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PubMed1992

Policy directions in urban health in developing countries--the slum improvement approach.

The urban development, or housing, sector has a longer experience of addressing the problems of the urban poor in developing countries than the health sector. In recent years the policy of 'slum improvement', which involves both sectors, has attracted the support of international donors. This article documents the development of the slum improvement approach and addresses key issues of the approach which have implications for health planning: covering the poorest dwellers; relocation; land tenure; gentrification; debt burdens and the impact on women. Questions about the approach which still need answering are defined and a summary of the constraints in slum improvement and potential solutions is presented.

Developing Countries↗
PubMed2006

Emerging changes in reproductive behaviour among married adolescent girls in an urban slum in Dhaka, Bangladesh.

Structural and social inequalities, a harsh political economy and neglect on the part of the state have made married adolescent girls an extremely vulnerable group in the urban slum environment in Bangladesh. The importance placed on newly married girls' fertility results in high fertility rates and low rates of contraceptive use. Ethnographic fieldwork among married adolescent girls, aged 15-19, was carried out in a Dhaka slum from December 2001-January 2003, including 50 in-depth interviews and eight case studies from among 153 married adolescent girls, and observations and discussions with family and community members. Cultural and social expectations meant that 128 of the girls had borne children before they were emotionally or physically ready. Twenty-seven had terminated their pregnancies, of whom 11 reported they were forced to do so by family members. Poverty, economic conditions, marital insecurity, politics in the household, absence of dowry and rivalry among family, co-wives and in-laws made these young women acquiesce to decisions made by others in order to survive. Young married women's status is changing in urban slum conditions. When their economical productivity takes priority over their reproductive role, the effects on reproductive decision-making within families may be considerable. This paper highlights the vulnerability of young women as they pragmatically make choices within the social and structural constraints in their lives.

Abortion, Induced↗
PubMed1999

Determinants of mortality among children in the urban slums of Dhaka city, Bangladesh.

The growing slum population in the developing world is an increasing challenge for local health authorities. Little is known of the patterns of disease occurrence including treatment types offered in this population. The paper describes reported child mortality and its determinants, including the main diseases affecting children and treatments, in the slum population of Dhaka city, Bangladesh. 1500 households in three slum communities were included in a cross-sectional survey. Reported death rates in the households per 1000 children (0-107 months) within the last year from the interview were 20.5 for boys and 27.0 for girls. More girls than boys died in infancy (age < 12 months). The most frequent reported causes of deaths were tetanus in infancy and diarrhoea among children aged < or = 12 months. Vaccination coverage (DPT, polio, measles and BCG) was 73% for children < 3 years of age. The results showed that gender difference in mortality may have been influenced by the patterns of treatment received during sickness and the choice of treatment was determined by the financial ability of the households. Household income, children's vaccinations, TT immunization of mothers and personal cleanliness appeared to be significantly associated with child mortality. Despite the relatively high vaccination coverage for this population, child mortality remained alarmingly high, indicating that socioeconomic and environmental conditions must be improved to substantially reduce morbidity and mortality in this population.

Accidents↗
PubMed2002

Livelihoods, nutrition and health in Dhaka slums.

OBJECTIVES: To identify groups within Dhaka slums that report similar patterns of livelihood, and to explore nutritional and health status. DESIGN: A random sample of households participated in a longitudinal study in 1995-1997. Socio-economic and morbidity data were collected monthly by questionnaire and nutritional status was assessed. Cluster analysis was used to aggregate households into livelihood groups. SETTING: Dhaka slums, Bangladesh. SUBJECTS: Five-hundred and fifty-nine households. MAIN OUTCOME MEASURES: Socio-economic and demographic variables, nutritional status, morbidity. RESULTS: Four livelihood groups were identified. Cluster 1 was the richest cluster with land, animals, business assets and savings. Loans as well as income were higher, which shows that this group was credit-worthy. The group was mainly self-employed and worked more days per month than the other clusters. The cluster had the second highest body mass index (BMI) score, and the highest children's nutrition status. Cluster 2 was a poor cluster and was mainly dependent self-employed. Savings and loans were lower. Cluster 3 was the most vulnerable cluster. Members of this group were mainly casual unskilled, and 40% were female-headed households. Total income and expenditure were lowest amongst the clusters. BMI and children's nutritional status were lowest in the slum. Cluster 4 was the second richest cluster. This group comprised skilled workers. BMI was the highest in this cluster and children's nutritional status was second highest. CONCLUSIONS: Cluster analysis has identified four groups that differed in terms of socio-economic, demographic and nutritional status and morbidity. The technique could be a practically useful tool of relevance to the development, monitoring and targeting of vulnerable households by public policy in Bangladesh.

Adult↗
PubMed1999

A nutritional profile of non-pregnant women from the slums of Dinajpur, Bangladesh.

The health and nutritional status of many urban slum dwellers in the developing world is said to be deteriorating. The nutritional profile of 328 adult, non-pregnant women from the slums of Dinajpur, Bangladesh, confirms this. Results of a cross-sectional survey showed that approximately half the women were acutely malnourished and all but six were anaemic. This, despite the fact that the slums of Dinajpur are considered relatively 'better-off' than many in the developing world; most families having permanent land tenureship, and access to basic education and health services.

Adolescent↗
PubMed2000

Changes in nutritional status and morbidity over time among pre-school children from slums in Pune, India.

OBJECTIVE: To investigate changes in nutritional status and morbidity over time among pre-school slum children. DESIGN: Longitudinal. METHODS: Children in the age group of 0-5 years from three slums in Pune (n = 845) were studied for a period of two years. Measurement of weight (up to 20 g) and height (up to 0.1 cm), morbidity (in last 7 days) and clinical assessment was undertaken once every four months. RESULTS: Peak prevalence of malnutrition was observed around 18 months and shorter period (3.5 months) of exclusive breastfeeding was probably responsible. Morbidity was generally higher in rainy season and was associated with wasting but not stunting. Gastrointestinal illness and fever contributed 50% of total morbidity days. Higher morbidity affected significantly growth velocities in weight throughout pre-school age. Height velocities were significantly low upto three years of age but there appeared no scope for catch-up growth as velocities remained similar thereafter. Higher morbidity in younger children (less than 2 years) led to deterioration of nutritional status over time in 30% to 50% children. CONCLUSION: Shorter period of exclusive breastfeeding results in undernutrition at an early age among slum children. Morbidity further deteriorates the nutritional status

Anthropometry↗
PubMed2001

Risk factors for acute respiratory infections among the slum infants of Dhaka city.

A cross-sectional study was conducted in five slums of Dhaka city. The study population was all adult women of reproductive age having an infant aged less than one year with a view to assessing the prevalence of Acute Respiratory Infections (ARIs) among the slum infants and also to identify the factors responsible for it. A total of 1,008 mothers were interviewed. Among them, 927 had children aged 0-12 months. Mothers with live infants (927) were asked if their children had any disease during the two weeks prior to the interview. Respiratory infection was the highest among the prevalent diseases (ARI 72%, diarrhoeal diseases 28%, measles 4% and others 4%). So, an emphasis was given in this regard. Out of 228 ARI cases, percentage of mild (78%) and severe ARI (11%) were present in children aged less than 6 months, whereas moderate ARI (23%) was higher in 6 months and above age groups. The variation was statistically significant between the two age groups (p<0.05). But there was no significant difference in ARI by sex (p>0.05). In logistic analysis, maternal age below 20 years, working mothers, low housing and socio-economic index, no household possession, no access to piped water and infant's age above 6 months appeared to be significant predictors of ARIs. The risk of acquiring ARI was 3.33 times higher in low socio-economic index, 3 times in no access to piped water, 2.39 times in low housing index, 1.9 times in mother's age below 20 years, 1.85 times in infant's age above 6 months, 1.69 times in working mothers. On the other hand, household possessions had protective effects on ARIs. The study provides important information for policy makers regarding the prevention of ARI among the children of the slum dwellers.

Acute Disease↗
PubMed2001

Epidemiological investigation of cholera outbreak in a periurban slum colony in Chandigarh.

An investigation was carried out in a periurban slum colony in Chandigarh in September 1999 following a report of two microscopically confirmed cases of cholera admitted in Govt. Medical College Hospital, Chandigarh. Rapid survey in the colony covering a population of 1404 found that there were 14 cases of diarrhoea in the colony with attack rate of 9.97/1000 population. Majority (70%) of cases were females and 62% cases were under five years of age. Health education, ORS packets and medications were distributed to cases. Water sampling was also done and it was found that water from one of the hand pump was positive for V. cholerae 01 biotype El Tor serotype Ogawa. Closing of that hand pump and chlorination of drinking water in other parts of slum was recommended to higher health authorities, which was done immediately. Surveillance for diarrhoeal diseases was found to be poor. Provision of safe drinking water, improving sanitation and strengthening of disease surveillance is necessary for control of cholera and other diarrhoeal diseases in slum areas.

Child↗
PubMed1992

Status of lymphatic filariasis in some select slum clusters of Delhi.

Filaria surveys conducted in some select slum clusters namely Hari Nagar, Yamuna pusht near Vijaya Ghat along the Ring Road and Timarpur in Delhi during 1989, 1991 and 1992 respectively, covering a population of approximately 5000 slum dwellers revealed the presence of bancroftian microfilaria (mf) carriers and disease cases. The mf and disease rates (per cent) in these three slum areas were in the order of 6.3, 2.2, 3.7 and 1.4, 0.5 and 0.1 respectively. The mf density varied from 3.1 to 12.3 per 20 cumm. blood. High ten man hour densities of Culex quinquefasciatus (581) in Yamuna pusht followed by (355) in Timarpur were recorded during entomological investigations. Hari Nagar accounted for least ten man hour density of Cx. quinquefasciatus (160), because collection was made during winter months (November-December). The dissection of Cx. quinquefasciatus did not reveal any human filarial infection except in Yamuna pusht where out of 139 only one Cx. quinquefasciatus was found infective.

Animals↗
PubMedDate not supplied

Operational feasibility and bio-efficacy of alphacypermethrin (Fendona) treated jute curtains to control urban malaria in a slum settlement of Delhi, India.

Operational feasibility and bio-efficacy of alphacypermethrin treated curtains was evaluated in slum settlements of Andrews Ganj, New Delhi. Jute curtains treated with alphacypermethrin @ 100 mg/m2 were fixed on windows, doors and eves before on set of transmission and evaluations were carried out for two years. Entomological evaluation revealed that jute curtains treated with alphacypermethrin in Slum-I resulted drastic reduction in daytime indoor resting mosquitoes such as An. stephensi, Ae. aegypti and Cx. quinquefasciatus. Similarly, malaria incidence also reduced in the treated curtain used area when compared to that of in untreated curtain and without curtain areas. Bioassay tests on An. stephensi and Cx. quinquefasciatus showed that alphacypermethrin could produce > 70 per cent mortality up to six months in case of An. stephensi--a principal urban malaria vector and hence two rounds of treatment are sufficient in an year to protect inhabitants from malaria. The study indicates alphacypermethrin treated curtains could curtail malaria transmission in slum settlements and is operationally feasible in small houses and is also cost-effective.

Animals↗
PubMed2004

Nutritional problems in urban slum children.

Nutritional problems like protein energy malnutrition (PEM), anemia and vitamin A deficiency continue to plague a large proportion of Indian children. The diets and nutritional status of urban slum children in India is far away from being satisfactory. The nutritional status of slum children is worst amongst all urban groups and is even poorer than the rural average. Urban migration has not provided them salvation from poverty and undernutrition. Another distressing feature is the lack of any significant improvement over the years in this population. Most common causes of malnutrition include faulty infant feeding practices, impaired utilization of nutrients due to infections and parasites, inadequate food and health security, poor environmental conditions and lack of proper child care practices. High prevalence of malnutrition among young children is also due to lack of awareness and knowledge regarding their food requirements and absence of a responsible adult care giver. With increasing urban migration in the years ahead, the problem of malnutrition in urban slums will also acquire increasing dimension unless special efforts are initiated to mitigate the health and nutrition problems of the urban poor. Improving nutritional status of urban poor requires a more direct, more focused, and more integrated strategy.

Child↗
PubMed2004

Prevalence of type 2 diabetes in urban slums of Dhaka, Bangladesh.

This cross-sectional study was conducted to estimate the prevalence of type 2 diabetes along with its risk factors in urban slum population of Dhaka, Bangladesh. A random sample of 1555 slum dwellers of Dhaka city (age > or = 20 years) were included in the study. Capillary blood glucose levels, fasting and 2-h after 75g oral glucose load (for a selected subjects, n = 476), were measured. Height, weight, waist and hip circumferences, blood pressure and some other important socio-demographic information on age, sex, education, income, and occupation status were collected. The overall prevalence of type 2 diabetes was found to be 8.1 percent, and the prevalence for men and women were 7.7 percent and 8.5 percent respectively. Prevalence of diabetes was found to be lower following 2-h glucose values in the selected population compared to the FBG procedure. Age, sex, literacy and waist to hip ratio for men were found as significant risk factors following both fasting blood glucose and 2-h post glucose values adjusted for a number of confounding variables. Poor to moderate agreement was observed between fasting blood glucose and 2-h glucose (kappa 0.41, p < 0.001). The agreement was even poorer between impaired fasting glucose and impaired glucose tolerance. Poor agreement between FBG and 2-h BG may raise concern for the dependability of diagnostic procedures. Higher prevalence of type 2 diabetes in the urban slum may indicate an epidemiological transition due to fast urban migration and possibly urbanization. However, this issue needs further exploration.

Adult↗
PubMed2005

Understanding and addressing childhood immunization coverage in urban slums.

The National Population Policy (2000) aims at complete protection of all children against vaccine preventable diseases by 2010. Urban poor, many residing in slums, comprise about one fourth of India's 285 million urban population. 60% of the children aged 12-23 months in urban India are fully immunized; coverage among urban poor children is a dismal 43%. The inter state variations of immunization coverage in urban areas, reveals a service coverage gap which calls for a rethink on resource allocation and strengthening processes to improve immunization coverage amongst urban poor. Debilitating environmental conditions and high population density in slums expedite disease transmission. Comparisons of urban rural disease incidence indicate a particular urban risk for vaccine preventable diseases. This paper attempts to understand the current scenario and challenges in improving immunization coverage in urban slums; immunization being one of the most successful public health interventions of the past century. It also discusses possible mechanisms for effectively reaching the often left out urban poor. Coordinated activities by the multitude of providers, accurate information based outreach, effective monitoring and community enablement to demand quality services are critical for improving utilization of immunization services by a heterogeneous urban poor population.

Child↗
PubMed2004

Improving environmental conditions of a slum in Chandigarh by an awareness campaign.

An intervention project, in the form of an environmental awareness campaign was conducted in a slum of Chandigarh with a population of about 40,000, from December 1998-April 1999. The activities enforced during this campaign included focus group discussions with general public and mothers, household visit by medical students, distribution of literature, use of mass media by involving local residents, primary child care workers, teachers and school children. Evaluation of this campaign was carried out in May 1999 and compared with the baseline data obtained from a survey done in 1997. The study revealed that the method of storing water in covered buckets and utensils had improved significantly from 14.3% and 4.7% in the baseline survey to 35.2% (P < 0.001) and 16.2% (P < 0.01) respectively. Refuse disposal in the community bin and own bin had significantly improved to 22.2% (P < 0.001) and 19% (P < 0.01) from 8.4% and 11.2% respectively in the baseline survey. 51.2% of the residents using own bins disposed the refuse finally into the community bin. The use of community latrines had significantly increased among males (50.0%), females (47.7%) and children (41.2%) after intervention as compared to 32.8%, 32.5% and 16.7% respectively as found in the baseline survey (P < 0.001) and similarly open defaecation had significantly reduced among them. Further the study shows that the awareness regarding diarrhoea as hazard of unsafe water had improved significantly from 28.7% in baseline survey to 55.6% after intervention (P < 0.001). Knowledge of the residents regarding hazards of refuse disposal in the open and open defaecation had also improved significantly. Simple environmental awareness campaign can change the knowledge and behavioural practices of slum dwellers and could be a model for launching similar projects in other slums of India and other developing countries.

Adult↗
PubMed1991

An investigation of hypertension in a slum of Nakhon Ratchasima.

There is evidence that Thai people living in slums may be at high risk of developing hypertension. The present study was undertaken on a random sample of 1,000 subjects aged 20 and over living in a slum in Muang district of Nakhon Ratchasima during 1 February to 31 may 1988. This study consisted of measurements of blood pressure and body build, with administration of an interview on demographic characteristics, sociocultural factors and food frequency patterns. The results were based on 804 respondents. It was found that the prevalence of hypertension was 16.9%, nearly half of the hypertensives being mild cases. Only a low proportion of the proven cases was both aware of their condition and receiving treatment. About one fifth of the treated cases had blood pressure under 160 mm Hg systolic and 95 mm Hg diastolic. Based on these findings, it is concluded that these slum inhabitants are at high risk of developing hypertension. Community interventions are needed in order to prevent complications related to hypertension. Health education aimed at increasing community awareness of hypertension should be a major component of the community intervention.

Adult↗
PubMedDate not supplied

[Dental treatment needed for the people in 156 Bangkok slums].

The survey of the dental treatment needed for the slum people in Bangkok was part of the mobile public health service program under the Bangkok Community Development Project, Ministry of University Affairs which was proposed by the Bangkok Representatives, Prachakorn Thai Party which aimed to provide the needed dental service to the slum people. There was a limited amount of time to carry out the survey, because the main purpose of the project was to provide the services, the survey data was obtained without any affect to the service time. From 156 slums and 40 primary schools in Bangkok 19,333 cases received the services. It was found that 15,681 cases needed scaling, 42,183 teeth needed filling and 36,923 teeth needed extractions. The Prevalence of tooth decay was 4.1 teeth per person. The clinician could carry out this survey without the need for high technical skill in Dental public health. This kind of data was enough for planning the dental service program. By doing this kind of work, we would have more information for improving our dental profession. The good and up to date data would bring us the unity in our dental profession.

Adolescent↗
PubMed1982

Seroepidemiology of amoebiasis in the villagers in Phichit Province and urban slum dwellers in Bangkok, Thailand.

A serological survey was conducted in the villages of Phichit Province, Northern region and in the urban slum communities in Bangkok to determine whether amoebiasis was endemic in the areas and to determine the prevalence rates. Six rural villages, ethnically and culturally alike with a population of 3,019 and two urban slums with a population of 1,510 were surveyed. Sera were tested for indirect hemagglutination antibody (IHA) to Entamoeba histolytica and the stools examined for the parasite by direct smear method. Positive IHA titres (greater than or equal to 1:128) were detected in 482 (11%) and 176 (20%) sera, and E. histolytica found in 639 (2%) and 208 (3%) stool specimens of rural and urban slum populations respectively. Out of a total of 88 persons who showed significant levels of IHA antibodies to E. histolytica antigen, 5 had E. histolytica cysts in their stool specimens. The survey confirmed, serologically and parasitologically, that amoebiasis is endemic in the lower socio-economic areas. Substandard living and sanitary conditions within the areas were considered responsible for the transmission of the disease.

Adolescent↗
PubMed1996

Participatory analysis for redefining health delivery in a Bombay slum.

BACKGROUND: This paper explores the application of participatory methods in a Bombay slum of 33 households, Budh Mandir, to establish the local women's perception of their health status. METHOD: Six participatory meetings were conducted alongside informal interviews with key informants. The meetings were structured with health ranking, mapping and seasonal mapping exercises. RESULTS: The participatory exercises expose the differences in perceptions between professional health deliverers and the women of Budh Mandir, as well as providing data at a household scale about the incidence of disease and important differences in the interpretation of health problems. CONCLUSIONS: Differences in the perception between local women and health professionals are noted, which, it is argued, have important implications in redefining health delivery. Some methodological problems are identified and solutions are offered. It is argued that participatory methods can act as a process through which slum dwellers can demand appropriate health care for themselves and their families. In so doing, they can redefine their health needs in order that health intervention can be directed more appropriately.

Alcoholism↗