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Raoofi A, Amirkhani M, Monjazeb M, Peykari N. The Slums in the Mirror of Health: A Systematic Review Analysis from Iran. Int J Prev Med 2022; 13:137. [PMID: 36618537 PMCID: PMC9811963 DOI: 10.4103/ijpvm.ijpvm_71_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/14/2021] [Indexed: 01/10/2023] Open
Abstract
Background One billion worldwide population is living in slum areas that mostly accompanied with high rates of poverty, illiteracy, unemployment, unhealthy situation, and inappropriate health-care services. The prediction of enormous growth of slums by 2030 led to a raise to address the "plight of slums" in Sustainable Development Goals (SDGs). Methods To address evidence-based health-related priorities, we conducted a systematic review to summarizing evidences on health situations of slums population in Iran. Six electronic databases were systematically searched for published studies without any restriction on age, sex, and language to assess health situations of slums in Iran reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. All identified articles were screened, quality assessed, and data extracted by two authors independently. Results The finding of this systematic review in addition to overall view categorized in five categories: health system, reproductive health, infectious diseases, noncommunicable diseases and their risk factors, social issues besides overall situation of Slums. Conclusions Community-based participatory interventions with socioeconomic approach on modifiable risk factors; active response of health system; establishment new health care centers in slum areas; augmenting the quality of care; active case finding; and elevating health knowledge, attitude, and practice is crucial to achieve SDG's in Slum area.
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Affiliation(s)
- Azam Raoofi
- Ph.D. Student of Health Policy, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Manzar Amirkhani
- Ph.D., Ministry of Health and Medical Education, Shahid Beheshty University, Tehran, Iran
| | - Maryam Monjazeb
- MSc of Landscape Architecture, Shahid Beheshty University, Tehran, Iran
| | - Niloofar Peykari
- Ph.D. of Epidemiology, Associate Professor, Ministry of Health and Medical Education, Tehran, Iran,Address for correspondence: Dr. Niloofar Peykari, Associate Professor, Epidemiology, Ministry of Health and Medical Education, Tehran, Iran. Ministry of Health and Medical Education, Eyvanak St, Qods Town, Tehran, Iran. E-mail:
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Attafuah PYA, Everink IHJ, Lohrmann C, Abuosi AA, Schols JMGA. Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals. Front Public Health 2022; 10:988076. [PMID: 36299759 PMCID: PMC9589493 DOI: 10.3389/fpubh.2022.988076] [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: 07/06/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Background Besides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care. Aims This study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults. Method A qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant. Results A total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement. Conclusion Health professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.
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Affiliation(s)
- Priscilla Yeye Adumoah Attafuah
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana,Department of Health Services Research and Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands,*Correspondence: Priscilla Yeye Adumoah Attafuah
| | - Irma H. J. Everink
- Department of Health Services Research and Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Christa Lohrmann
- Department of Nursing, Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Aaron Asibi Abuosi
- Health Services Management Department, University of Ghana Business School, Accra, Ghana
| | - Jos M. G. A. Schols
- Department of Health Services Research and Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands,Department of Family Medicine and Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Mehrolhassani MH, Yazdi-Feyzabadi V, Rafiee N, Ghasemi S. Health protection challenges of slums residents during the COVID-19 pandemic, according to the social determinants of health framework: A case study of Kerman city in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:197. [PMID: 36003257 PMCID: PMC9393957 DOI: 10.4103/jehp.jehp_958_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) pandemic can aggravate the health problems in slum areas. The present study intends to examine the challenges of health protection of slum's residences during the COVID-19 pandemic with the Social Determinants of Health perspective, in Kerman city in Iran. MATERIALS AND METHODS The present study was a qualitative content analysis. Data were collected by purposeful sampling in-depth and semi-structured interviews with 16 people. The interviews were conducted (from October to December 2020) with the local representatives of the slum's residents, health-care workers, managers of facilitation offices, and welfare social service centers that are located in slum areas (Interview's guide is attached). The textual material from the interviews was entered into the MAXQDA software and directed content analysis was used to analyze the data. RESULTS Data analysis led to the identification of 4 categories (Sociocultural, Situational, Economical, and Physical environment) and 12 subcategories: Sociocultural: lack of awareness, begging culture, low trust in disease control programs, low bottom-up planning, and increasing violence; Situational: decreasing donors' activities and canceling important meetings; Economical: unemployment, decreasing in income, and increasing limitations of many institutions in providing resources; and Physical environment: inadequate space and inappropriate conditions in some houses and alleys for people protection against Corona viruses. CONCLUSIONS Slum residents have faced many challenges during the COVID-19 pandemic. These challenges can affect the health of slum and other urban dwellers. Multidisciplinary thinking and actions are needed. Increase awareness and engagement slum residents in control disease programs should be considered.
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Affiliation(s)
- Mohammad Hossein Mehrolhassani
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Noora Rafiee
- Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Ghasemi
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Fayehun O, Ajisola M, Uthman O, Oyebode O, Oladejo A, Owoaje E, Taiwo O, Odubanjo O, Harris B, Lilford R, Omigbodun A. A contextual exploration of healthcare service use in urban slums in Nigeria. PLoS One 2022; 17:e0264725. [PMID: 35213671 PMCID: PMC8880927 DOI: 10.1371/journal.pone.0264725] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria. Methods The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants’ environmental and population characteristics, relative to their patterns of healthcare use. Results A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed. Conclusion The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa.
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Affiliation(s)
- Olufunke Fayehun
- Department of Sociology, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | | | - Olalekan Uthman
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Abiola Oladejo
- Department of Sociology, University of Ibadan, Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olalekan Taiwo
- Department of Geography, University of Ibadan, Ibadan, Nigeria
| | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Akinyinka Omigbodun
- Department of Obstetrics & Gynecology, University of Ibadan, Ibadan, Nigeria
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Attafuah PYA, Everink I, Abuosi AA, Lohrmann C, Schols JMGA. Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study. BMJ Open 2022; 12:e057264. [PMID: 35149573 PMCID: PMC8845194 DOI: 10.1136/bmjopen-2021-057264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana. DESIGN The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire. SETTINGS Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community. PARTICIPANTS This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally. RESULTS Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains. CONCLUSIONS The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.
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Affiliation(s)
- Priscilla Yeye Adumoah Attafuah
- Community Health Nursing Department, School of Nursing and Midwivery, University of Ghana, Legon, Ghana
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Irma Everink
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Aaron Asibi Abuosi
- Public Administration and Health Services Management, University of Ghana, Legon, Ghana
| | - Christa Lohrmann
- Department of Nursing Science, Medical University of Graz, Graz, Austria
| | - Jos M G A Schols
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Mehrolhasani MH, Yazdi-Feyzabadi V, Ghasemi S. Community empowerment for health promotion in slums areas: A narrative review with emphasis on challenges and interventions. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:263. [PMID: 34485560 PMCID: PMC8396054 DOI: 10.4103/jehp.jehp_1628_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 06/13/2023]
Abstract
Community empowerment has been proposed since the 1980s as a way to increase people's power to influence social determinants of health. However, community empowerment for health promotion in urban slums still faces challenges. The present study examined interventions, challenges, actors, scopes, and the consequences mentioned in various studies and with emphasizing interventions and executive challenges tried to create a clear understanding of empowerment programs in slums and improving their health. Narrative review method was used to conduct the study. Databases including PubMed, Scopus, Embase, Web of Science, and Cochrane were searched. The selection of studies was done according to the "community empowerment" defined by the World Health Organization, the concept of bottom-up approach for health promotion of Laverack and Labonte's study and definition of slums by UN-HABITAT. Finally, Hare and Noblit's meta-synthesis was used to analyze the studies. From 15 selected studies, the most intervention proposed for empowerment was identified to be "residents' participation in expressing problems and solutions." The challenge of "creating a sense of trust and changing some attitudes among residents" was the greatest challenge in the studies. Moreover, "improving living conditions and health services" were the most important outcomes, "slum residents" and "governments" were the most important actors, and "sanitation" was the most important scope among the studies. Having a comprehensive view to the health and its determinants and attention to the factors beyond neighborhood and health sector would lead to fewer implementation challenges and better intervention choices to health promotion of slum dwellers.
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Affiliation(s)
- Mohammad Hosein Mehrolhasani
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Ghasemi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Poortaheri N, Alimohammadzadeh K, Hosseini SM, Maher A, Bahadori M. Health needs assessment of the residents of the informal settlements in South-Eastern Iran: A case study of Bam city. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:239. [PMID: 34395676 PMCID: PMC8318141 DOI: 10.4103/jehp.jehp_1448_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/12/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Informal settlements are considered as one of the social problems in societies. As the residents do not have adequate access to basic services, including health services, their health is at risk. This study was conducted to evaluate the access to health services and determine the health needs of informal settlements in Bam city. MATERIALS AND METHODS This cross-sectional study was carried out in the spring of 2020 in Bam. The sample size was 400 residents of informal settlements in Bam, and the multi-stage random cluster sampling was used. A researcher-made questionnaire was used to collect the required data. The validity of the questionnaire was confirmed using the content validity, and its reliability was 85% by Cronbach's alpha. The data were analyzed using the SPSS version 23 software and descriptive statistics (frequency, mean, standard deviation, and percentage) as well as analytical statistics (Mann-Whitney and Kruskal-Wallis tests). RESULTS More than 50% of the individuals had good access to general practitioners and health centers. However, over 50% had poor access to dental, para-clinical, specialist, and hospital services. Furthermore, 49.3% of the people assessed their health status as poor in the previous year. A total of 46 items in the areas of communicable and non-communicable diseases, women's health, mental and social health and addiction, environmental health, etc., were identified as the most important health needs of the informal settlement residents. CONCLUSION Informal settlements are facing various health problems including environmental health, mental and social health, and addiction, meeting which requires collaboration of all stakeholders as well as provision of a comprehensive program and appropriate service packages.
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Affiliation(s)
- Naeimeh Poortaheri
- PhD Student in Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Associate Professor, Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran/Health Economics Policy Research Center, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Assistant Professor, Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ali Maher
- Assistant Professor, Department of Health Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Full Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Ortiz-Rodríguez MA, Aldaz-Rodríguez MV, González-Robledo LM, Villa A, Bouzas C, Pastor R, Tur JA. Association between the Use of Health Services, Cardiovascular Risk Factors and Metabolic Syndrome in Mexican Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5336. [PMID: 34067845 PMCID: PMC8156833 DOI: 10.3390/ijerph18105336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Background: The use of health services is a complex behavioral phenomenon affected by multiple factors (availability, distance, cost, quality, attitudes, cultural beliefs, socioeconomic characteristics, and individuals' self-perception of health). Mexico has a segmented health system, and the access to it depends on the labor insertion and the population's ability to pay. Objective: To assess association between use of health services and cardiovascular and metabolic syndrome risk factors among Mexican adults. Methods: Analytical cross-sectional nationally representative study carried out on Mexican adults (≥20-year-old adults of both sexes; n = 4595). Socioeconomic factors, geographic area, health care coverage, information about the use of health services, previous medical diagnoses of diabetes and hypertension, and smoking were assessed. Anthropometrics, triglyceride, total cholesterol, HDL-cholesterol, and glucose plasma levels were measured. Metabolic syndrome (MetS) and cardiovascular risk factors were assessed. Prevalences were expressed in terms of percentages, and significant differences were calculated using χ2 test. Univariate and multivariate analysis was performed to evaluate the association between the use of health services and cardiovascular risk factors and sociodemographic variables. Results: The probability of using health services is higher and more significant in subjects with obesity, diabetes (OR (95% CI): 1.73 (1.49-2.00; p < 0.001), hypertension (OR (95% CI): 1.29 (1.14-1.45; p < 0.001), hypertriglyceridemia (OR (95% CI): 1.30 (1.15-1.46; p < 0.001), and in those with hypercholesterolemia (OR (95% CI): 1.23 (1.03-1.39; p = 0.001). Conclusions: Among health service users, there is a positive significant association between the use of health services and the presence of metabolic syndrome, obesity, diabetes, hypertension, hypertriglyceridemia, and hypercholesterolemia.
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Affiliation(s)
- María Araceli Ortiz-Rodríguez
- Faculty of Nutrition, Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico; (M.A.O.-R.); (L.M.G.-R.)
| | | | - Luz María González-Robledo
- Faculty of Nutrition, Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico; (M.A.O.-R.); (L.M.G.-R.)
| | - Antonio Villa
- Faculty of Medicine, National Autonomous University of Mexico, México City 04360, Mexico; (M.V.A.-R.); (A.V.)
| | - Cristina Bouzas
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Faculty of Health Sciences, Catholic University of Avila, 05005 Avila, Spain
| | - Rosario Pastor
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- Faculty of Health Sciences, Catholic University of Avila, 05005 Avila, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
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Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2020; 97:348-357. [PMID: 32333243 PMCID: PMC7182092 DOI: 10.1007/s11524-020-00438-6] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.
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Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA USA
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology unit, University of Cambridge, UK & School of Public Health and Family Medicine, Cambridge, UK
- University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
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