Unmet and unperceived needs for type 2 diabetes self-management among slum dwellers in Iran: a cross-sectional study

AIM

This study aimed to identify unmet and unperceived needs for T2D self-management among those residing in Tabriz slums, Iran, in 2022.

BACKGROUND

Type 2 diabetes (T2D) and its complications are more common among slum dwellers. T2D is a lifelong disease that requires continuous care. By contrast, slum dwellers are less likely to adhere to standard health care.

METHODS

This study is cross-sectional. We included 400 patients using a systematic random sampling method. Unmet and unperceived needs were assessed through a researcher-made questionnaire. The questionnaire was developed based on Iran's Package of Essential Non-Communicable Diseases (IraPEN) instructions and an expert panel. Data were analyzed using SPSS version 22.

FINDINGS

Need for more healthcare cost coverage by insurance organizations (85.5%), financial support to provide medicine (68%), free and accessible sports equipment in the area (48.5%), continuous access to blood sugar test instruments (47.8%), know how to test blood sugar and interpret the results (47.7%), more communication with healthcare providers (42.3%), and detailed education from health professionals (41.2%) were the most common unmet needs. The least perceived need was to know how to care for feet (16%).

Whether occupational injuries of the industrial workers can be prevented: an analysis from the slums of West Bengal-India?

A lack of research exists concerning the heterogeneity of the occupational injuries of slum dwellers across industries which has a close link with health expenditure and hence livelihood. It necessitates analysing their occupational injuries and associated out-of-pocket health expenditures. Multi-stage random sampling is used to collect the primary data and the logit model is used for data analyses. Permanent non-fatal injuries in the civil-mechanical industries and temporary non-fatal injuries in textile industries are common. The share of health expenditure of the injured workers seeking medical consultations remains 59% of their average monthly income. Average monthly income, parental occupation, types of industry, job security, risk intensity, and salary basis are significant estimates of occupational injuries. The differences in the nature and extent of the occupational injuries of the workers across industries in the light of the socio-demographic and working environment context provide significant insight into the policy implications.

Drivers of cardiovascular disease risk factors in slums in Kampala, Uganda: a qualitative study

BACKGROUND

Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease.

OBJECTIVE

This study explored the drivers of CVD risk factors in slums in Kampala, Uganda.

METHODS

This qualitative study employed focus group discussions (FGDs) to collect data among slum residents. A total of 10 FGDs separate for gender and age group were held in community public places. Discussions were audio-recorded, transcribed, and transcripts analysed thematically with the aid of Atlas ti 7.0. Study themes and sub-themes are presented supported by participant quotations.

RESULTS

Five themes highlighted the drivers of CVD risk factors in slum communities. (1) Poverty: a critical underlying factor which impacted access and choice of food, work, and housing. (2) Poverty-induced stress: a key intermediate factor that led to precarious living with smoking and alcohol use as coping measures. (3) The social environment which included socialisation through drinking and smoking, and family and peers modelling behaviours. (4) The physical environment such as the high availability of affordable alcohol and access to amenities for physical activity and healthy foods. (5) Knowledge and information about CVD risk factors which included understanding of a healthy diet and the dangers of smoking and alcohol consumption.

CONCLUSION

To address CVD risk in slums, broad-ranging multisectoral interventions are required, including economic empowerment of the slum population, stress reduction and coping interventions, and alcohol legislation. Also, there is a need for community CVD sensitisation and screening as well as increasing access to physical activity amenities and healthy foods within slums.

Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches

Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.

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.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums

Background

Rapid urbanization and increased women's involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa.

Methods

We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers' knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment.

Findings

A total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers' education level, type of center, support received, caregiver-child ratio, number of children in the center, and center providers' KAP score (p < 0.05). However, in the multivariable regression, only higher levels of center provider KAP (β = 0.51; 95% CI: 0.18, 0.84; p = 0.003) and center type (β = 8.68; 95% CI: 2.32, 15.04; p = 0.008) were significantly associated with center quality score.

Implication

Our results show that center providers' knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision.

Mitigating household psychosocial and economic impact of coronavirus pandemic in Mathare slums, Nairobi, Kenya: an initiative by the German doctors in Kenya

The Psychosocial and Economic Impact of COVID-19 Pandemic in Mathare slums were adverse which necessitated mitigation strategies to be employed to cushion the most vulnerable and help them cope with the new 'state of affairs'. The pandemic was characterized by a surge in the respiratory infections, unemployment, households going hungry, gender-based violence in families, child abuse cases and increased rates of teenage pregnancy. Retrospective case study design was employed; secondary data from hospital departments were extracted for analysis from March 2020 to December 2021. Interventions in focus were health service provision, Gender based and child abuse services, food distribution, wet-feeding program, business grants and house rent grants. The most common burden faced by Mathare residents was food insecurity which was mitigated by giving 9,423 Patients' food baskets while 1,423 patients enrolled to the wet feeding program. Gender Based Violence services provided doubled in the year 2021 with physical and emotional violence being more common than sexual violence which was at 6.2%. Child abuse services were provided more in the year 2020 and 96 teenage mothers were assisted to go back to school. About 158 families received rent grants; which was a 30.4% increase from the year 2020. There was a 75.5% increase in the year 2021 of residents who received business grants. In a pandemic the effects are beyond health hence it is necessary to manage patients comprehensively using a multi-sectorial approach. However it is important to put regulations to avoid overdependence.

Prevalence and predictors of intimate partner violence against men in Kisumu slums, Kenya

Background

Men in sub-Saharan Africa experience intimate partner violence, with few reporting their cases to the legal authorities or coming out for assistance. Consequently, data on the prevalence and drivers of intimate partner violence in different parts of sub-Saharan Africa are inadequate. Therefore, this study was designed to investigate the prevalence and predictors of intimate partner violence against men in Kisumu slums, Kenya.

Methods

This retrospective cross-sectional study included 398 randomly selected male participants from Kisumu slums, sampled data collected from Community Health Volunteers. We used a multinomial regression analysis to assess determinants and forms of violence.

Results

A total of 398 respondents out of 438 eligible men participated in the survey. The prevalence of intimate partner violence against men was 76.1%. From the multinomial regression, men who were married or living together, compared with never married, were 2.13 times more likely to have experienced physical violence (95% CI = 0.91-4.97, p = 0.080) and 2.41 times more likely to have experienced economic violence (95% CI = 1.20-4.84, p = 0.013). Compared to never married, men who divorced or separated were 5.42 times more likely to have experienced sexual violence (95% CI = 0.97-30.37, p = 0.055). Men who had primary education or less were 2.39 times more likely to have experienced sexual violence (95% CI = 1.02-5.61, p = 0.045). Men who were Muslim, compared with Protestants, were 2.37 times more likely to have experienced psychological or emotional violence (95% CI = 0.87-6.37, p = 0.086).

Conclusions

Sexual, physical, and emotional violence is common among men in Kisumu slums, and the prevalence differs by age, marital status, education, and religion. Safe spaces should be created that will enable men of diverse socio-demographic characteristics to share their experiences of violence by intimate partners. Policies, including education to increasing awareness of this issue, should be enacted to protect men from intimate partner violence.

Water, Sanitation, and Hygiene Challenges in Informal Settlements in Kampala, Uganda: A Qualitative Study

Diarrhea causes 1.6 million deaths annually, including 525,000 children. Further, chronic diarrhea puts children at risk for mineral deficiencies, malnutrition, and stunting which, in turn, can result in cognitive deficits, poor performance in school, and decreased disease immunity in adulthood. Most diarrhea is caused by water contaminated by fecal matter. Interventions to improve clean water and sanitation can save lives; however, challenges persist in informal settlements. In this study, we explored the views of residents of informal settlements regarding water and sanitation in their communities. Focus group interviews were conducted with residents of 6 informal settlements in Kampala, Uganda (n = 165 people), and 6 key informant interviews were conducted with governmental and nongovernmental organizations that work to improve informal settlements or provide services to them. The results from this study demonstrate that, although these informal settlements had many infrastructure "upgrades" such as latrines and toilets, water taps, wells, and garbage collection and drainage systems, the water, sanitation, and hygiene (WASH) system and its components largely failed due to point-of-use charges of water taps and toilets and the difficulty of emptying cesspits. Our results suggest that WASH must be considered a system and that multiple upgrading efforts are needed for WASH systems to work, including road construction and better oversight of fecal sludge disposal.

Knowledge, Attitude and Practices Towards Dengue Fever Among Slum Dwellers: A Case Study in Dhaka City, Bangladesh

Objectives: This study intends to evaluate Dhaka city slum dwellers' responses to Dengue fever (DF). Methods: 745 individuals participated in a KAP survey that was pre-tested. Face-to-face interviews were performed to obtain data. Python with RStudio was used for data management and analysis. The multiple regression models were applied when applicable. Results: 50% of respondents were aware of the deadly effects of DF, its common symptoms, and its infectious nature. However, many were unaware that DF could be asymptomatic, a previously infected person could have DF again, and the virus could be passed to a fetus. Individuals agreed that their families, communities, and authorities should monitor and maintain their environment to prevent Aedes mosquito breeding. However, overall 60% of the study group had inadequate preventative measures. Many participants lacked necessary practices such as taking additional measures (cleaning and covering the water storage) and monitoring potential breeding places. Education and types of media for DF information were shown to promote DF prevention practices. Conclusion: Slum dwellers lack awareness and preventative activities that put them at risk for DF. Authorities must improve dengue surveillance. The findings suggest efficient knowledge distribution, community stimulation, and ongoing monitoring of preventative efforts to reduce DF. A multidisciplinary approach is needed to alter dwellers' behavior since DF control can be done by raising the population's level of life. People and communities must perform competently to eliminate vector breeding sites.

Measuring Coverage of Essential Maternal Postnatal Care Services in the Squatter Settlements of Islamabad Capital Territory in Pakistan

This study aimed to assess the coverage of essential postnatal maternal care services among women residing in the slums of Islamabad. A community-based, cross-sectional study was conducted to assess the coverage of essential postnatal care (PNC) services. Using random sampling, 416 women living in the squatter settlements of Islamabad Capital Territory were selected as study participants. Data was analyzed by using SPSS version 22. Descriptive statistics were employed to display frequencies for categorical variables, whereas mean, median, and standard deviation were calculated for continuous variables. The analysis of data showed that 93.5 percent of the women utilized postnatal services at least once after delivery. Approximately 9 percent and 4 percent of women received all eight recommended services within 24 h of birth and beyond 24 h of birth, respectively. Effective PNC services were received by only 1 percent of the women. The study revealed that the utilization of effective PNC was very low. The majority of the women delivered in health institutions and received their first PNC checkups, but follow-up for the recommended checkups was very low. These results can help health professionals and policymakers in designing programs and developing efficient strategies that would improve PNC service utilization in Pakistan.

Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis

Background and Aims

The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers.

Methods

A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis.

Results

A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors.

Conclusion

Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.

Frequency of impaired glucose tolerance and its correlates in females of reproductive age in urban slums of Lahore, 2019

BACKGROUND

The prevalence of diabetes mellitus has almost reached global epidemic proportions. Fortunately, the progress of the disease can be stemmed at the prediabetic level. The objective of the present study was to determine the frequency of impaired glucose tolerance (IGT) and its predictors in females of reproductive age in the urban slums of Lahore.

MATERIALS AND METHODS

A cross-sectional study was conducted among females of reproductive age in the slums of metropolitan Lahore. The calculated sample size was 384. Data were collected using a structured questionnaire covering demographic variables, lifestyle, medical, and dietary history. The oral GT test was carried out on the study participants after a 10 hour overnight fasting. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS version 23). Frequency distributions and percentages were calculated for categorical variables, and the mean and standard deviation were calculated for continuous variables. The Chi-square test or Fisher's exact test, as appropriate, was used to determine the association between IGT and various categorical variables. Logistic regression analysis was performed to determine the correlates of IGT after adjusting for confounders.

RESULTS

The final sample size was 394 women; 17% of whom had IGT, and 8.6% had newly diagnosed diabetics. Results of logistic regression showed increased waist/hip ratio, lower literacy of father or husband, age, and low intake of pulses as significant predictors of IGT (P < 0.05).

CONCLUSION

The frequency of IGT is high in females of reproductive age living in the urban slums of Lahore. There is a need for targeted health promotion and educational activities to improve the health and social conditions of slum dwellers.

Risks of Anaemia Among Pre-School Children Following Maternal Nutrition Education and Counselling in Urban Informal Settlements of Nairobi, Kenya

Slum environment may pose risk to child health and nutrition. This study assessed the risks of anemia among under five-year-old children, five years after implementing a nutrition education and counseling intervention in two urban slums in Nairobi, Kenya. A cross-sectional study was conducted in May 2018 as a follow-up of a randomized controlled study carried out between 2012-2015. A trained nurse measured hemoglobin levels of 438 children from households which participated in the initial study. Multivariate logistic regression was conducted to identify risks of anemia. The mean (+SD) age of the children was 55.9 (5.3) months and mean (+SD) hemoglobin was 10.7 (1.5) g/dL. Anemia prevalence was 59.8%, 33.9% had mild, 24.7% moderate, and 1.2% severe anemia. Absence of home toilet (AOR = 3.31; 95% CI, 1.20-9.09), household which paid to use a toilet facility (AOR = 1.86; 95% CI, 1.12-3.08), child's frequency of eating colored fruits and vegetables (AOR = 0.28; 95% CI, 0.08-0.96), meat and meat products (AOR = 0.31; 95% CI, 0.23-6.01), number of meals a child aged <15years ate a day preceding the study (AOR = 1.49; 95% CI, 1.14-1.98), and a mother who had a history of anemia (AOR = 2.89; 95% CI, 1.22-12.01), were factors significantly associated with child's anemia status. The environment of urban informal settings influences child anemia status. Further studies with interventions are therefore required in order to improve sanitation facilities and access to meats, fruits, and vegetables in urban slums through innovative kitchen gardens and small animal husbandry.

Divided infrastructure: legal exclusion and water inequality in an urban slum in Mumbai, India

Inadequate water access is central to the experience of urban inequality across low- and middle-income countries and leads to adverse health and social outcomes. Previous literature on water inequality in Mumbai, India's second largest city, offers diverse explanations for water disparities between and within slums.⁽¹⁾ This study provides new insights on water disparities in Mumbai's slums by evaluating the influence of legal status on water access. We analyzed data from 593 households in Mandala, a slum with legally recognized (notified) and unrecognized (non-notified) neighborhoods. Relative to households in a notified neighborhood, households in a non-notified neighborhood suffered disadvantages in water infrastructure, accessibility, reliability, and spending. Non-notified households used significantly fewer liters per capita per day of water, even after controlling for religion and socioeconomic status. Our findings suggest that legal exclusion may be a central driver of water inequality. Extending legal recognition to excluded slum settlements, neighborhoods, and households could be a powerful intervention for reducing urban water inequality.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

Towards a Link between Quantitative and Qualitative Sciences to Understand Social Systems Using the Example of Informal Settlements

Urbanization is one of the defining trends of our time and appropriate models are needed to anticipate the changes in cities, which are largely determined by human behavior. In the social sciences, where the task of describing human behavior falls, a distinction is made between quantitative and qualitative approaches, each of which has its own advantages and disadvantages. While the latter often provide descriptions of exemplary processes in order to describe phenomena as holistically as possible, the goal of mathematically motivated modeling is primarily to make a problem tangible. Both approaches are discussed in terms of the temporal evolution of one of the dominant settlement types in the world today: informal settlements. These areas have been modeled in conceptual works as self-organizing entities and in mathematical works as Turing systems. It is shown that the social issues surrounding these areas need to be understood both qualitatively and quantitatively. Inspired by the philosopher C. S. Peirce, a framework is proposed in which the various modeling approaches describing these settlements can be combined to arrive at a more holistic understanding of this phenomenon by using the language of mathematical modeling.

Depressive symptoms and associated social and environmental factors among women living in informal settlements in Nairobi, Kenya

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower - and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18-75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict.

A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18-24 Living in the Urban Slums of Kampala, Uganda

This paper examines the link between place and mental health using a qualitative assessment and focus group discussion with young women, ages 18 to 24 years of age, residing in three slums in Kampala, Uganda. The assessment, conducted in August of 2022, engaged 15 women who participated in Uganda Youth Development Drop-in center activities. The objective was to assess mental health and the link between place and mental health. Facilitated group discussions and photograph review yielded the following results. In terms of understanding their views of mental health and wellbeing, participants clearly focused on feelings. However, they also assessed resilience, the environment and a person's choice as relating to their mental health. Participants also found the physical spaces related to sports, education, worship, workplaces and green space to be linked to happiness. In terms of the attributes that were linked to sadness, participants listed the physical locations where drugs are sold, clubs for dancing and partying and also sanitation issues in the community. Participants frequently reported on the social environment and reflected on harassment, discrimination, alcohol use and criminal behavior that did not reflect a specific physical space, but rather the embedded social interactions they may face or observe by living in close proximity to hotspots for criminal activity. Given the dire shortages of mental health services and care that are available in this setting, a better understanding of young women's perceptions of place and mental health will be key for low-cost interventions and strategies to mitigate the contextual factors that may exacerbate mental illness.

"Next, it will be you": Women's Fear of Victimization and Precautionary Safety Behaviors in Informal Settlement Communities in Nairobi, Kenya

Around one billion people live in informal settlements globally, including over half of Nairobi, Kenya's 3 million residents. The purpose of this study was to explore women's fear of victimization within Mathare, an informal settlement in Nairobi, Kenya and how fear of victimization influences women's behaviors. Fifty-five in-depth interviews were conducted with women in 2015-2016. A modified grounded theory approach guided data collection and analysis. Findings suggest fear of victimization is a serious concern in informal settlements, but women have found ways to adapt their behaviors to cope and to continue to function and protect their children despite fearing victimization.

Drivers of Solid Waste Segregation and Recycling in Kampala Slums, Uganda: A Qualitative Exploration Using the Behavior Centered Design Model

Solid-waste management is a challenge in many cities, especially in low-income countries, including Uganda. Simple and inexpensive strategies such as solid-waste segregation and recycling have the potential to reduce risks associated with indiscriminate waste management. Unfortunately, these strategies have not been studied and adopted in slums in low-income countries. This cross-sectional qualitative study, therefore, used the behavioral-centered design model to understand the drivers of recycling in Kampala slums. Data were coded using ATLAS ti version 7.0, and content analysis was used for interpreting the findings. Our findings revealed that the study practices were not yet habitual and were driven by the presence of physical space for segregation containers, and functional social networks in the communities. Additionally, financial rewards and awareness related to the recycling benefits, and available community support were found to be critical drivers. The availability of infrastructure and objects for segregation and recycling and the influence of politics and policies were identified. There is, therefore, need for both the public and private sector to engage in developing and implementing the relevant laws and policies on solid waste recycling, increase community awareness of the critical behavior, and create sustainable markets for waste segregated and recycled products.

Perception, Prevalence, and Determinants of Intimate Partner Violence During Pregnancy in Urban Slums of Pune, Maharashtra, India

There is limited evidence on the prevalence and determinants of violence against pregnant women in India. Previous studies were entirely restricted to the violence against women in the reproductive age group. There is lack of evidence about the factors affecting violence against women during pregnancy. Understanding such factors, women's perception regarding violence during pregnancy and their justification of such violence could manifest an important aspect of violence. Women living in slum communities particularly are victims of violence. In this context, this study intended to examine women's perception, prevalence of, and factors affecting the violence against women during pregnancy in the slum communities of Pune. A community-based cross-sectional study of 1-year duration was undertaken in urban slums of Pune city, Maharashtra, India. The study participants were women who have delivered 2 years preceding the survey. Using simple random sampling, 500 women were selected from 10 purposively selected slums. House-to-house visits were made and face-to-face interviews conducted using a pretested structured questionnaire. Univariate, bivariate, and logistic regression analyses were applied. The study results show that 15.3% of women have experienced violence during their recent pregnancy. Furthermore, 9.2% of women experienced physical violence, 1.8% sexual violence, and 11.2% psychological violence. Education level of women, husband's education and alcohol consumption, history of violence in the family, and provision of spurious justification for violence have emerged as some of the leading factors associated with the violence inflicted during pregnancy. Effective interventions at both community and health care settings are needed urgently to reduce the violence inflicted during pregnancy.

Exploring Factors Associated with Women's Willingness to Provide Digital Fingerprints in Accessing Healthcare Services: A Cross-Sectional Study in Urban Slums of Bangladesh

Digital fingerprints are increasingly used for patient care and treatment delivery, health system monitoring and evaluation, and maintaining data integrity during health research. Yet, no evidence exists about the use of fingerprinting technologies in maternal healthcare services in urban slum contexts, globally. The present study aimed to explore the recently delivered women's willingness to give digital fingerprints to community health workers to access healthcare services in the urban slums of Bangladesh and identify the associated factors. Employing a two-stage cluster random sampling procedure, we chose 458 recently delivered women from eight randomly selected urban slums of Dhaka city, Bangladesh. Chi-square tests were performed for descriptive analyses, and binary logistic regression analyses were performed to explore the factors associated with willingness to provide fingerprints. Overall, 78% of the participants reported that they were willing to provide digital fingerprints if that eased access to healthcare services. After adjusting for potential confounders, the sex of the household head, family type, and household wealth status were significantly associated with the willingness to provide fingerprints to access healthcare services. The study highlighted the potentials of using fingerprints for making healthcare services accessible. Focus is needed for female-headed households, women from poor families, and engaging husbands and in-laws in mobile health programs.

Impact of Housing and Infrastructure on handwashing in Peru

BACKGROUND

The metropolitan area of Lima, Peru has a third of the nation's population living in slum dwellings that are hypothesized to contribute to inefficient household hygienic practices. The purpose of this study was to quantitatively assess which living conditions have the greatest impact on handwashing practices.

METHODS

A cross-sectional epidemiological design of participants ≥16 y of age from San Juan de Miraflores, a slum on the outskirts of Lima, Peru, was used. Poisson regression was applied to assess the impact of living conditions on handwashing practices.

RESULTS

We could not demonstrate a relationship between living conditions (home structure, overcrowding, water, grey water disposal) and reported handwashing. The reported lack of handwashing is associated with the number of children in the home (those with children <5 y of age were more likely not to report washing their hands) and length of stay in the slum in years.

CONCLUSIONS

Living conditions play an important role in one's health, therefore improved study designs are needed to determine which strategies are likely to be the most effective in improving outcomes for slum dwellers.

Perspectives of Local Community Leaders, Health Care Workers, Volunteers, Policy Makers and Academia on Climate Change Related Health Risks in Mukuru Informal Settlement in Nairobi, Kenya-A Qualitative Study

Sub-Saharan Africa has been identified as one of the most vulnerable regions to climate change. The objective of this study was to explore knowledge and perspectives on climate change and health-related issues, with a particular focus on non-communicable diseases, in the informal settlement (urban slum) of Mukuru in Nairobi, Kenya. Three focus group discussions and five in-depth interviews were conducted with total of 28 participants representing local community leaders, health care workers, volunteers, policy makers and academia. Data were collected using semi-structured interview guides and analyzed using grounded theory. Seven main themes emerged: climate change related diseases, nutrition and access to clean water, environmental risk factors, urban planning and public infrastructure, economic risk factors, vulnerable groups, and adaptation strategies. All participants were conscious of a link between climate change and health. This is the first qualitative study on climate change and health in an informal settlement in Africa. The study provides important information on perceived health risks, risk factors and adaptation strategies related to climate change. This can inform policy making, urban planning and health care, and guide future research. One important strategy to adapt to climate change-associated health risks is to provide training of local communities, thus ensuring adaptation strategies and climate change advocacy.

Coherence between Existing System of Defining Urban Poor with Kuppuswamy and Hashim's System; Which is More Relevant?

Background

Identification of below poverty line (BPL) households is of paramount importance to provide benefits under poverty alleviation and other programs.

Objectives

(1) To assess households in urban slums in terms of housing, assets, and amenities. (2) To compare three different systems of socioeconomic status (SES) - ration card holders, Modified Kuppuswamy Scale, and Hashim's system.

Materials and Methods

A cross-sectional, community-based study was conducted in urban slums of field practice area of a medical college, Pune. Considering 35% of urban households in India qualify as poor, sample size of 593 households was calculated. A predesigned, validated, pretested questionnaire was used, covering sociodemographic domains including indicators of three systems. Agreement between these scales was calculated by kappa statistics.

Results

Total 639 households were surveyed covering 3078 slum population. Percentage of BPL families according to possession of yellow ration card, Modified Kuppuswamy Scale, and Hashim's system were 35.99%, 48.67%, and 48.51%, respectively. The proportion of agreement between Kuppuswamy scale and ration card was 55.71% and for Hashim system and ration card was 51.79%.

Conclusions

The present study revealed no agreement between these three systems. Hashim system gives more accurate and realistic picture of SES of the urban slums households owing to its holistic approach.

Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis

AIMS

The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations.

METHODS

Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression.

RESULTS

Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes.

CONCLUSIONS

Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.

Living environment and health of under-five children in urban slums of a coastal region in South India

Objective

The primary objective of the study was to determine the association between the living environment and morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums in southern India.

Methods

This study included 224 mothers of under-five children living in urban slums of Udupi Taluk, Karnataka. A total of 17 urban slums were selected randomly using random cluster sampling.

Results

Undernutrition was high among children of illiterate mothers (63.8%), and the children of working mothers were affected by more morbidity (96.6%) as compared with housewives. Morbidity was also found to be high among children belonging to families with low incomes (66.1%) and low socio-economic backgrounds (93.1%). Safe drinking water, water supply, sanitation, hygiene, age of the child, mother's and father's education, mother's occupation and age, number of children in the family, use of mosquito nets, type of household, and family income were significantly associated with child morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums.

Conclusion

Overall, in our study, family characteristics including parental education, occupation and income were significantly associated with outcomes among under-five children. The availability of safe drinking water and sanitation, and the use of mosquito nets to prevent vector-borne diseases are basic needs that need to be urgently met to improve child health.

Funding

Self-funded.

Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study

Context:

Development is an ongoing process through which an individual acquires competence to function adequately. Developmental delay is said to occur when a child fails to reach the age-appropriate anticipated milestones. This imparts long-term direct as well as indirect effects on the health of a community obviating routine measurement of its prevalence especially in high-risk populations.

Aim:

To find out the prevalence and correlates of developmental delay among children under two years of age in slums of Burdwan Municipality, West Bengal.

Settings and Design:

A community-based descriptive cross-sectional study.

Methods and Materials:

This study was conducted between September-November 2019 among 240 study subjects selected by multistage simple random sampling. Data were collected by interviewing the respondents using a predesigned, pretested schedule. Developmental status was assessed by applying Trivandrum Developmental Screening Chart (TDSC). Chi-square test and logistic regression was done to find associations.

Results:

Prevalence of developmental delay was 6.6%(95%CI 3.6-9.8) and proportion was more among male infants. Chi square test revealed gender (p = 0.03), mothers' education (p = 0.00), socio-economic status (p = 0.00), parity (p = 0.02), birth spacing (p = 0.01) birth weight (p = 0.00) to be significantly associated with developmental delay and multivariable analysis showed all the factors to be significant predictors except gender, parity and birth spacing. Gestational duration, maternal age at delivery, mode of delivery was not found to be significantly associated with developmental delay.

Conclusion:

Developmental delay is considerably high in the study area. A larger study using appropriate tool and follow-up may elicit the burden and associated determinants.

"Our Home Is a Muddy Structure": Perceptions of Housing and Health Risks Among Older Adults in Contrasting Neighborhoods in Ghana

Aging occurs in a variety of social and physical environmental settings that affect health. However, despite their rapidly growing populations, public health research in sub-Saharan Africa has yet to address the role of residential environments in the health and well-being of older adults. In this study, we utilized an ethnographic research methodology to explore barriers and facilitators to health among older adults residing in two contrasting neighborhoods in Accra, Ghana. Our specific objective was to identify patterns of health risks among older adults in the two neighborhoods. Data were collected through qualitative interviews with a purposive sample of health workers (n = 5), community leaders (n = 2), and older adults residing in a slum and non-slum neighborhood (n = 30). Our thematic data analysis revealed that, despite different underlying drivers, health barriers across the slum and non-slum were largely similar. The harmful effects of these health barriers - poor built environments, housing precariousness, unsanitary living conditions, defective public services, and social incivilities - were mitigated by several facilitators to health, including affordable housing and social supports in the slum and better housing and appealing doors in the non-slum. Our study contributes to a more nuanced understanding of the ways in which aging and urban environments intersect to influence population health in resource poor settings. In particular, rather than the commonly referenced dichotomy of poor and non-poor settlements in discourses of neighborhood health, our findings point to convergence of health vulnerabilities that are broadly linked to urban poverty and governmental neglect of the elderly.

Status of salt iodization, related awareness and practice at the household level in slums of Burdwan Municipality, West Bengal

Background:

Monitoring adequacy of salt iodization at consumption level and exploring the reasons for inadequacy, especially in marginalized communities, is crucial to achieve the target coverage of universal salt iodization.

Aims:

To assess the iodine content of salt used at household level, related awareness and practice of respondents and their socio demographic correlates.

Settings and Designs:

This cross-sectional descriptive study was conducted in the slums of Burdwan Municipality in 2019.

Methods and Material:

A total of 330 households were selected by cluster sampling. Salt iodine content was estimated at household level semi-quantitatively by Iodine testing kit, following recommended guidelines. One respondent from each household was interviewed to assess their awareness and practice regarding iodized salt. Kruskal Wallis test, Mann Whitney U test and Multivariable logistic regression was used.

Results:

All 330 households were using iodized salt; 77.6% were consuming adequately iodized and 22.4% were consuming inadequately iodized salts. Only 30.9% of the respondents were aware about the importance of iodized salt, few had correct practice despite inadequate knowledge and none, except one, practiced adding salt at the end of cooking. Awareness and practice were associated with caste and age of the respondents, respectively. Keeping salt container near the oven, adjusting for keeping salt in uncovered container, significantly predicted inadequate level of iodization [AOR 6.17 (95% CI: 2.68-14.26)].

Conclusion:

Inadequate iodization, lack of awareness regarding iodized salt and faulty storing practices amounting to increased risk of inadequate iodization are still prevalent emphasizing the need, in policy, for health education.

Effect of feeding practices on nutritional status of infant and young children residing in urban slums of berhampur: A decision tree approach

Background

Appropriate infant and young child feeding (IYCF) practices in the early years of life will ensure optimal growth and development of the child. However, many children are not fed in the recommended way.

Objectives

To assess the risk of malnutrition as a result of various feeding practice patterns among the children with the application of the decision tree algorithm.

Methods

It was a community-based cross-sectional study conducted in the urban slums of Berhampur Municipal Corporation in Ganjam District, Odisha, India, from January to December 2019. Among a sample of 360 children of 6-23 months, nutritional status and feeding practices were determined. Data were analyzed using R version 3.6.1 developed by R Foundation for Statistical Computing, Vienna, Austria. The effect of IYCF practices on nutritional status was explained with the decision tree method with the use of a Chi-squared automatic interaction detection algorithm.

Results

The prevalence of children with early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum meal frequency (MMF), and minimum dietary diversity (MDD) was 62.2%, 59.7%, 41.9%, and 19.4%, respectively. The prevalence of wasting, stunting, and underweight among the participants was 36.4%, 31.1%, and 35.3%, respectively. The significant factors which classified and predicted wasting were EBF, EIBF, and MDD, for stunting factors were EBF, MMF, and MDD and for underweight, significant factors were EBF, EIBF, and MDD.

Conclusion

With the decision tree approach, the probability of malnutrition in relation to various feeding practices patterns can be easily explained to the mothers and health workers as compared to interpreting odds ratio and strict adherence to IYCF guidelines can also be ensured.

Spread of COVID-19 in urban neighbourhoods and slums of the developing world

We study the spread of COVID-19 across neighbourhoods of cities in the developing world and find that small numbers of neighbourhoods account for a majority of cases (k-index approx. 0.7). We also find that the countrywide distribution of cases across states/provinces in these nations also displays similar inequality, indicating self-similarity across scales. Neighbourhoods with slums are found to contain the highest density of cases across all cities under consideration, revealing that slums constitute the most at-risk urban locations in this epidemic. We present a stochastic network model to study the spread of a respiratory epidemic through physically proximate and accidental daily human contacts in a city, and simulate outcomes for a city with two kinds of neighbourhoods-slum and non-slum. The model reproduces observed empirical outcomes for a broad set of parameter values-reflecting the potential validity of these findings for epidemic spread in general, especially across cities of the developing world. We also find that distribution of cases becomes less unequal as the epidemic runs its course, and that both peak and cumulative caseloads are worse for slum neighbourhoods than non-slums at the end of an epidemic. Large slums in the developing world, therefore, contain the most vulnerable populations in an outbreak, and the continuing growth of metropolises in Asia and Africa presents significant challenges for future respiratory outbreaks from perspectives of public health and socioeconomic equity.

COVID-19 and community healthcare: perspectives from Nairobi's informal settlements

Urban slums are often characterized by overcrowding, inaccessibility of basic services such as running water and abject poverty. These may affect adherence to COVID-19 containment measures and worsen the effect of the virus on slum residents. We explore the overall practices and impact of the COVID-19 mitigation measures on the lives of Nairobi’s urban poor. This was done through a three-week cycle of telephone interviews with residents, local healthcare providers, religious leaders and key decision makers in two of Nairobi’s slums. As the number of COVID-19 cases increase in Kenya, greater efforts are needed to protect those in environments that make it challenging to implement the containment measures. Collaborative effort is needed to firmly and quickly implement social protections and food security measures, protection against domestic violence, and strengthening response at Level One (community level).

Health, quality of life, and wellbeing of older slum dwellers in sub-Saharan Africa: A scoping review

A growing population of older adults resides in sub-Saharan Africa's urban slums. Although environmental conditions in slums are adversarial, there is limited knowledge on the wellbeing of older adults residing in these settings. This review sought to understand the scope, extent, and nature of current research on the health and wellbeing of older slum dwellers in sub-Saharan Africa. We searched 8 bibliographic databases for studies examining the health and wellbeing of older slum dwellers in the region. We also completed a grey literature search. The literature search together yielded 3,388 records, of which we selected 25 for review following a rigorous screening process. The included studies covered a variety of health issues of concern to older slum dwellers: (1) disease and injury prevalence; (2) self-assessed health and quality of life status; (3) physical/mental health impairment and disability; (4) healthcare access and utilisation; and (5) sociodemographic disparities in health and wellbeing. The gaps in this literature include a regional bias in research efforts, near absence of non-slum control samples, and limited research on the health impacts of the built environment of slums. Suggestions for future research are presented.

Observing sensitivity in slums in Yemen: the veiled challenge

This study represents the first video observation of parenting practices conducted in Yemen, where women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 minutes during free interaction. The mothers' veils did not hamper the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. Mothers with a higher educational level and those experiencing more social support were more sensitive. About half of the mothers had their child perform household chores, which was related to lower sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

Sensitive parenting in urban slums in Makassar, Indonesia: the roles of experienced child maltreatment and sociodemographic risk

In the context of urban slums in Makassar in Indonesia, this study aimed to test whether maternal sensitivity was associated with maternal history of childhood maltreatment, and whether this association was mediated by current partner conflict and current cumulative sociodemographic risk. A total of 98 mothers and their 2-4 year-old children were videotaped in a naturalistic observation. Maternal sensitivity was coded using the Ainsworth scales. In addition, mothers were interviewed to assess childhood trauma, current partner conflict, and current sociodemographic risk. There was a significant negative correlation between maternal experienced childhood maltreatment and observed maternal sensitivity. Current partner conflict and sociodemographic did not mediate the association between childhood maltreatment and maternal sensitivity.

PTSD Predicts Smoking Cessation Failure in a Trauma-Exposed Population

The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population. Methods: Participants were 310 smokers who attempted quitting smoking, either successfully (quitters, n = 213) or not (relapsers, n = 97), who lived in slums and were attending a family doctor program. Measurements included a general questionnaire covering sociodemographic characteristics, clinical status and life habits, and the Posttraumatic Stress Disorder Checklist - Civilian Version. Differences in sociodemographic, clinical and lifestyle characteristics between quitters and relapsers were compared using a chi-square test. Because of the small sample size, full and partial PTSD were collapsed into a single category. Results: Significant differences (p ≤ .15) between quitters and relapsers were found in age, body mass index (BMI), income, alcohol consumption, and in the presence of full/partial PTSD diagnosis and of all three symptom clusters separately. Four logistic regression models predicting smoking cessation were modeled to control for confounding factors and included as independent variables a full/partial PTSD diagnosis and the three posttraumatic symptom clusters. The avoidance/numbing cluster presented the strongest association with relapse status (ORa 2.04, 95% CI [1.15, 3.63], p = .015), followed by the full/partial PTSD (ORa 1.80, 95% CI [1.04, 3.14], p = .038). The re-experiencing and the hyperarousal clusters were non-significantly associated with smoking cessation (ORa 1.34, 95% CI [0.80, 2.31], ns and ORa 1.65, 95% CI [0.96, 2.84], ns, respectively). Conclusions: Full/partial PTSD and posttraumatic symptom clusters uniquely predict risk for smoking relapse and thus may be a useful therapeutic target in trauma-exposed smokers.

COVID-19 and Slums: A Pandemic Highlights Gaps in Knowledge About Urban Poverty

According to the United Nations, about 1 billion persons live in so-called slums. Numerous studies have shown that this population is particularly vulnerable to infectious diseases. The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, emphatically underlines this problem. The often high-density living quarters coupled with a large number of persons per dwelling and the lack of adequate sanitation are reasons why measures to contain the pandemic only work to a limited extent in slums. Furthermore, assignment to risk groups for severe courses of COVID-19 caused by noncommunicable diseases (eg, cardiovascular diseases) is not possible due to inadequate data availability. Information on people living in slums and their health status is either unavailable or only exists for specific regions (eg, Nairobi). We argue that one of the greatest problems with regard to the COVID-19 pandemic in the context of slums in the Global South is the lack of data on the number of people, their living conditions, and their health status.

Soil-transmitted helminthiasis: A neglected tropical disease among urban slum dwelling school-aged children of a sub-Saharan African city

Background

The need to generate a robust epidemiological data on the neglected tropical diseases is imperative, in order to encourage access to formal care, drive public policies and ensure the allocation of resources by policy-makers.

Objectives

The objective of this study was to determine the prevalence of soil-transmitted helminthiasis (STH) and its association with nutritional variables among primary school pupils living in urban slums in a South-Eastern sub-Saharan African city of Enugu, Nigeria.

Methods

The stool samples of school-aged children living in urban slums were analyzed for ova of the helminths using the Kato-Katz methods, whereas the nutritional assessment (weight and height) was obtained and analyzed to indicate acute or chronic malnutrition. Degrees of helminthic load were then classified. The socioeconomic status was determined while the prevalence of STH and the relationship between it and the nutritional stratus was assessed to ascertain any significance between being malnourished and having STH as this will inform policy decisions.

Results

There were a total of 371 analyzed stool samples from 228 females (61.5%) and 143 males (38.5%), with 285 (76.8%) from the lowest socioeconomic class. The prevalence of STH was 18.1%, while that of acute and chronic malnutrition were 3.3% and 7.5%, respectively. The intensity of infestation was, however, light, with the highest mean egg intensity of 74.4 ± 32.8 documented for ascariasis. There was no statistically significant association between the presence of STH and various indices of acute and chronic malnutrition (P > 0.05).

Conclusion

STHs prevalence is high among children living in urban slums. Nutritional status was, however, not adversely affected by helminthic infestation.

Preventing COVID-19 Amid Public Health and Urban Planning Failures in Slums of Indian Cities

The COVID‐19 pandemic has brought renewed attention to the lack of urban planning and its public health implications in developing countries. Slum communities face the dual challenges of chronically poor residential environments and the acute effects of a pandemic and the preventive measures that follow. In this paper, I assess the effectiveness and implications of social distancing, frequent handwashing, and lockdown in the context of slums in Indian cities, where overcrowding, lack of access to water and sanitation, and dependence on daily wages for sustenance and livelihood are common. Using data from multiple sources, I demonstrate that not only will these measures be hard to achieve in slums in the short term due to specific characteristics of these habitats, but they will bring new challenges in the long term due to disproportionate impacts on the urban poor. Lessons learned from this pandemic will require us to rethink public health responses and urban planning practices that could better prepare our cities for future pandemics.

Gender and the Digital Divide Across Urban Slums of New Delhi, India: Cross-Sectional Study

Background

Disparities in access to specific technologies within gender groups have not been investigated. Slum settings provide an ideal population to investigate the contributing factors to these disparities.

Objective

This study aimed to examine gender differences in mobile phone ownership, internet access, and knowledge of SMS text messaging among males and females living in urban slum settings.

Methods

A convenience sampling approach was used in sample selection from 675 unnotified slums. A total of 38 slum sites were then selected across four geographic zones. Of these, 10% of the households in each slum site was selected from each zone. One household member was interviewed based on their availability and fulfillment of the eligibility criteria. Eligible individuals included those aged 18 years and above, residing in these slums, and who provided voluntary consent to participate in the study. Individuals with mental or physical challenges were excluded from the study.

Results

Our results showed that females were half as likely to own mobile phones compared with males (odds ratio [OR] 0.53, 95% CI 0.37-0.76), less likely to have internet access (OR 0.79, 95% CI 0.56-1.11), or know how to send text messages (OR 0.93, 95% CI 0.66-1.31). The predictors of mobile phone ownership, internet access, and text messaging between males and females included age, individual education, housing type, and the number of earning members in a household in the adjusted analysis. Among males, the number of earning members was a predictor of both mobile phone ownership and text messaging, whereas household education was a predictor of both internet access and text messaging. Age and individual education only predicted internet access, whereas housing type only predicted text messaging. Among females, household education was a predictor of all the technology outcomes. Age and type of toilet facility only predicted mobile phone ownership; housing type only predicted internet access whereas television ownership with satellite service and smoking behavior only predicted text messaging.

Conclusions

Our study findings showing disparate access to technology within gender groups lend support for further research to examine the causal mechanisms promoting these differences to proffer significant solutions. Specifically, our study findings suggest that improving household education is crucial to address the disparate access and usage of mobile phones, the internet, and text messaging among women in slum settings. This suggestion is due to the consistency in household educational level as a predictor across all these technology indicators. In addition, the mechanisms by which the number of household earning members influences the disparate access to technology among men call for further exploration.

A study of self-reported health problems of the people living near railway tracks in Raipur city

Noise is pervasive in everyday life and can cause both auditory and nonauditory health effects. Noise-induced hearing loss remains highly prevalent in occupational settings. Nonauditory effects of noise can cause tinnitus, headache, auricular plenitude, dizziness, and gastric, visual, sleep, and mood disorders, endocrine imbalance, and cardiovascular disorders. A cross-sectional study among resident above the age of 18 years of the selected urban slum near railway track of Raipur City with a sample size of 400 was conducted. 23.0% of the study subjects responded of facing auditory fatigue, followed by 11.5% of the study subjects reported of hearing loss, 6% of the study participants perceived that the surrounding noise led to an increase in their blood pressure. Loss of sleep/insomnia was reported by 6% of resident in our study. Health effects of environmental noise are manifold, serious and, because of the widespread exposure, very prevalent. These factors stress the need to regulate and reduce environmental noise exposure.

Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries

Objective

The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up.

Methods

We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue.

Results

We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system.

Conclusions

For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.

Promoting family integrated early child development (during first 1000 days) in urban slums of India (fine child 3-3-1000): Study protocol

AIMS

This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000 days for families in Delhi urban slums.

BACKGROUND

The first 1,000 days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development.

DESIGN

This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development.

METHODS

This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13 months and 25 months without intervention to document the impact.

DISCUSSION

The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries.

IMPACT

The first 1,000 days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000 days in three sums of Delhi, India.

Slums, Space, and State of Health-A Link between Settlement Morphology and Health Data

Approximately 1 billion slum dwellers worldwide are exposed to increased health risks due to their spatial environment. Recent studies have therefore called for the spatial environment to be introduced as a separate dimension in medical studies. Hence, this study investigates how and on which spatial scale relationships between the settlement morphology and the health status of the inhabitants can be identified. To this end, we summarize the current literature on the identification of slums from a geographical perspective and review the current literature on slums and health of the last five years (376 studies) focusing on the considered scales in the studies. We show that the majority of medical studies are restricted to certain geographical regions. It is desirable that the number of studies be adapted to the number of the respective population. On the basis of these studies, we develop a framework to investigate the relationship between space and health. Finally, we apply our methodology to investigate the relationship between the prevalence of slums and different health metrics using data of the global burden of diseases for different prefectures in Brazil on a subnational level.

Morbidity Pattern, Availability and Utilization of Health Services: A Study among the Male Youth (15-24 Years) Living in the Slums

Background

Youth is considered as a healthy period but their health is greatly influenced by the hostile living conditions in the slums. When this is accompanied by poor health infrastructure, health risk escalates multiple times.

Objectives

The objective was (1) to study the health problems of the male youth living in the slums and (2) to study the availability and utilization of health services for the male youth living in the slums.

Subjects and Methods

Study design: Cross-sectional study. Study population: Male youth (15-24 years). Study settings: Four urban slums of Amritsar city. Study period: January 1, 2017-December 31, 2017. Sample size: One thousand male youths. Inclusion criteria: Male youth (15-24 years) with consent. Exclusion criteria: Male youth (15-24 years) not given consent, not available at home on the third repeat visit, and mentally unstable or deaf or dumb.

Results

The morbidity pattern showed that 47.5% suffered from any disease during the past 3 months and 3.3% were hospitalized in the past 1 year. Majority of the cases were due to diseases of the respiratory system and gastrointestinal system. Private health sectors including chemist shops were utilized more in case of both outpatient (88.9%) and inpatient services (57.6%) as compared to public health sector. The private health facilities were within 500 m from majority (89.6%) of households in the slums of Amritsar city.

Conclusions

Primary health care needs to be strengthened in the slums. Effective and easily accessible health-care services should be provided by the government at the doorsteps of slum households. The Information Education Communication/Behavior Change Communication activities regarding disease prevention should be strengthened to promote and protect good health.

Awareness Among Parents About Pneumococcal Conjugate Vaccine in Routine Immunization Program to Prevent Pneumococcal Pneumonia in Bangladesh

Introduction

This study was conducted in two purposively selected slums of Dhaka to assess parents’ awareness of pneumococcal conjugate vaccine (PCV) in reducing the occurrence of death due to pneumococcal pneumonia.

Methods

Using a semi-structured questionnaire, face-to-face interviews were conducted with 150 parents. Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) and Chi-square (χ2) test performed to determine associations.

Results

About 35% of parents were found to be aware of PCV; of them, 92.5% were informed by health service providers, and 81.1% mentioned benefits of PCV. Most parents were unaware of the PCV vaccination status of children, and no significant association was found between vaccination status and parents’ socioeconomic status. Aware parents vaccinated their children, and the association of awareness with vaccination status was statistically significant for PCV-1 (P = 0.04) and PCV-2 (P < 0.001). Although 7.4% of parents did not vaccinate their child with PCV-3 due to a child’s sickness or other priorities in household work, the association was significant (P = 0.01).

Conclusion

Strengthened efforts by health service providers, prioritizing dissemination of key messages on PCV, its benefits, and side-effects, can motivate parents and reduce dropout rates.

Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India

Background

Despite evidence regarding the beneficial effects of vaccines, vaccination uptake has not been up to the mark across the globe in various sociocultural and sociodemographic groups. Logistics and workforce have been issues of concern to public health managers, but the latent issue of vaccine hesitancy leading to vaccine delays and refusals has not been widely addressed particularly in the Indian context.

Objectives

The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for childhood vaccinations in slums of Siliguri, India.

Methods

A cross-sectional study was carried out among 194, 0-59 months' children residing in slums of Siliguri in 2016. Data were collected at the household with interviews of mothers/primary caregivers using a predesigned pretested interview schedule developed based on the validated version of vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Associations were analyzed using logistic regression.

Results

Majority 161 (83%) of the families were vaccine-hesitant and only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy.

Conclusion

Most of the families of the children were vaccine-hesitant in the area. Uniformity in schedules in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mothers' education can address the issue of vaccine hesitancy.