Seroprevalence and renal carriage of pathogenic Leptospira in livestock in Cotonou, Benin

BACKGROUND

Leptospirosis is a zoonotic disease. It is particularly prevalent in tropical countries and has major consequences for human and animal health. In Benin, the disease's epidemiology remains poorly understood, especially in livestock, for which data are lacking.

OBJECTIVES

To characterise Leptospira seroprevalence and locally circulating serogroups in livestock from Cotonou and to estimate the prevalence of Leptospira renal carriage in cattle.

METHODS

We conducted a cross-sectional study in February 2020 during which livestock were sampled at an abattoir and in an impoverished city district. We analysed blood samples from 279 livestock animals (i.e. cattle, sheep, goats and pigs) using the microscopic agglutination test. Additionally, samples of renal tissue from 100 cattle underwent 16s rRNA (rrs) real-time PCR analysis.

RESULTS

For the 131 cattle, 85 sheep, and 50 goats tested, seroprevalence was 18% (95% confidence interval [CI] [12%, 26%]), 9% (95% CI [4%, 17%] and 2% (95% CI [0%, 9%]), respectively, and most of the seropositive animals were associated with 1:100 titres. All 13 pigs were seronegative. Leptospira DNA was found in the renal tissue of 10% (95% CI [5%, 18%]) of the cattle tested (n = 100). Leptospira borgpetersenii was the main species present (n = 7), but Leptospira interrogans (n = 2) and Leptospira kirschneri (n = 1) were also detected. Various serogroups (Canicola, Grippotyphosa, Sejroe, Icterohaemorrhagiae, Pomona, Pyrogenes, Australis and Autumnalis) were detected using microscopic agglutination test without a clear predominance of any of them.

CONCLUSIONS

These results suggest that abattoir workers and people living in close contact with livestock in poor urban areas are exposed to the risk of Leptospira infection.

Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh

BACKGROUND

Typhoid fever, or enteric fever, is a highly fatal infectious disease that affects over 9 million people worldwide each year, resulting in more than 110,000 deaths. Reduction in the burden of typhoid in low-income countries is crucial for public health and requires the implementation of feasible water, sanitation, and hygiene (WASH) interventions, especially in densely populated urban slums.

OBJECTIVE

In this study, conducted in Mirpur, Bangladesh, we aimed to assess the association between household WASH status and typhoid risk in a training subpopulation of a large prospective cohort (n=98,087), and to evaluate the performance of a machine learning algorithm in creating a composite WASH variable. Further, we investigated the protection associated with living in households with improved WASH facilities and in clusters with increasing prevalence of such facilities during a 2-year follow-up period.

METHODS

We used a machine learning algorithm to create a dichotomous composite variable ("Better" and "Not Better") based on 3 WASH variables: private toilet facility, safe drinking water source, and presence of water filter. The algorithm was trained using data from the training subpopulation and then validated in a distinct subpopulation (n=65,286) to assess its sensitivity and specificity. Cox regression models were used to evaluate the protective effect of living in "Better" WASH households and in clusters with increasing levels of "Better" WASH prevalence.

RESULTS

We found that residence in households with improved WASH facilities was associated with a 38% reduction in typhoid risk (adjusted hazard ratio=0.62, 95% CI 0.49-0.78; P<.001). This reduction was particularly pronounced in individuals younger than 10 years at the first census participation, with an adjusted hazard ratio of 0.49 (95% CI 0.36-0.66; P<.001). Furthermore, we observed an inverse relationship between the prevalence of "Better" WASH facilities in clusters and the incidence of typhoid, although this association was not statistically significant in the multivariable model. Specifically, the adjusted hazard of typhoid decreased by 0.996 (95% CI 0.986-1.006) for each percent increase in the prevalence of "Better" WASH in the cluster (P=.39).

CONCLUSIONS

Our findings demonstrate that existing variations in household WASH are associated with differences in the risk of typhoid in densely populated urban slums. This suggests that attainable improvements in WASH facilities can contribute to enhanced typhoid control, especially in settings where major infrastructural improvements are challenging. These findings underscore the importance of implementing and promoting comprehensive WASH interventions in low-income countries as a means to reduce the burden of typhoid and improve public health outcomes in vulnerable populations.

Health-seeking behaviour and its determinants of health of Under-5 Children living in urban slums of Chennai, India 2018

Background

Appropriate health-seeking behaviour could help in reducing child mortality and morbidity. Information on social factors of mortality and health-seeking behaviours of caregivers of under-5 children from slums of Indian cities is minimal in literature.

Objectives

We estimated the prevalence of health-seeking behaviour for morbidity ofunder-5 children and its determinants in urban slums in Chennai city, India.

Methods

A cross-sectional study was conducted using a mixed-method design among primary caregivers of under-5 children living in Chennai slums, India. Two-stage cluster sampling was adopted to select 40 slums. A total of 233 primary caregivers were interviewed. Nine focus group discussions and 18 in-depth interviews were conducted among the primary caregivers. Prevalence of inappropriate health-seeking behaviour was estimated, and determinants were identified by multivariate binary logistic regression analysis. Thematic analysis was done on qualitative data.

Results

We interviewed 233 primary caregivers. The weighted prevalence of inappropriate health-seeking behaviour for under-five children in urban slums of Chennai was 53.9% (95% CI: 46.9 - 60.8). Primary caregivers educated above secondary school were more likely (AOR of 2.3, 95% CI: 1.3-4.1) to follow inappropriate health-seeking behaviour compared to those educated below. Similarly, caregivers who were unaware of young child feeding practices (AOR of 3.6, 95% CI: 1.9-6.5) and early care-seeking and health practices (AOR of 2.5, 95% CI: 1.3-4.9) were more likely to engage in inappropriate health-seeking behaviour compared to those who were aware and we found that illness symptoms influenced health-seeking behaviour and that early disease detection might prevent severe illness.

Conclusion

Health-seeking behaviour was found to be suboptimal among under-5 children in Chennai's urban slums. We suggest policymakers improve interventions on early care-seeking of common childhood illnesses in the urban health programme.

Factors Associated With Parent-Adolescent Communication on Sexual and Reproductive Health Issues in Urban Slums of Ibadan, Southwest Nigeria

In Nigeria, adolescents in urban slums are increasingly at risk of adverse sexual and reproductive health (SRH) outcomes. However, little is known about how individual factors predict parent-adolescent communication on SRH issues in a resource-poor urban setting in Ibadan. Thus, this study investigated individual factors associated with parent-adolescent communication on SRH issues in urban slums of Ibadan, southwest, Nigeria. This study is part of a larger project that explores the socio-ecological factors influencing parent-adolescent communication on SRH issues in selected slums in Ibadan, Nigeria. Within this broader framework, this paper relies on the quantitative data obtained in 10 selected slums. Interviewer-administered structured questionnaire [scripted on open data kits (ODK)] was utilized to collect data from a sample of 796 parent-adolescent dyads. Six SRH topics were investigated to describe the issues discussed. Analytical techniques utilized include; frequency counts, chi-square, and multinomial logistic regression. Parent-adolescent communication regarding SRH issues is not uncommon in urban slums of Ibadan but characterized by indirect communication, threat and warning. Parents and adolescents' age, gender, marital/relationship status, educational attainments and religion played influential role in parent-adolescent communication regarding SRH issues. These factors were identified to be significantly associated with the pattern of parent-adolescent discussion of SRH issues. Age-specific SRH education should be available to adolescents and parents need to be educated on appropriate SRH information and the best way to engage their adolescents on SRH issues.

Cervical cancer awareness and risk factors among women residing in an urban slum in Lagos, Southwest Nigeria

Background

Poor awareness of cervical cancer and high prevalence of its risk factors may be responsible for the large burden of cervical cancer in low-income countries. This study assessed awareness of cervical cancer and prevalence of risk factors among women residing in a slum in Lagos, Nigeria.

Methods

This was a descriptive cross-sectional study carried out amongst 305 women of reproductive age (15-49 years) in Idi-Araba, a slum in Urban Lagos. Data were collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software.

Results

Mean age of respondents was 33.5(9.0) years. Only 12.8% of the respondents had heard of cervical cancer. Ninety-five percent of respondents were sexually active and 56.2% had more than one lifetime sexual partner. Close to half (47.3%) of respondents had their first sexual intercourse before the age of 20. One in five (22.2%) had 5 or more children. Half of the respondents (54.8%) had had abnormal vaginal discharge.

Conclusion

Awareness of cervical cancer among the women was poor and prevalence of risk factors of cervical cancer was high. Campaigns aimed at increasing awareness of cervical cancer, and screening should be carried out by governmental and charitable organizations for women residing in slums.

Tracking Water, Sanitation, and Hygiene Practices: Waste Management and Environmental Cleaning in the Slums of North India

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.

Factors associated with fathers' involvement in infant and young child feeding and nurturing care in the urban slums of Bangladesh: A cross-sectional study

Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context-specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross-sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p < .00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p = .00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p = .03). Having child in the age group of 14-20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21-30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p = .01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development.

Health-Seeking Behavior Regarding Coughs in Urban Slums in Lagos, Nigeria

BACKGROUND

TB is a major cause of morbidity and mortality, with slum residents being disproportionately affected. This study aimed to assess health-seeking behavior among adult residents of slum communities presenting with coughs in Lagos, Nigeria.

METHODS

A community-based, cross-sectional study was conducted across six urban slums in Nigeria as part of community outreaches to mark World TB Day. A structured, pretested questionnaire was used to capture relevant sociodemographic details and questions regarding symptoms of coughs and related symptoms as well as care-seeking behavior. Data were explored, analyzed, and presented using descriptive statistics.

RESULTS

A total of 632 respondents participated in this study. The majority were 25-34 years old (24.7%), male (65.8%), Christian (55.7%), married (73.7%), with secondary education (37.8%), with 3-4 persons per household (41%) and with 1-2 persons per room (44.5%). In total, 26.6% had had a cough for two weeks or more and were considered as presumptive TB patients. Overall, 37.2% of respondents with a cough visited patent proprietary medicine vendors (PPMVs) as the first port of call. Good health-seeking behavior was exhibited by only 36.2% of respondents. In total, 38.9% delayed seeking care from a health facility (government or private) more than one month after the onset of symptoms. None of the factors included in the multivariate analysis showed a significant association with good health-seeking behavior (i.e., visiting government or private hospitals/clinics).

CONCLUSIONS

The poor health-seeking behavior, delay in seeking TB care and preference for PPMVs emphasizes the need for National tuberculosis programs (NTPs) to further engage these informal providers in TB prevention, diagnosis and treatment services in urban slum communities.

Factors Associated with Reported COVID-like Symptoms and Seroprevalence Data Matched with COVID-like Symptoms in Slums and Non-Slums of Two Major Cities in Bangladesh

OBJECTIVES

To examine the levels and socio-demographic differentials of: (a) reported COVID-like symptoms; and (b) seroprevalence data matched with COVID-like symptoms.

METHODS

Survey data of reported COVID-like symptoms and seroprevalence were assessed by Roche Elecsys^® Anti-SARS-CoV-2 immunoassay. Survey data of 10,050 individuals for COVID-like symptoms and seroprevalence data of 3205 individuals matched with COVID-like symptoms were analyzed using bivariate and multivariate logistic analysis.

RESULTS

The odds of COVID-like symptoms were significantly higher for Chattogram city, for non-slum, people having longer years of schooling, working class, income-affected households, while for households with higher income had lower odd. The odds of matched seroprevalence and COVID-like symptoms were higher for non-slum, people having longer years of schooling, and for working class. Out of the seropositive cases, 37.77% were symptomatic-seropositive, and 62.23% were asymptomatic, while out of seronegative cases, 68.96% had no COVID-like symptoms.

CONCLUSIONS

Collecting community-based seroprevalence data is important to assess the extent of exposure and to initiate mitigation and awareness programs to reduce COVID-19 burden.

COVID-19 Vaccine Acceptance, Attitude and Perception among Slum and Underserved Communities: A Systematic Review and Meta-Analysis

This systematic review summarises the literature on Coronavirus Disease 2019 (COVID-19) vaccination, including acceptance, uptake, hesitancy, attitude and perceptions among slum and underserved communities. Relevant studies were searched from PubMed, Scopus, Web of Science and Google Scholar, following a pre-registered protocol in PROSPERO (CRD42022355101) and PRISMA guidelines. We extracted data, used random-effects models to combine the vaccine acceptance, hesitancy and uptake rates categorically, and performed meta-regression by R software (version 4.2.1). Twenty-four studies with 30,323 participants met the inclusion criteria. The overall prevalence was 58% (95% CI: 49-67%) for vaccine acceptance, 23% (95% CI: 13-39%) for uptake and 29% (95% CI: 18-43%) for hesitancy. Acceptance and uptake were positively associated with various sociodemographic factors, including older age, higher education level, male gender, ethnicity/race (e.g., Whites vs African Americans), more knowledge and a higher level of awareness of vaccines, but some studies reported inconsistent results. Safety and efficacy concerns, low-risk perception, long distance to vaccination centres and unfavourable vaccination schedules were prominent reasons for hesitancy. Moreover, varying levels of attitudes and perceptions regarding COVID-19 vaccination were reported with existing misconceptions and negative beliefs, and these were strong predictors of vaccination. Infodemic management and continuous vaccine education are needed to address existing misconceptions and negative beliefs, and this should target young, less-educated women and ethnic minorities. Considering mobile vaccination units to vaccinate people at home or workplaces would be a useful strategy in addressing access barriers and increasing vaccine uptake.

Influence of Water Hyacinth (Eichhornia crassipes) on Concentration and Distribution of Escherichia coli in Water Surrounding an Informal Floating Community in Iquitos, Peru

Floating communities exist throughout the world. Many live on water with a high pathogen load due to difficulties associated with sewage management. In Claverito, an informal floating community in Iquitos, Peru, we conducted a controlled experiment to test the ability of water hyacinth (Eichhornia crassipes) to remove Escherichia coli from water. When river E. coli concentrations were at or below ∼1,500 CFU 100 mL^-1, water hyacinth reduced shallow concentrations (8 cm depth) down to levels deemed safe by U.S. EPA for recreational use. Above this threshold, plants were able to reduce E. coli levels within shallow water, but not down to "safe" levels. At deeper depths (>25 cm), there was evidence that plants increased E. coli concentrations. Water hyacinth removed E. coli from shallow water by providing a surface (i.e., submerged roots) onto which E. coli sorbed and by protecting organisms that can potentially consume E. coli. Unfortunately, because of root association, the total E. coli load within the water column was greater with water hyacinth present. The use of water hyacinth to keep surface water around floating communities low in E. coli could be beneficial as this is the water layer with which people most likely interact. Aquatic vegetation naturally proliferates in and around Claverito. While this study was based on curating aquatic plants in order to achieve a water-quality outcome, it nonetheless supports concrete actions for Claverito residents under non-curated conditions, which are outlined at the end of the manuscript.

Intra-Urban Variation of Intimate Partner Violence Against Women and Men in Kenya: Evidence from the 2014 Kenya Demographic and Health Survey

Although urban areas are diverse and urban inequities are well documented, surveys commonly differentiate intimate partner violence (IPV) rates only by urban versus rural residence. This study compared rates of current IPV victimization among women and men by urban residence (informal and formal settlements). Data from the 2014 Kenya Demographic and Health Survey, consisting of an ever-married sample of 1,613 women (age 15-49 years) and 1,321 men (age 15-54 years), were analyzed. Multilevel logistic regression was applied to female and male data separately to quantify the associations between residence and any current IPV while controlling for regional variation and other factors. Results show gendered patterns of intra-urban variation in IPV occurrence, with the greatest burden of IPV identified among women in informal settlements (across all types of violence). Unadjusted analyses suggest residing in informal settlements is associated with any current IPV against women, but not men, compared with their counterparts in formal urban settlements. This correlation is not statistically significant when adjusting for women's education level in multivariate analysis. In addition, reporting father beat mother, use of current physical violence against partner, partner's alcohol use, and marital status are associated with any current IPV against women and men. IPV gets marginal attention in urban violence and urban health research, and our results highlight the importance of spatially disaggregate IPV data-beyond the rural-urban divide-to inform policy and programming. Future research may utilize intersectional and syndemic approaches to investigate the complexity of IPV and clustering with other forms of violence and other health issues in different urban settings, especially among marginalized residents in informal urban settings.

Geospatial Mapping of Indoor Air Quality and Respiratory Illnesses in an Urban Slum

Introduction Air pollution is a well-recognized determinant of health. The general perception has focused primarily on outdoor pollution, and indoor pollution which may be due to smoking, biomass use, an extension of outdoor pollution, etc. has been neglected. It is therefore imperative to understand the levels of indoor pollution and find out if these are associated with high rates of illnesses, particularly, respiratory diseases. Material and methods This was a cross-sectional study involving 300 houses and 727 participants in an urban slum, selected through simple random sampling. Indoor air quality was assessed using the Prana C -Air Plus air quality monitor (Prana Air, New Delhi, India). The instrument detected formaldehyde, air quality index (AQI), temperature, humidity, PM2.5, PM10 particles, and total volatile organic (TVO) compounds. Socio-demographic details were noted, and geospatial mapping was done using Q-GIS software (www.qgis.org). A questionnaire was used to survey the residents of those houses. Ethical committee clearance was obtained before starting the project. Results The mean distribution of pollution parameters over the entire study area was AQI - 67.4±65.48, PM 2.5 - 37.6±35.82 μg/m³, formaldehyde - 0.09±0.37 mg/m³, PM 10 - 43.9±38.59 μg/m³, TVO compounds - 0.43±2.13 mg/m³, CO₂ - 1128.9±323.86 ppm, temperature - 23.7±21.2 degree Celsius, and PM 1 - 24.3±20.5 μg/m³; 2.6% of the participants had respiratory diseases, and a significant association was found between the AQI, TVO compounds and ventilation, and respiratory diseases (p<0.05). Conclusion Indoor air pollution not unlike outdoor pollution can have dramatic health effects and needs to be addressed to lower the overall respiratory disease burden. The AQI, TVOC, and poor ventilation/cross-ventilation are associated with respiratory illnesses. Geospatial mapping shows a concentration of cases in areas of high pollution.

"Good Food Causes Good Effects and Bad Food Causes Bad Effects": Awareness, Meanings and Perceptions of Malnutrition among Pakistani Adolescents Living in Slums through Photodiaries and Interviews

Around 30% of the urban population of Southern Asia lives in a slum setting where basic necessities such as sanitation, education, employment, infrastructure are lacking, and people are more exposed to health problems. Children living in slums are at high risk of malnutrition. However, there is limited knowledge on adolescents living in slums. We explored awareness and meanings of malnutrition (under and over-nutrition) as well as examining malnutrition risk factors among adolescents living in a slum. A qualitative approach was undertaken using photodiaries and semi-structured interviews with 14 adolescents (13-16 years old) living in a slum in Karachi (Pakistan). An inductive strategy was used moving from open-ended data to patterns using reflexive thematic analysis. We identified widespread malnutrition awareness amongst these adolescents. Food consistently underpinned participants' narratives and photodiaries, which was reflected in how they made sense of malnutrition: undernutrition was understood as lack of food, while overnutrition as excess of food. This study identified malnutrition drivers: sanitation, exercise, families, peers, wellbeing, gender, nutritional knowledge, media, and most importantly, food. People's responsibility to eat healthily was highlighted by the participants, implying that people are to be blamed for their poor lifestyle choices. Following this responsibility discourse, most participants contemplated merely individually focused health interventions in order to overcome the problem of malnutrition in their area. It is necessary to study slum food environments better to implement effective nutrition programs and interventions to reduce malnutrition in slum settings.

Common mental disorders among women and its social correlates in an urban marginalized populace in South India

BACKGROUND

Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community.

METHODS

This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0.

RESULTS

Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband's alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation.

CONCLUSION

Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women's education and empowerment, and support system are likely to decrease the burden of CMDs in this population.

Effect of cognitive-behavioral training on fear of childbirth and sleep quality of pregnant adolescent slum dwellers

BACKGROUND

Fear of childbirth is a common problem during pregnancy, which can give rise to sleep disorders and diminish sleep quality. This study aimed to determine the effect of cognitive-behavioral training on fear of childbirth and sleep quality of pregnant adolescent slum dwellers who visited the slum health centers of Zahedan city, Iran, in 2020.

MATERIALS AND METHODS

This quasi-experimental study was conducted in 2020 on 100 pregnant adolescent slum dwellers between 11 and 19 years old at 24-28 weeks pregnant. Multi-stage sampling was used and the participants were randomly divided into an intervention and a control group. The intervention group received four sessions of cognitive-behavioral training at weekly intervals. The control group only received routine care. The Wijma Delivery Expectancy/Experience Questionnaire and the Pittsburgh Sleep Quality Index were filled before and 4 weeks after the training course. The data were analyzed in SPSS 21 using independent t-test, paired t-test, Fisher's exact test, and Chi-squared test. and covariance. A P value of < 0.05 was considered significant.

RESULTS

After the intervention, the fear of childbirth significantly decreased (P = 0.004), and sleep quality significantly improved (P = 0.001) in the intervention group compared with the control group. The results of analysis of covariance to control the significant effect of pre-test scores showed that the mean score of fear of childbirth (P = 0.03) and mean score of sleep quality (P = 0.001) in the two groups after the intervention was statistically significant.

CONCLUSION

The results showed that in addition to reducing fear of childbirth, cognitive-behavioral training improved the sleep quality of women in the intervention group. Therefore, this training could be used as an easy and accessible method without complications to improve women's health.

A Systematic Review of Water, Sanitation, and Hygiene for Urban Poor in Low- and Middle-Income Countries during the COVID-19 Pandemic through a Gendered Lens

Inadequate water, sanitation, and hygiene (WASH) among urban poor women is a major urban policy concern in low- and middle-income countries (LMICs). There was a paucity of systematic information on WASH among the urban poor during the pandemic. We reviewed the opportunities and challenges faced by the urban poor in LMICs during the COVID-19 pandemic. We used the PRISMA guidelines to conduct a comprehensive search of 11 databases, including MEDLINE, Embase, Web of Science, and CINAHL, between November 2019 and August 2021. We used thematic analysis to synthesize the qualitative data and meta-analyses to estimate the pooled prevalence. We screened 5008 records, conducted a full-text review of 153 studies, and included 38 studies. The pooled prevalence of shared water points was 0.71 (95% CI 0.37-0.97), non-adherence to hygiene practices was 0.15 (95% CI 0.08-0.24), non-adherence to face masks was 0.27 (95% CI 0.0-0.81), and access to shared community toilets was 0.59 (95% CI 0.11-1.00). Insufficient facilities caused crowding and long waiting times at shared facilities, making physical distancing challenging. Women reported difficulty in maintaining privacy for sanitation, as men were present due to the stay-at-home rule. Due to unaffordability, women reported using cloth instead of sanitary pads and scarves instead of masks.

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

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.

Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey

Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18-22, living in Kenya's informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.

Prevalence and associated factors of domestic violence among married women in an urban slum in South India

Introduction

Domestic violence (DV) is a public health problem with an estimated global prevalence of 35%. The prevalence rate of spousal domestic violence in Telangana is 36.4% which is higher than the national average of 25.3%. Despite being a punishable offense, DV is still on the rise in India. Hence, there is need to assess its extent and determining factors for planning of remedial measures.

Objective

To estimate the prevalence of domestic violence and its associated factors among married women of an urban slum in Telangana.

Methodology

A cross-sectional study was conducted among 18- to 45-year-old married women in urban slums of Telangana. The sample size was 200. Multistage random sampling was done. Data collection was done using questionnaire with information regarding socio-demographic details, types of domestic violence, help-seeking behaviours, awareness, and outcome. The victims were directed towards medical and legal help, and further counselling. Descriptive analysis was done to find proportion of domestic violence. The associated factors were found using Chi-square test and logistic regression.

Results

Domestic violence was reported by 70.5% of the study participants. Physical abuse (67%) was the main offense followed by emotional abuse (38.5%). Though 89% of women were aware of domestic violence being punishable by law, only 9.5% of women sought help. Woman's older age (COR = 2.015, 95% CI: 1.088-3.733, P = 0.026), illiteracy (COR = 2.181,95% CI: 1.097-4.3381, P = 0.026), longer married life (COR = 1.961, 95% CI: 1.008-3.815, P = 0.047), husband's early exposure to abuse (COR = 4.439, 95% CI: 1-19.705, P = 0.034) and alcohol intake (COR: 1.995, 95% CI: 1.038-3.838, P = 0.037) were found to be significant factors in the bivariate analysis. Husband's exposure to abuse in childhood (AOR = 5.326, 95% CI: 1.163-24.400, P = 0.031) and alcohol intake (AOR = 2.206, 95% CI: 1.109-4.389, P = 0.024) were found to be independent predictors.

Conclusion

Domestic violence is highly prevalent in urban slums of south India. A woman's age, education, duration of marriage, husband's early exposure to abuse, and alcohol intake are determining factors. Awareness programs need to be conducted regarding helplines, medical and legal aspects. All domestic violence cases should be registered, and social, psychological and legal support be provided to the victim.

Rise of informal slums and the next global pandemic

Informal slums are growing exponentially in the developing world and these will serve as the breeding ground for a future global pandemic. Virtually every sustainable development goal is unmet in slums around the globe thus we must act now to divert a global humanitarian crisis.

Community empowerment for health promotion in slums areas: A narrative review with emphasis on challenges and interventions

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.

Characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda

Background

This study assessed characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda.

Methods

We conducted a household-based cross-sectional study among 395 households in Kasubi slum using a semi-structured questionnaire and observational checklist to collect data.

Results

Almost 98.0% (387/395) of households owned a sanitation facility and 77.0% (298/387) shared it with other households. The most common type of sanitation facility was a pit latrine with slab (66.9% [259/387]). Most (90.5% [305/337]) latrines had a door or shutter, a roof (92.9% [313/337]) and a depth >1.5 m (68.2% [229/337]). Overall, 21.3% (84/395) and 65.6% (259/395) of households had improved and functional sanitation facilities, respectively. Only 16.5% (65/395) of the households had a hand-washing facility. Student-led (adjusted prevalence rate [PR] 2.67 [95% confidence interval [CI] 1.83–3.94]) and households that owned their house (adjusted PR 2.17 [95% CI 1.33–3.53]) were 2.67 and 2.17 times more likely to have improved sanitation facilities, respectively. Households that owned their house (adjusted PR 1.90 [95% CI 1.18–3.05]) were 1.9 times more likely to possess a hand-washing facility.

Conclusions

The coverage of improved sanitation and hygiene facilities was low. The majority of households were using a shared pit latrine with a slab that had no hand-washing facility. Sanitation and hygiene interventions should prioritize improving sanitation and hygiene facilities.

Social harms and social class in Iranian youth and adolescents living in slums in the suburbs: a systematic review

BACKGROUND

Socioeconomic and environmental factors can affect the health of the people living in slums in the suburbs. In these areas, the youth and adolescents are the main age groups susceptible to a multitude of harms such as addiction, AIDS, delinquency, aggressive behavior, and prostitution. The present study was conducted to investigate the state of social harms and social class in Iranian youth and adolescents living in slums in the suburbs.

METHODS

In the present systematic review, the researchers searched for observational and qualitative papers published in Persian or English languages during 2010-2020 timespan in the following databases: Embase, PubMed, Scopus, Web of Science, Irandoc databases, Google Scholar, SID, and Magiran. Based on MESH, the keywords of "social class", "social harm", "youth", "adolescent", and "slum" were chosen. Papers were assessed according to the inclusion criteria, and the quality of the papers was evaluated using the Newcastle-Ottawa scale for quantitative articles and the COREQ scale for qualitative ones.

RESULTS

Of 491 articles assessed, 11 (eight cross-sectional and three qualitative papers) were deemed suitable. According to the results, social harms reported were: drug abuse (two studies), female sex workers (two studies), poverty (two studies), AIDS (two studies), social insecurity (two studies), psychedelic substances (one study), alcohol (one study), delinquency (one study), divorce (one study), physical problems (one study), prostitution because of poverty (one study), unemployment (one study), and adolescents' forced labor due to destitution (one study). Moreover, the assessed papers used education (three studies), economic status (three studies), occupation (two studies), income (two studies), place of residence (two studies), social status (two studies), and cultural status (one study) as indicators of the social class in the individual and their parents, and categorized them in three groups of high (one study), middle (three studies), and low classes (seven studies).

CONCLUSION

The present systematic review investigated, for the first time in Iran, social harms and social class in the youth and adolescents living in slums in the suburbs. The results showed that social harm is high among the youth and adolescents in outskirt slums of Iranian cities. Therefore, any attempt to empower the youth and adolescents living in these parts will have direct effects on the health of the residents of these areas.

Prevalence of Depression and Anxiety during the COVID-19 Pandemic among the Residents of an Urban Slum in North India

Objectives  This study aimed to estimate the prevalence of depression and anxiety, and assess the knowledge, practice, and concerns regarding coronavirus disease 2019 (COVID-19) among the residents of an urban slum in Chandigarh, India.

Materials and Methods  Participants were screened using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales.

Results  The mean (standard deviation) age of 200 enrolled participants was 33 (13) years with 83% ( n = 166) being females. The prevalence of depression and anxiety was 3.5% (95% confidence interval [CI]: 0.95–6.05) and 2.5% (95% CI: 0.34–4.66), respectively. Of total, 46% ( n = 92) knew that COVID-19 can transmit through droplets and 30.5% ( n = 61) were concerned that they might get infected with disease. Half of the participants ( n = 100) believed that there was unnecessary worry regarding COVID-19 and 78% ( n = 156) covered mouth while coughing or sneezing.

Conclusion  To cope with this critical situation, it is necessary to strengthen the awareness programs targeting the mental health issues of the people.

Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India

Background

Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India.

Methods

Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure.

Results

Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home.

Conclusion

The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.

Social inequality, noise pollution, and quality of life of slum dwellers in Pokhara, Nepal

This work is a cross-sectional comparative study conducted on 528 residents in the slum and non-slum areas of Pokhara, Nepal. Of the total number of respondents, 90.2% in the slums and 63.3% in the non-slums indicated the existence of a main source of noise, and 80.7% in the slums and 66.0% in the non-slums replied that they had been highly annoyed by noise. The indoor noise levels measured for 24 h were higher in slums than in non-slums, ranging from 59 to 78 dBA and from 51 to 69 dBA, respectively. The Mann-Whitney U test showed a significantly poorer status of slum dwellers in four health domains. Logistic regression analysis identified that living in a slum was a significant predictor (OR, 2.35; 95% CI, 1.35-4.09) of a low level of health. Meanwhile, a high level of noise annoyance was a good determinant (OR, 6.71; 95% CI, 3.13-14.36) of low quality of life among slum dwellers revealing a distinguishing negative effect of the high level of noise annoyance in the slum areas.

Coronavirus disease 2019 and slums in the Global South: lessons from Medellín (Colombia)

The coronavirus disease 2019 (COVID-19) pandemic is hitting the world's most vulnerable people hardest, primarily the communities living in slums in the Global South. Lockdown, handwashing and social distancing are impossible privileges for many urban dwellers - measures which make structural inequities more visible, exacerbating racial, gender and class differences. There are many social determinants of health to explain these inequalities that trigger a high prevalence of infectious and chronic diseases. In Medellín (Colombia), it is a challenge to cope with this crisis, especially when the resources and aid provided by the government and institutions are limited. Yet, an organized social response is happening in some communes and slums, with high community participation, as a potentially effective key to control the pandemic. Once the emergency is over, communities in slums will have to face the social and economic reactivation, and effectively react to the multiple social and psychological consequences, new waves of COVID-19 or other pandemics.

Strategies to Connect Low-Income Communities with the Proposed Sewerage Network of the Dhaka Sanitation Improvement Project, Bangladesh: A Qualitative Assessment of the Perspectives of Stakeholders

In Bangladesh, approximately 31% of urban residents are living without safely managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing low-income communities (LICs) under a sewerage connection within the proposed sewerage network plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bills equally among sharing households, or by users per household. Participants also suggested the government’s cooperation with development-partners/NGOs to ensure sewerage connection construction, operation, and maintenance and prerequisite policy changes such as assuring land tenure.

The 'Health Transformation Plan' in Iran: A policy to achieve universal health coverage in slums and informal settlement areas

Universal health coverage (UHC) is one of the strategies that health decision- and policy-makers worldwide are implementing to guarantee a good health status to everyone. Living in slums is characterized by several issues, including homelessness and malnutrition, environmental challenges, lack of sanitation and access to safe, healthy drinking water, waste disposal problems, widespread social disruptions, job insecurity, feelings of dissatisfaction and inadequacy. In Iran, the 'Health Transformation Plan' (HTP), despite its weaknesses, has had good effects on the health level of people living in slums, ensuring insurance coverage and reducing many economic, social and cultural problems, with a dramatic decline in out-of-pocket expenditures. Good governmental financial support and an adequate revision of the initial packages of health services and provisions have resulted in a higher access rate to healthcare. The HTP has been, indeed, a major step towards reaching UHC in Iran. If policy- and decision-makers can further improve the present situation and provide more and better-quality services to these people, it can be expected that health indicators in suburbs will be significantly improved. Researchers should monitor the impact of HTP and examine its effects on health indicators, specifically among particularly vulnerable groups such as children, women and the elderly.

Impaired Quality of Life and Its Determinants among Postmenopausal Women of Slum Communities in Bhubaneswar, India

BACKGROUND

The severity of menopausal symptoms negatively impacts a woman's quality of life (QoL).

OBJECTIVE

The aim of the study was to assess the prevalence of menopause-related impaired QoL and determine its associated factors among postmenopausal women living in slum areas of Bhubaneswar, India.

MATERIALS AND METHODS

This cross-sectional study was conducted among 198 postmenopausal women aged 45-65 years during the year 2016-2017. The Menopause Rating Scale (MRS) was used to assess the prevalence and severity of menopausal symptoms.

RESULTS

Joint and muscular discomfort was the most prevalent moderate-to-severe symptom (90.4%), followed by hot flushes (72.8%), irritability (67.2%), and physical and mental exhaustion (64.2%). More than two-third (133, 67.2%) of women had impaired QoL (severe total MRS score ≥17). Multivariate logistic regression analysis revealed that impaired QoL was associated younger age (adjusted odds ratio [AOR]: 4.6, 95% confidence interval [CI]: 2.12-9.98), tobacco consumption (AOR: 2.0, 95% CI: 1.05-3.82), not being satisfied in relation with husband (AOR: 3.33, 95% CI: 1.84-6.06), not having autonomy in health-care decision-making in the family (AOR: 2.30, 95% CI: 1.12-4.73), history of reproductive tract infection (AOR: 4.57, 95% CI: 1.71-12.19), and earlier onset of menopause (AOR: 3.26, 95% CI: 1.18-8.96).

CONCLUSION

The point prevalence of menopause-related impaired QOL in postmenopausal women living in slums of Bhubaneswar was high. Incorporating these determinants in the existing strategies can be useful to improve the QoL of these women.

Combating Climate Change-induced Heat Stress: Assessing Cool Roofs and Its Impact on the Indoor Ambient Temperature of the Households in the Urban Slums of Ahmedabad

Background

The rising global temperature and frequent heatwaves are the adverse effects of climate change. The causalities and ill impacts of the heat stress were higher among the slum dwellers because of the vulnerable household structures, which were made by heat-trapping materials like tin sheets, cement sheet (asbestos), plastic, and tarpaulin. The houses are not only dwellings but also a source of livelihood for many slum dwellers as they are involved in home-based work. The increase in the temperature of more than 40°C severely affects health and increases energy expenditures.

Objective

The present study conducted to identify the efficient cool roof technologies that reduce indoor temperature of the households and improve the heat resilience of dwellings located in the urban slums of Ahmedabad.

Methodology

The performances of cool roof interventions were compared with the nonintervention - roof types, namely, tin, asbestos/cement sheet, and concrete. Relative humidity/temperature data loggers (Lascar EL-USB-2-LCD, Sweden) were used to measure the indoor ambient temperature and humidity. The questionnaire-based survey also has been conducted to understand the socioeconomic status and the perceptions related to roofing and health.

Results

The results revealed that selected cool roof technologies including Thermocol insulation, solar reflective white paint on the outer surface of the roof, and Modroof are effectively reducing the indoor temperature as compared to the nonintervention roofing.

Conclusion

Cool roof technologies have a wider scope as number of informal settlements are increasing across the cities in India and other developing countries. The governments may not able to provide proper housing to all these inhabitants due to various reasons including the land tenure of the habitats. Validated cool roof technologies can be promoted as these structures are not requires legal sanctions and easily dismantled and installed in multiple places and safeguards the investment of urban poor.

Typical epidemiology of respiratory virus infections in a Brazilian slum

Host population size, density, immune status, age structure, and contact rates are critical elements of virus epidemiology. Slum populations stand out from other settings and may present differences in the epidemiology of acute viral infections. We collected nasopharyngeal specimens from 282 children aged ≤5 years with acute respiratory tract infection (ARI) during 2005 to 2006 in one of the largest Brazilian slums. We conducted real‐time reverse transcription‐polymerase chain reaction (RT‐PCR) for 16 respiratory viruses, nested RT‐PCR‐based typing of rhinoviruses (HRVs), and collected clinical symptoms. Viruses were common causes of respiratory disease; with ≥1 virus being detected in 65.2% of patients. We detected 15 different viruses during 1 year with a predominance of HRV (33.0%) and human respiratory syncytial virus (hRSV, 12.1%) infections, and a high rate of viral coinfections (28.3%). We observed seasonality of hRSV, HRV and human coronavirus infections, more severe symptoms in hRSV and influenza virus (FLU) infections and prolonged circulation of seven HRV clusters likely representing distinct serotypes according to genomic sequence distances. Potentially unusual findings included the absence of human metapneumovirus detections and lack of typical FLU seasonal patterns, which may be linked to the population size and density of the slum. Nonetheless, most epidemiological patterns were similar to other studies globally, suggesting surprising similarities of virus‐associated ARI across highly diverse settings and a complex impact of population characteristics on respiratory virus epidemiology.

Large epidemiological study of respiratory viruses in children from one of the biggest Brazilian slums using sensitive molecular PCR assays

Viruses are common causes of respiratory disease in pediatric patients from a Brazilian slum

15 distinct viruses circulate in the Brazilian slum, with highest prevalence of rhinoviruses and human respiratory syncytial virus

The epidemiology of virus‐associated respiratory infections presents surprising similarities worldwide despite drastic differences in socioeconomic status and population characteristics

Prevalence, associated risk factors of depression and mental health needs among geriatric population of an urban slum, Cuttack, Odisha

OBJECTIVES

To find the prevalence of depression among elderly population of urban slum of Cuttack and to study its association with sociodemographic factors, comorbidities, and various life events and also to explore the mental health needs of the study subjects as perceived by them.

METHODS

It was a cross-sectional study carried out in the urban slum, Jobra of Cuttack city in Odisha. Simple random sampling was done using random number table to select the study subjects. Predesigned pretested questionnaire including Geriatric Depression Scale, Lawton's Instrumental Activities of Daily Living, and Katz Index of Independence in Activities of Daily living and questions on important life events including their perceptions regarding existing mental health services were used for data collection. Data were analyzed using SPSS, and binary logistic analysis was done to find the independent determinants of severe depression among elderly.

RESULTS

Out of 354 study subjects, 249 (70.3%) were males. Depression in severe and mild form was present among 44.9% and 36.2%, respectively. Independent risk factors of severe depression by multiple logistic regression analysis were low socioeconomic class, female gender, diabetes mellitus, hypertension, death in family members, conflicts in family, and chronic illness in family members.

CONCLUSION

The prevalence of depression among the elderly in the urban slum was close to 80% with 45% being at risk of severe depression. Females from low socioeconomic class with comorbidities and having life stressors need to be screened regularly in the community level, and facility for counseling should be provided to them.

Health services utilization among slum dwellers: An experience from Iran

INTRODUCTION

Health services utilization is a complex behavioral phenomenon affected by multiple factors including availability, distance, cost and quality of health services as well as personal attitudes, cultural beliefs, and socioeconomic characteristics. This study aimed to assess the status of health-care utilization among dwellers of slums in one of the Iran's big cities.

METHODS

This was a cross-sectional study in which 559 slums people were selected using a random clustered sampling method. Data on health services utilization were collected using health equity assessment and response tool questionnaire. Data analysis was performed using descriptive statistics and logistic regression analysis through SPSS ver. 22.

RESULTS

In this study, 42.5% (238) people who required outpatient services. 21% (118) of them were able to use them. Furthermore, among the families, who needed outpatient services during the past month, 15% (38) were able to use the services for at least once. Regarding inpatient services, 62% (349) of people needed hospitalization, of which 31% (175) were able to be hospitalized. Age (P = 0.2), gender (P = 0 <001), marital status (P = 0 <001), income status (P = 0.1), and education (P = 0.21) determined utilization of outpatient services; however, inpatient services utilization was affected by age (P = 0.03), gender (P = 0.02), marital status (P = 0 <001), and income status (P = 0.32). The final model of multiple regression showed that, there was a relationship between age (odds ratio [OR] =1.7, confidence interval [CI] 95% = 0.47-0.88), marital status (OR = 2.78, CI 95% = 0.64-1.2), and the use of inpatient services.

CONCLUSION

The utilization of health services in slum areas is not desirable. As it was showed that the utilization of health services in slums people is a multifactorial event; thus, proper planning and policy for this increasingly demand are essential.

A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study

Context

Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide.

Aims, Setting, Materials and Methods

A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health.

Results

Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing.

Conclusion

There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.

Psychosocial determinants of stress among adolescents in an urban slum in a city of Western Maharashtra: a cross-sectional study

INTRODUCTION

Stress is a major underlying factor in the manifestation of many mental disorders. The prevalence of stress among Indian adolescents varies from 13% to 45%. Hence, the present study was done to assess the psychosocial determinants of stress among adolescents in an urban slum.

METHODOLOGY

This was a cross-sectional analytical study (community based) in an urban slum from January to July 17 with a sample of 230 adolescents aged 10-19 years. An Indian Council of Medical Research (ICMR) tool validated for use in the community was self-administered. Data was analyzed using SPSS 20.0.

RESULTS

The commonest stressors were perceived threat to economic position (84.3%), economic difficulty of meeting expenses for treatment of self/family members (63.5%), upcoming exams (61). The stressors that occurred significantly more often (p < 0.05) in males as compared to females were related to sexual desire, conflicts in love affairs, getting a job/employment issues, exam failure and interpersonal relationships within the family. Stressors that occurred significantly more often (p < 0.05) in females than in males were fear of sexual abuse/assault. Significant correlates of the presence of stress were male gender, nuclear family and low family income (p < 0.05).

CONCLUSION

The stressors in adolescents in an urban slum are both internal and external. There are gender differentials in type of stressors faced by adolescents.

Using a Birth Center Model of Care to Improve Reproductive Outcomes in Informal Settlements-a Case Study

The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings.

Hypertension prevalence and risk factors among residents of four slum communities: population-representative findings from Port-au-Prince, Haiti

OBJECTIVES

The aim of this study was to estimate the prevalence of hypertension and its risk factors among adults in four slum communities in Port-au-Prince.

METHODS

Cluster area random sampling was used to select adults for a health and demographic survey, including anthropometric measurements. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg, or current hypertension treatment, and was age-standardized to WHO world population. Correlates of hypertension were tested using sex-stratified logistic regression.

RESULTS

Overall, 20.3% of adults had hypertension (28.5% age-standardized), including 22.3% of men and 18.9% of women. Three percent of participants reported current hypertension treatment, and 49.5% of them had their hypertension controlled. Overweight/obesity (BMI ≥25) was the most common risk factor (20.6% among men, 48.5% among women), while smoking was less common (11.8 and 3.9%, respectively). Increasing age and hypertension prevalence in immediate surroundings were associated with greater odds of hypertension. Among men, having in-migrated in the 3 years prior (versus ≥3 years) was also associated with hypertension [adjusted odds ratio (aOR)=3.32, 95% confidence interval (95% CI): 1.79-6.17], as was overweight and obesity (aOR = 1.90, 95% CI: 1.09-3.33, and aOR = 5.73, 95% CI: 2.49-13.19, respectively) and nonreceipt of needed medical care in the preceding 6 months (aOR = 2.82, 95% CI: 1.35-5.88) among women.

CONCLUSION

Hypertension prevalence was high across the age spectrum, in addition to substantial levels of overweight/obesity and unmet healthcare needs. It is important to better understand the possible effects of intraurban migration and environmental risk factors on hypertension and ensure that the benefits of increasingly cost-effective prevention and treatment programmes extend to slum residents.

Knowledge, attitude and practice of cervical cancer prevention, among women residing in an urban slum in Lagos, South West, Nigeria

Introduction

cervical cancer is the most common genital tract malignancy among women in Nigeria. Cancer of the cervix is preceded by a curable premalignant stage which can be detected by screening. The disease can also be prevented by Human papillomavirus (HPV) immunization. Women living in slums usually have poor reproductive health knowledge and poor health behaviours. Mostly of low socioeconomic status, these women are at higher risk of cervical cancer. This study assessed the knowledge, attitude and preventive practices towards cervical cancer among women living in an urban slum in Lagos, Nigeria.

Methods

this descriptive cross-sectional study was carried out among 305 women of reproductive age in Idi-Araba, Lagos, Nigeria. Multistage sampling method was used to select respondents. Data was collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software.

Results

only 39 (12.8%) had heard about cervical cancer. Knowledge of cervical cancer, screening and Human papilloma virus (HPV) immunization was poor. Most respondents (64.3%) did not consider themselves at risk for cervical cancer. However, majority (88.9%) were willing to undergo screening and 93.8% were willing to take HPV immunization or recommend the vaccine to a friend/relative. Only 2(0.7%) had done a cervical cancer screening test and none had taken HPV vaccine or immunized their eligible daughters.

Conclusion

there is thus the need for increased awareness creation and health education programs on cervical cancer prevention among such population of women.

Menstrual hygiene among adolescent girls - A study from urban slum area

Background:

Adolescence has been recognized as a special period that requires specific attention as it marks the onset of menarche, an important milestone, and hence good hygienic practices during menstruation are crucial to maintain a healthy life.

Aims and Objectives:

This study was planned to assess knowledge, beliefs, and source of information regarding menstruation, and also to assess hygiene among them.

Materials and Method:

A cross-sectional study was carried out in urban slum area. Data were collected using pre-tested proforma during the period of 1^st June to 31^th August 2017. Among the 100 adolescent girls, 72% were between 15 and 19 years. A maximum of 47% were having high school education. About 47% mothers were illiterate; 27% girls had menarche at 14 years and 82% had regular cycles. About 76% had no knowledge of menses before menarche. The source of information was mother in 84%. Only 16% girls commented that bleeding initiated in uterus. About 60% girls used sanitary pad and the rest used cloth pieces. About 22% used water and no soap for hand washing. Multiple restrictions were practiced.

Conclusion:

This study reported that menstrual hygiene was unsatisfactory among adolescent girls. Therefore, girls should be educated about the facts of menstruation and proper hygienic practices.

Spatial Video Health Risk Mapping in Informal Settlements: Correcting GPS Error

Informal settlements pose a continuing health concern. While spatial methodologies have proven to be valuable tools to support health interventions, several factors limit their widespread use in these challenging environments. One such technology, spatial video, has been used for fine-scale contextualized mapping. In this paper, we address one of the limitations of the technique: the global positioning system (GPS) coordinate error. More specifically, we show how spatial video coordinate streams can be corrected and synced back to the original video to facilitate risk mapping. Past spatial video collections for the Mathare informal settlement of Kenya are used as an illustration as these data had been previously discarded because of excessive GPS error. This paper will describe the bespoke software that makes these corrections possible, and then will go on to investigate patterns in the coordinate error.

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India

Background

One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health.

Objective

The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India.

Methods

It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing.

Results

About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP.

Conclusion

The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Comparison of domains of self-reported physical activity between Kenyan adult urban-slum dwellers and national estimates

BACKGROUND

Non-communicable diseases (NCDs) - largely the result of modifiable behavioral risks such as physical inactivity that gradually develop into physiological risks - are a main cause of morbidity and mortality worldwide. In Kenya, a nationally representative STEPwise survey of risk factors for NCDs established that 10.8% of Kenyans accumulated low levels of total physical activity.

OBJECTIVES

The goal of our analyses was to compare domains of self-reported physical activity in two Nairobi slums to national estimates.

METHODS

Levels and time of self-reported activity in three domains (work, transport, and recreation), collected as part of a SCALE-UP study conducted in Korogocho and Viwandani slums in Nairobi, were compared to STEPwise findings.

RESULTS

The samples included a total of 10,128 participants (5,628 slum, 4,500 national). Only 7.1% and 4.0% of slum dwellers reported low levels of work and transport physical activity, respectively, but 95.9% reported low levels of recreation-related activity. Slum residents reported higher mean daily minutes of total activity than the national estimate (499 minutes versus 291 minutes), however, both samples spent similar proportions of total activity on work (79.0% slum, 78.3% national), transport (20.4% slum, 18.1% national), and recreation (0.6% slum, 3.6% national) activities.

CONCLUSIONS

While the total amount of time spent in different domains of self-reported activity differs between urban slum residents and the national Kenyan population, proportions of time in each of the three domains are similar. It is important that such differences or similarities be considered when addressing NCD risk factors in these populations.

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala, Uganda

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22-15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01-1.96). Older children (12-18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26-4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03-12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21-3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11-0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.

Air pollution and environmental risk factors for altered lung function among adult women of an urban slum area of Delhi: A prevalence study

Background:

Household and ambient air pollution are jointly responsible for about 7 million premature deaths annually. Women living in slums, with unhealthy environment, both indoors and outdoors, particularly those living close to industrial and/or vehicular pollution zones due to multiple sources of air pollution, are at the higher risk of having impaired lung function tests.

Objective:

The aim of this study was to estimate the prevalence of abnormal lung functions and to identify the environmental risk factors associated with them among adult women of 18–59 years.

Materials and Methods:

A total of 550 women aged 18–59 years were approached in a representative urban slum. Five hundred consented to participate and 299 had prebronchodilator spirometry satisfying ATS standards. House visits to assess environmental conditions were conducted to determine their association with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Chi-square test was used to test the association of risk factors with lung functions. ANOVA was used to test the association of mean values of FEV1 and FVC with age.

Results:

Out of 299 participants with acceptable spirometric curves, 5% had reduced FEV1/FVC ratio than the normal and 26.8% and 17.4% had lower values than predicted for FVC and FEV1, respectively. Altered lung function was related to age, tobacco smoking, and history of respiratory disease.

Conclusions:

Both ambient and household air pollution have a deleterious pulmonary effect on long-term women residents of a representative urban slum in Delhi.

Adaptive functioning and its associated factors among girl children residing in slum areas of Bhubaneswar, India

AIM

Adaptive functioning develops throughout early childhood, and its limitation is a reflection that the child has developmental or emotional problems or even mental retardation. Little is known about the adaptive functioning or developmental status of slum children. The present cross-sectional study was undertaken during the year 2014 to assess the status of adaptive functioning among girl children aged between 3 and 9 years residing in slum areas of Bhubaneswar and to explore the factors associated with poor adaptive functioning.

METHODS

Stratified multi-stage cluster random sampling technique was used to select the study population; 256 mother-child pairs from 256 households in selected slum areas were studied. Demographic information was collected, and adaptive functioning was assessed using the modified Vineland Social Maturity Scale. Univariate and multivariate analyses was carried out using Statistical Package for Social Sciences (SPSS) version 21.

RESULTS

One-fifth (54, 21%) of the girls sampled had poor adaptive functioning, and 44 (17%) had poor cognitive functioning. Multivariate analysis revealed that the age of the child, parents' education, presence of stunting in children and attending school/early childhood centre were strong predictors of adaptive functioning in slum children.

CONCLUSION

One-fifth of girls from slums are developmentally vulnerable; parental education, stunting and early childhood education or exposure to schooling are modifiable factors influencing children's adaptive functioning. Health, education and welfare sectors need to be aware of this so that a multi-pronged approach can be planned to properly address this issue in one of the most disadvantaged sections of the society.

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

Background

It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages.

Objective

The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations.

Design

We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted.

Results

In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately much higher mortality burden than those living elsewhere. Slum communities had higher coverage of maternal health services than rural communities but it was not possible to compare maternal mortality rates across these residential domains. Compared to rural areas, slum communities had lower fertility and higher contraceptive use rates but these differences were reversed when slums were compared to other urban populations. Slum–rural differences in infant mortality were found to be larger in Bangladesh compared to Kenya.

Conclusion

Mortality and morbidity indicators were worse in slums than elsewhere. However, indicators of access to care and health service coverage were found to be better in slums than in rural communities.

Common mental disorder and its socio-demographic correlates among married women residing in slum areas of Bhubaneswar, India

The mental health of women residing in slum areas is a neglected and important public health concern. The present cross-sectional study was undertaken during 2012-2013 to assess frequently occurring mental disorders and associated factors among married women 15-45 years of age, residing in slum areas of Bhubaneswar, India. A multistage, cluster, random sampling design was applied to select the study areas. The presence of a mental disorder was determined using a validated, self-reported questionnaire, developed by the World Health Organization. Using a predesigned, pretested schedule, relevant data were collected from 362 eligible, willing women respondents. Eighty women (22.1%) had a mental disorder, 56 (70.0%) of whom never consulted a health-care provider. Results of multiple logistic regression indicated that presence of a mental disorder was positively associated with not being satisfied with managing household financial affairs, not having time to attend social obligations, attending religious services less than four times per month, addiction of a family member to alcohol or drugs, and misunderstandings or quarrels in the family. Policy makers should be encouraged to incorporate such determinants in schemes or programs intended to promote the mental health of married slum women.

Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE-UP study

Background

A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and other CVD risk factors in a slum setting in Nairobi, Kenya.

Design

Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP), while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method.

Results

We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, −2.75 mmHg (95% CI −4.33 to −1.18, p=0.001) and −1.67 mmHg (95% CI −3.17 to −0.17, p=0.029), respectively. Among people with hypertension at baseline, SBP was reduced by −14.82 mmHg (95% CI −18.04 to −11.61, p<0.001) in the intervention and −14.05 (95% CI −17.71 to −10.38, p<0.001) at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence.

Conclusions

We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and suboptimal adherence in the intervention group.