, 67.6%) were aged 1-5 years. In addition, of those diagnosed with pneumonia, 50,348 (56.8%) were from the same age group. Furthermore, bronchiolitis was found among 10,830 (12.2%) children aged 5-9 years. The majority (46,906, 52.9%) of the studied population belonged to the Pathan ethnicity, followed by Sindhi (21,522, 24.2%), and most of them (84,330, 95.1%) were of a lower socioeconomic status. Conclusions This study found that pneumonia is the most common respiratory disease followed by bronchiolitis in children and adolescents in a marginalized slum population of Karachi, Pakistan. Both pneumonia and bronchiolitis have seasonal variations in their occurrence.
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Affiliation(s)
- Hina Sharif
- Research & Publication Department, SINA Health & Education Welfare Trust, Karachi, Pakistan
| | - Shah Sumaya Jan
- Department of Anatomy, Government Medical College, Srinagar, India
| | - Sana Sharif
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tooba Seemi
- Research & Publication Department, SINA Health & Education Welfare Trust, Karachi, Pakistan
| | - Hira Naeem
- Research & Publication Department, SINA Health & Education Welfare Trust, Karachi, Pakistan
| | - Junaid Rehman
- Public Health Department, SINA Health, Education & Welfare Trust, Karachi, Pakistan
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de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
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Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
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11
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Coffey D, Khera R, Spears D. Mothers' Social Status and Children's Health: Evidence From Joint Households in Rural India. Demography 2022; 59:1981-2002. [PMID: 36111967 PMCID: PMC10355193 DOI: 10.1215/00703370-10217164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The premise that a woman's social status has intergenerational effects on her children's health has featured prominently in population science research and in development policy. This study focuses on an important case in which social hierarchy has such an effect. In joint patrilocal households in rural India, women married to the younger brother are assigned lower social rank than women married to the older brother in the same household. Almost 8% of rural Indian children under 5 years old-more than 6 million children-live in such households. We show that children of lower-ranking mothers are less likely to survive and have worse health outcomes, reflected in higher neonatal mortality and shorter height, compared with children of higher-ranking mothers in the same household. That the variation in mothers' social status that we study is not subject to reporting bias is an advantage relative to studies using self-reported measures. We present evidence that one mechanism for this effect is maternal nutrition: although they are not shorter, lower-ranking mothers weigh less than higher-ranking mothers. These results suggest that programs that merely make transfers to households without attention to intrahousehold distribution may not improve child outcomes.
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Affiliation(s)
- Diane Coffey
- Department of Sociology and Population Research Center, The University of Texas at Austin, Austin, TX, USA; r.i.c.e
| | - Reetika Khera
- Department of Humanities and Social Sciences, Indian Institute of Technology, Delhi, India
| | - Dean Spears
- Department of Economics and Population Research Center, The University of Texas at Austin, Austin, TX, USA; IZA, Bonn, Germany; r.i.c.e
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Pandya N, Jensen LA, Bhangaokar R. Moral reasoning among children in India: The intersection of culture, development, and social class. APPLIED DEVELOPMENTAL SCIENCE 2021. [DOI: 10.1080/10888691.2021.2007770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Win H, Wallenborn J, Probst-Hensch N, Fink G. Understanding urban inequalities in children's linear growth outcomes: a trend and decomposition analysis of 39,049 children in Bangladesh (2000-2018). BMC Public Health 2021; 21:2192. [PMID: 34847918 PMCID: PMC8631262 DOI: 10.1186/s12889-021-12181-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children. METHODS We combined six rounds of Demographic and Health Survey data spanning 2000-2018 and used official poverty rates to classify the urban population into poor and non-poor households. We identified key stunting determinants using stepwise selection method. Regression-decomposition was used to quantify contributions of these key determinants to poverty-based intra-urban differences in child linear growth status. RESULTS Key stunting determinants identified in our study predicted 84% of the linear growth difference between urban poor and non-poor children. Child's place of birth (27%), household wealth (22%), maternal education (18%), and maternal body mass index (11%) were the largest contributors to the intra-urban child linear growth gap. Difference in average height-for-age z score between urban poor and non-poor children declined by 0.31 standard deviations between 2000 and 2018. About one quarter of this observed decrease was explained by reduced differentials between urban poor and non-poor in levels of maternal education and maternal underweight status. CONCLUSIONS Although the intra-urban disparity in child linear growth status declined over the 2000-2018 period, socioeconomic gaps remain significant. Increased nutrition-sensitive programs and investments targeting the urban poor to improve girls' education, household food security, and maternal and child health services could aid in further narrowing the remaining linear growth gap.
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Affiliation(s)
- Hayman Win
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - 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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Murarkar S, Gothankar J, Doke P, Dhumale G, Pore PD, Lalwani S, Quraishi S, Patil RS, Waghachavare V, Dhobale R, Rasote K, Palkar S, Malshe N, Deshmukh R. Prevalence of the Acute Respiratory Infections and Associated Factors in the Rural Areas and Urban Slum Areas of Western Maharashtra, India: A Community-Based Cross-Sectional Study. Front Public Health 2021; 9:723807. [PMID: 34765581 PMCID: PMC8576147 DOI: 10.3389/fpubh.2021.723807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Acute respiratory infections (ARIs) continue to be the most important cause of morbidity and mortality among under-five children. Some demographic and environmental factors are associated with ARIs among under-five children. This study was conducted with the objective to estimate the prevalence of ARIs among under-five children in the rural areas and densely populated urban slum areas in Maharashtra, India and to assess the association of the selected sociodemographic and household environmental factors with ARI. This study was conducted in 16 selected clusters from the rural areas and densely populated urban slum areas of the two districts in Maharashtra, India. Structured and validated proforma was used for collecting the data on the sociodemographic and household environmental risk factors. A total of 3,671 under-five children were surveyed. The prevalence of ARIs for the preceding month was 50.4%. It was higher among the children living in the rural areas (54.2%) compared to the children living in the urban areas (46.7%) (p = 0.01). The prevalence of ARIs was reported to be 51.4 and 49.4% in boys and girls, respectively. In the multivariate analysis, the researchers found that living in rural areas (p = 0.01) and parental smoking (p = 0.04) were significantly associated with the ARIs. An intervention such as reducing parental smoking habits at the household level may reduce ARIs.
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Affiliation(s)
- Sujata Murarkar
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Jayashree Gothankar
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Prakash Doke
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Girish Dhumale
- Medical College Sangli, Bharati Vidyapeeth (Deemed to be) University, Sangli, India
| | - Prasad D Pore
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Sanjay Lalwani
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Sanjay Quraishi
- Medical College Sangli, Bharati Vidyapeeth (Deemed to be) University, Sangli, India
| | - Reshma S Patil
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India.,Department of Community Medicine, Symbiosis Medical College for Women, Symbiosis International University, Pune, India
| | - Vivek Waghachavare
- Medical College Sangli, Bharati Vidyapeeth (Deemed to be) University, Sangli, India
| | - Randhir Dhobale
- Medical College Sangli, Bharati Vidyapeeth (Deemed to be) University, Sangli, India
| | - Kirti Rasote
- Medical College Sangli, Bharati Vidyapeeth (Deemed to be) University, Sangli, India
| | - Sonali Palkar
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
| | - Nandini Malshe
- Medical College Pune, Bharati Vidyapeeth (Deemed to be) University, Pune, India
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Mahapatra T, Mahapatra S, Chakraborty ND, Raj A, Bakshi B, Banerjee B, Saha S, Guha A, Dutta S, Kanungo S. Intervention to improve diarrhea related knowledge and practices among informal healthcare providers in slums of Kolkata. J Infect Dis 2021; 224:S890-S900. [PMID: 34718638 PMCID: PMC8687078 DOI: 10.1093/infdis/jiab499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In the densely populated slums of Kolkata, informal healthcare providers’ (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance. Methods A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation. Results Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved. Conclusions Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up.
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Affiliation(s)
- Tanmay Mahapatra
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sanchita Mahapatra
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Aparna Raj
- CARE India Solutions for Sustainable Development, Patna, India
| | - Bhawani Bakshi
- CARE India Solutions for Sustainable Development, Patna, India
| | - Barnali Banerjee
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Snehasish Saha
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Abhijit Guha
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Suman Kanungo
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
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Evaluating the Accuracy of Gridded Population Estimates in Slums: A Case Study in Nigeria and Kenya. URBAN SCIENCE 2021. [DOI: 10.3390/urbansci5020048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low- and middle-income country cities face unprecedented urbanization and growth in slums. Gridded population data (e.g., ~100 × 100 m) derived from demographic and spatial data are a promising source of population estimates, but face limitations in slums due to the dynamic nature of this population as well as modelling assumptions. In this study, we compared field-referenced boundaries and population counts from Slum Dwellers International in Lagos (Nigeria), Port Harcourt (Nigeria), and Nairobi (Kenya) with nine gridded population datasets to assess their statistical accuracy in slums. We found that all gridded population estimates vastly underestimated population in slums (RMSE: 4958 to 14,422, Bias: −2853 to −7638), with the most accurate dataset (HRSL) estimating just 39 per cent of slum residents. Using a modelled map of all slums in Lagos to compare gridded population datasets in terms of SDG 11.1.1 (percent of population living in deprived areas), all gridded population datasets estimated this indicator at just 1–3 per cent compared to 56 per cent using UN-Habitat’s approach. We outline steps that might improve that accuracy of each gridded population dataset in deprived urban areas. While gridded population estimates are not yet sufficiently accurate to estimate SDG 11.1.1, we are optimistic that some could be used in the future following updates to their modelling approaches.
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Using Fuzzy Cognitive Maps to Assess Liveability in Slum Upgrading Schemes: Case of Pune, India. URBAN SCIENCE 2021. [DOI: 10.3390/urbansci5020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liveability assessments of informal urban settlements are scarce. In India, a number of slum upgrading schemes have been implemented over the last decades aiming at better living conditions. However, these schemes rarely consider improvement in liveability as an explicit criterion, assuming that better physical conditions and the provision of basic services inevitably lead to better liveability. We use Fuzzy Cognitive Maps (FCMs) to analyse liveability in four different informal settlements in Pune (India). We compare the liveability by conducting semi-structured interviews with residents and by analysing them in individual and aggregated FCMs. Each settlement represents an archetypical form of the upgradation process: non-upgraded (base case), in-situ upgraded, relocated, and temporary resettlement. The FCMs show that the liveability indicators availability of community space, proximity to public transportation, feeling of belonging, and good relationship with neighbours and community are central elements of these neighbourhoods’ liveability. The results suggest that upgradation may lead to an improved overall liveability but can also reduce it if not designed properly. The fostering of community agency, an integration of the neighbourhood into the formal city fabric, and the maintaining of cohesion during the shift from horizontal to vertical living emerged as critical factors. To ensure sustainable integration of liveability considerations in slum upgrading schemes, we suggest using indicators well-adapted to the local context, co-created with local experts and stakeholders, as well as periodic post-occupancy liveability evaluations.
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Nethan ST, Sinha DN, Kedar A, Kumar V, Sharma S, Hariprasad R, Mehrotra R. Tobacco use among urban slum dwellers attending a cancer screening clinic in the National Capital Region of India: a cross-sectional study. Ecancermedicalscience 2021; 15:1230. [PMID: 34158834 PMCID: PMC8183651 DOI: 10.3332/ecancer.2021.1230] [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: 03/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco consumption in India varies based on the place of residence (urban/rural). Minimal, exclusive information exists regarding the same for ‘urban slum’ dwellers. The current study determines the tobacco use pattern among such individuals in Noida, Uttar Pradesh (India). Methods A cross-sectional study was conducted among the urban slum residents visiting the institutional clinic between December 2016 and June 2019. Apart from tobacco history, routine recording of the basic demographic details and oral visual examination was carried out for the participants. For categorical data, the percentage of different parameters was calculated and for quantitative data, descriptive statistics were calculated. Chi-square or Fisher’s exact tests were employed to determine the association between the two categorical variables. To find the strength of association between tobacco use and the socio-demographic factors, univariate and multivariable binary logistic regression was used. Results Among 2,043 urban slum respondents (602 male, 1441 female), 15.0% (n = 308) currently consumed tobacco. The majority were smokeless tobacco (SLT) users (among both males and females). Among males, khaini (42.1%) and gutkha (32.5%) and among females gul (36.1%) were the most widely used tobacco products. Conclusion The majority of the Noida urban slum population attending the screening clinic consumed SLT. Gender variation in the tobacco form and product-specific consumption patterns indicates that the undertaking of urban slums-specific surveys is essential. Tobacco control programmes must incorporate appropriate strategies addressing such subgroups of tobacco users.
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Affiliation(s)
- Suzanne T Nethan
- School of Preventive Oncology, A/27, Anandpuri, West Boring Canal Road, Patna 800001, India
| | - Dhirendra N Sinha
- School of Preventive Oncology, A/27, Anandpuri, West Boring Canal Road, Patna 800001, India
| | - Ashwini Kedar
- National Viral Hepatitis Control Program, Ministry of Health & Family Welfare, Nirman Bhawan, Near Udyog Bhawan Metro Station, Maulana Azad Rd, Delhi 110011, India
| | - Vipin Kumar
- Nippon Data System Ltd., B-14, Sector 8, Noida 201301, India
| | - Shashi Sharma
- Senior Biostatistician, C58/25, B902, Jagdamba Apartments, Sector 62, Noida 201307, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, Indian Council of Medical Research-National Institute of Cancer Prevention & Research (ICMR-NICPR), I-7 Sector 39, Noida 201301, India
| | - Ravi Mehrotra
- Chief Executive Officer, ICMR - India Cancer Research Consortium, IRCS Building, Red Cross Road, Delhi 110003, India
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Kalyanasundaram M, Sabde Y, Annerstedt KS, Singh S, Sahoo KC, Parashar V, Purohit M, Pathak A, Lundborg CS, Rousta K, Bolton K, Atkins S, Diwan V. Effects of improved information and volunteer support on segregation of solid waste at the household level in urban settings in Madhya Pradesh, India (I-MISS): protocol of a cluster randomized controlled trial. BMC Public Health 2021; 21:694. [PMID: 33836723 PMCID: PMC8033734 DOI: 10.1186/s12889-021-10693-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Segregation of household waste at the source is an effective and sustainable strategy for management of municipal waste. However, household segregation levels remain insufficient as waste management approaches are mostly top down and lack local support. The realisation and recognition of effective, improved and adequate waste management may be one of the vital drivers for attaining environmental protection and improved health and well-being. The presence of a local level motivator may promote household waste segregation and ultimately pro-environmental behaviour. The present cluster randomized control trial aims to understand if volunteer based information on waste segregation (I-MISS) can effectively promote increased waste segregation practices at the household level when compared with existing routine waste segregation information in an urban Indian setting. METHODS This paper describes the protocol of an 18 month two-group parallel,cluster randomised controlled trialin the urban setting of Ujjain, Madhya Pradesh, India. Randomization will be conducted at ward level, which is the last administrative unit of the municipality. The study will recruit 425 households in intervention and control groups. Assessments will be performed at baseline (0 months), midline (6 months), end line (12 months) and post intervention (18 months). The primary outcome will be the comparison of change in proportion of households practicing waste segregation and change in proportion of mis-sorted waste across the study period between the intervention and control groups as assessed by pick analysis. Intention to treat analysis will be conducted. Written informed consent will be obtained from all participants. DISCUSSION The present study is designed to study whether an external motivator, a volunteer selected from the participating community and empowered with adequate training, could disseminate waste segregation information to their community, thus promoting household waste segregation and ultimately pro-environmental behaviour. The study envisages that the volunteers could link waste management service providers and the community, give a local perspective to waste management, and help to change community habits through information, constant communication and feedback. TRIAL REGISTRATION The study is registered prospectively with Indian Council of Medical Research- Clinical Trial Registry of India ( CTRI/2020/03/024278 ).
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Affiliation(s)
- Madhanraj Kalyanasundaram
- Division of Environmental Health and Epidemiology, ICMR - National Institute for Research in Environmental Health, Bhopal, 462 030, India
| | - Yogesh Sabde
- Division of Environmental Health and Epidemiology, ICMR - National Institute for Research in Environmental Health, Bhopal, 462 030, India
| | | | - Surya Singh
- Division of Environmental Monitoring and Exposure Assessment (Water & Soil), ICMR - National Institute for Research in Environmental Health, Bhopal, 462 030, India
| | | | - Vivek Parashar
- Department of Public Health and Environment, RD Gardi Medical College, Ujjain, 456006, India
| | - Manju Purohit
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Department of Pathology, RD Gardi Medical College, Ujjain, 456006, India
| | - Ashish Pathak
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Department of Paediatrics, RD Gardi Medical College, Ujjain, 456006, India
- Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, SE-751 85, Uppsala, Sweden
| | | | - Kamran Rousta
- Department of Resource Recovery and Building Technology, University of Boras, 50190, Boras, Sweden
| | - Kim Bolton
- Department of Resource Recovery and Building Technology, University of Boras, 50190, Boras, Sweden
| | - Salla Atkins
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, 330 14, Tampere, FI, Finland
| | - Vishal Diwan
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
- Division of Environmental Monitoring and Exposure Assessment (Water & Soil), ICMR - National Institute for Research in Environmental Health, Bhopal, 462 030, India.
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Nguyen PH, Scott S, Headey D, Singh N, Tran LM, Menon P, Ruel MT. The double burden of malnutrition in India: Trends and inequalities (2006-2016). PLoS One 2021; 16:e0247856. [PMID: 33630964 PMCID: PMC7906302 DOI: 10.1371/journal.pone.0247856] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7–8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
- * E-mail:
| | - Samuel Scott
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Derek Headey
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Nishmeet Singh
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Marie T. Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
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Huey SL, Jiang L, Fedarko MW, McDonald D, Martino C, Ali F, Russell DG, Udipi SA, Thorat A, Thakker V, Ghugre P, Potdar RD, Chopra H, Rajagopalan K, Haas JD, Finkelstein JL, Knight R, Mehta S. Nutrition and the Gut Microbiota in 10- to 18-Month-Old Children Living in Urban Slums of Mumbai, India. mSphere 2020; 5:e00731-20. [PMID: 32968008 PMCID: PMC7568645 DOI: 10.1128/msphere.00731-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022] Open
Abstract
In this cross-sectional study, we describe the composition and diversity of the gut microbiota among undernourished children living in urban slums of Mumbai, India, and determine how nutritional status, including anthropometric measurements, dietary intakes from complementary foods, feeding practices, and micronutrient concentrations, is associated with their gut microbiota. We collected rectal swabs from children aged 10 to 18 months living in urban slums of Mumbai participating in a randomized controlled feeding trial and conducted 16S rRNA sequencing to determine the composition of the gut microbiota. Across the study cohort, Proteobacteria dominated the gut microbiota at over 80% relative abundance, with Actinobacteria representation at <4%, suggesting immaturity of the gut. Increased microbial α-diversity was associated with current breastfeeding, greater head circumference, higher fat intake, and lower hemoglobin concentration and weight-for-length Z-score. In redundancy analyses, 47% of the variation in Faith's phylogenetic diversity (Faith's PD) could be accounted for by age and by iron and polyunsaturated fatty acid intakes. Differences in community structure (β-diversity) of the microbiota were observed among those consuming fats and oils the previous day compared to those not consuming fats and oils the previous day. Our findings suggest that growth, diet, and feeding practices are associated with gut microbiota metrics in undernourished children, whose gut microbiota were comprised mainly of Proteobacteria, a phylum containing many potentially pathogenic taxa.IMPORTANCE The impact of comprehensive nutritional status, defined as growth, nutritional blood biomarkers, dietary intakes, and feeding practices, on the gut microbiome in children living in low-resource settings has remained underreported in microbiome research. Among undernourished children living in urban slums of Mumbai, India, we observed a high relative abundance of Proteobacteria, a phylum including many potentially pathogenic species similar to the composition in preterm infants, suggesting immaturity of the gut, or potentially a high inflammatory burden. We found head circumference, fat and iron intake, and current breastfeeding were positively associated with microbial diversity, while hemoglobin and weight for length were associated with lower diversity. Findings suggest that examining comprehensive nutrition is critical to gain more understanding of how nutrition and the gut microbiota are linked, particularly in vulnerable populations such as children in urban slum settings.
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Affiliation(s)
- Samantha L Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Lingjing Jiang
- Division of Biostatistics, University of California, San Diego, California, USA
| | - Marcus W Fedarko
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
| | - Daniel McDonald
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Cameron Martino
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, California, USA
| | - Farhana Ali
- Department of Bioengineering, University of California, San Diego, California, USA
| | - David G Russell
- Department of Microbiology and Immunology, Cornell University, Ithaca, New York, USA
| | - Shobha A Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - R D Potdar
- Centre for the Study of Social Change, Mumbai, India
| | - Harsha Chopra
- Centre for the Study of Social Change, Mumbai, India
| | - Kripa Rajagopalan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Jere D Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York, USA
| | - Rob Knight
- Department of Bioengineering, University of California, San Diego, California, USA
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York, USA
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22
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Testing the theoretical similarities between food and water insecurity: Buffering hypothesis and effects on mental wellbeing. Soc Sci Med 2020; 244:112412. [DOI: 10.1016/j.socscimed.2019.112412] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022]
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The role of epigenetics in respiratory health in urban populations in low and middle-income countries. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2019; 4:e8. [PMID: 32047643 PMCID: PMC6983949 DOI: 10.1017/gheg.2019.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As urbanization increases in low- and middle-income countries (LMICs), urban populations will be increasingly exposed to a range of environmental risk factors for non-communicable diseases. Inadequate living conditions in urban settings may influence mechanisms that regulate gene expression, leading to the development of non-communicable respiratory diseases. We conducted a systematic review of the literature to assess the relationship between respiratory health and epigenetic factors to urban environmental exposures observed in LMICs using MEDLINE, PubMed, EMBASE, and Google Scholar searching a combination of the terms: epigenetics, chronic respiratory diseases (CRDs), lung development, chronic obstructive airway disease, and asthma. A total of 2835 articles were obtained, and 48 articles were included in this review. We found that environmental factors during early development are related to epigenetic effects that may be associated with a higher risk of CRDs. Epigenetic dysregulation of gene expression of the histone deacetylase (HDAC) and histone acetyltransferase gene families was likely involved in lung health of slum dwellers. Respiratory-related environmental exposures influence HDAC function and deoxyribonucleic acid methylation and are important risk factors in the development of CRD. Additional epigenetic research is needed to improve our understanding of associations between environmental exposures and non-communicable respiratory diseases.
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Global Ambitions, Local Contexts: Alternative Ways of Knowing the World. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2019. [DOI: 10.3390/ijgi8110516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this Special Issue, we bring together contributions from authors in the scientific discipline Geo-Information Science who engaged with the question: How does Geo-Information Science contribute to the development of Sustainable Development Goals (SDG) indicators? The editorial to the Special Issue situates the individual contributions in a broader social science debate, which critically examines the quantification of global policy goals and its effects on how we know and govern the world. We put forward concepts of ‘measuring the world’ and a brief history of the Geo-Information Science discipline, including its dominant positivist paradigm as well as scholarly debates that reflected on and shifted that paradigm. Given the global policy focus of the SDGs, we also briefly discuss policy science paradigms. We analyze the individual articles with regard to their contribution to the SDG indicator development trajectory. We also show how alternative ways of knowing and governing the world complement the dominant positivist paradigm.
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Huey SL, Finkelstein JL, Venkatramanan S, Udipi SA, Ghugre P, Thakker V, Thorat A, Potdar RD, Chopra HV, Kurpad AV, Haas JD, Mehta S. Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study. Front Public Health 2019; 7:191. [PMID: 31355176 PMCID: PMC6639755 DOI: 10.3389/fpubh.2019.00191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.
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Affiliation(s)
- Samantha Lee Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Julia Leigh Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
| | - Sudha Venkatramanan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Shobha A. Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | | | | | - Anura V. Kurpad
- Department of Physiology, St. John's Research Institute, Bangalore, India
| | - Jere Douglas Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
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Ssemugabo C, Wafula ST, Ndejjo R, Oporia F, Osuret J, Musoke D, Halage AA. Knowledge and practices of households on safe water chain maintenance in a slum community in Kampala City, Uganda. Environ Health Prev Med 2019; 24:45. [PMID: 31200642 PMCID: PMC6570909 DOI: 10.1186/s12199-019-0799-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background More than half of the disease burden in Uganda can be prevented through improving water, sanitation, and hygiene (WASH). In slum communities, water supply is insufficient but also highly contaminated; therefore, ensuring that the safe water chain is maintained by households is paramount to preventing water-related diseases. This study aimed at assessing knowledge and practices of households on safe water chain maintenance in slum communities in Kampala City, Uganda. Methods This was a community-based cross-sectional study carried out among 395 households in slum communities in Kampala, Uganda. Data were collected using a semi-structured questionnaire. Prevalence ratios (PRs) and their 95% confidence intervals were used as a measure of association between safe water chain management and associated knowledge and practice factors. The PRs were obtained using a multivariable modified Poisson regression with logarithm as the link function, with robust standard errors. Results Majority (76.7%, 303/395) of the households collected their water from a piped water system and paid for the water (72.9%, 288/395). Almost all (97.2%, 384/395) of the participants said that they knew the dangers associated with drinking unsafe water, boiled their drinking water (95.4%, 377/395), and used storage containers that minimize contamination (97.0%, 383/395). However, only (32.4%, 128/395) of the households satisfactorily maintained the safe water chain. Female- (adjusted PR = 1.82, 95% CI (1.19–2.78)) and student-led households (adjusted PR = 1.58, 95% CI (1.03–2.41)) and those whose heads had attained post-primary education (adjusted PR = 1.48, 95% CI (1.02–2.17)) were more likely to satisfactorily maintain the safe water chain. This was similar among members who thought most contamination occurs during storage (adjusted PR = 1.47, 95% CI (1.10–1.97)). Conclusion Only a third of the households maintained the safe water chain satisfactory. Female-led, student-led, and post-primary educated-led household and household that thought most contamination occurs during storage were more likely to maintain the safe water chain. There is a need to improve the level of awareness about the importance of the safe water chain among slum dwellers.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Frederick Oporia
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdullah Ali Halage
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Debnath R, Bardhan R, Sunikka-Blank M. Discomfort and distress in slum rehabilitation: Investigating a rebound phenomenon using a backcasting approach. HABITAT INTERNATIONAL 2019; 87:75-90. [PMID: 31217651 PMCID: PMC6559131 DOI: 10.1016/j.habitatint.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/26/2019] [Accepted: 03/30/2019] [Indexed: 05/03/2023]
Abstract
Slum rehabilitation policies in India is observed to have a rebound effect on the occupants, where rehabilitated occupants move back to the horizontal slums. In this study, we investigate the cause behind this rebound phenomenon based on a theory of homeostasis, where the loss of homeostasis refers to occupants' heightened discomfort and distress in their built environment. A novel methodological framework was developed to investigate it based on the principles of participatory backcasting approach and the theory of homeostasis. Thirty households in Mumbai's slum rehabilitation housing were interviewed to determine the social, economic and environmental cause of distress and discomfort. Granular information was obtained by further investigating the factors that influence occupants' attitude, emotions, health, control and habits in their built environment that regulates their holistic comfort and lack of stress. The causal linkages among these factors were established using a qualitative fault tree. Results show two primary cause of distress and discomfort in the study area owing to economic distress and built environment related discomfort. Economic distress was from low-income and high electricity bills due to higher household appliance ownership, and built environment discomfort was due to lack of social spaces and poor design of the slum rehabilitation housing. This study showed that mitigating such non-income drivers of distress and discomfort can prevent rebound phenomenon and improve the sustainability of the slum rehabilitation process.
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Affiliation(s)
- Ramit Debnath
- Behaviour and Building Performance Group, Department of Architecture, University of Cambridge, CB21PX, UK
- Centre for Sustainable Development, Department of Engineering, University of Cambridge, CB21PZ, UK
| | - Ronita Bardhan
- Centre for Research in Arts, Social Science and Humanities, University of Cambridge, CB39DT, UK
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, 400076, India
| | - Minna Sunikka-Blank
- Behaviour and Building Performance Group, Department of Architecture, University of Cambridge, CB21PX, UK
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The Scope of Earth-Observation to Improve the Consistency of the SDG Slum Indicator. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2018. [DOI: 10.3390/ijgi7110428] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The continuous increase in deprived living conditions in many cities of the Global South contradicts efforts to make cities inclusive, safe, resilient, and sustainable places. Using examples of Asian, African, and Latin American cities, this study shows the scope and limits of earth observation (EO)-based mapping of deprived living conditions in support of providing consistent global information for the SDG indicator 11.1.1 “proportion of urban population living in slums, informal settlements or inadequate housing”. At the technical level, we compare several EO-based methods and imagery for mapping deprived living conditions, discussing their ability to map such areas including differences in terms of accuracy and performance at the city scale. At the operational level, we compare available municipal maps showing identified deprived areas with the spatial extent of morphological mapped areas of deprived living conditions (using EO) at the city scale, discussing the reasons for inconsistencies between municipal and EO-based maps. We provide an outlook on how EO-based mapping of deprived living conditions could contribute to a global spatial information base to support targeting of deprived living conditions in support of the SDG Goal 11.1.1 indicator, when uncertainties and ethical considerations on data provision are well addressed.
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Capturing the Diversity of Deprived Areas with Image-Based Features: The Case of Mumbai. REMOTE SENSING 2017. [DOI: 10.3390/rs9040384] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ezeh A, Oyebode O, Satterthwaite D, Chen YF, Ndugwa R, Sartori J, Mberu B, Melendez-Torres GJ, Haregu T, Watson SI, Caiaffa W, Capon A, Lilford RJ. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 2017; 389:547-558. [PMID: 27760703 DOI: 10.1016/s0140-6736(16)31650-6] [Citation(s) in RCA: 283] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.
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Affiliation(s)
- Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory Research and Capacity Development Branch, United Nations Human Settlements Programme, UN Avenue Gigiri, UN Complex, GPO Nairobi, Kenya
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | | | - Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
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Nolan LB. Rural–Urban Child Height for Age Trajectories and Their Heterogeneous Determinants in Four Developing Countries. POPULATION RESEARCH AND POLICY REVIEW 2016. [DOI: 10.1007/s11113-016-9399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Objective A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum’s residents. Methods Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators—quantity, access, price, reliability, and equity—were collected via a structured survey of 521 households selected using population-based random sampling. Results In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts—on household economy, employment, education, quality of life, social cohesion, and people’s sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Conclusions Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household “water poverty” that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.
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