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PubMed1989

Child health in a Brazilian squatter settlement: acute infections and associated risk factors.

As a response to the need for more information about health problems in poor urban communities, a health survey was conducted in Rocinha, the largest squatter settlement, or favela, in Rio de Janeiro. A fifteen-day recall period was used to measure gastro-intestinal disorders, acute respiratory infections, and infections of the throat/ears/eyes in 600 children under 5 years of age. The respective prevalence of the three categories was 44, 79, and 14 per cent. Taking only severe episodes into account, the prevalence was 4, 12, and 2.5 per cent, respectively. Risk factors, such as household income and environmental conditions (socioeconomic status), migration status, maternal stress, magnitude of separation between child and mother, and age of child, are examined and implications of positive associations are discussed.

Acute Disease↗
PubMed1990

Malnutrition among children of adolescent mothers in a squatter community of Recife, Brazil.

In a study of 357 first time mothers in a squatter community of Recife it was found that 1 in 10 were less than 15 years old and 60 per cent less than 20 at the time of their first delivery. Two groups of mothers were distinguished, viz. adolescent mothers with a mean (SD) age at first delivery of 16.7 (0.78) years and older mothers with a mean (SD) age at first delivery of 25 (0.79). More than a third were living in common-law union. Of the adolescent mothers only 58 per cent were living with the child's father. A further 23 per cent had received financial support from their own parents during the pregnancy. The rest were expelled from home. The adolescent mothers were generally worse off with a per capita income generally half of that of older mothers. About a quarter of all children studied were below the 10th centile of NCHS standards (23 per cent by weight/age; 28 per cent by height/age). The undernourished first born was 2.5 times more likely to have an adolescent mother, four times more likely to be in a household with low income, and two times more likely to have an illiterate mother as compared to the first borns who remain well nourished. The implications of these findings for urban primary health care programmes are further discussed.

Adolescent↗
PubMed1990

Infant mortality and undernutrition in the squatter settlements of Karachi.

The socio-demographic and biological processes contributing to infant mortality and undernourishment were studied in five urban squatter settlements of Karachi. All those families who had experienced an infant death in the past 2 years (N = 106) were recruited into the study. Comparative children were selected by random numbers with geographical matching from families with at least one live infant and without a history of infant deaths in the past 2 years. The comparison children were weighed and those found underweight (27 per cent) were studied for the presence of risk factors. Forty-one per cent of all deaths were in the neonatal period, and in 47 per cent of cases deaths had occurred in infants with a birth order of 5 and above. Age, duration of breast feeding, birth interval, and the live/dead status of the previous sibling were significant biological variables accounting for 23 per cent of the variance for survival. Socio-economic status accounted for 22 per cent of the variance and health-seeking behaviour (antenatal care, immunization, etc.) for 28 per cent. Sixty-eight per cent of those underweight were more than 6 months old. Age, female sex, birth interval less than 24 months, duration of breast feeding, adolescent mother, alive/dead status of the previous child were significant influences accounting for 12 per cent of the variance. Socio-economic status and health seeking behaviour were also important determinants, but not to the same extent as in the case of infant death.

Adolescent↗
PubMed1999

Role of intrauterine growth retardation on physical growth of Pakistani squatter children from birth to 2 years of age.

A birth cohort of 727 squatter children from Karachi was followed to study growth patterns by measuring anthropometric parameters at specific ages during the first 2 years of life. The mean weight and length of the intrauterine growth retarded and appropriate for gestational age children fell below the 10th percentile of the NCHS standards after 9 months and further deteriorated in the subsequent study period. However, the intrauterine growth retarded children showed slightly higher growth velocities compared to appropriate for gestational age children in the first few months for all four measurements, but subsequently these differences in growth velocities diminished. Our results suggest that nutrition intervention strategies should begin in early pregnancy.

Anthropometry↗
PubMed1989

The nutritional status of children in an urban squatter community in Malaysia.

An anthropometric assessment was conducted on a sample of 309 children, aged twelve years and below, from an urban squatter community in Kuala Lumpur, Malaysia. The community consists mainly of Malays and Indians and is fairly established with a mean length of residence of about fifteen years. There was not much difference between the two ethnic groups with regard to educational status or income. Most of the residents were unskilled or semiskilled workers employed in factories and government agencies. About 40 percent of the infants and toddlers were found to be wasted, while about one-third of the older children were stunted. There appears to be some association between income per capita and nutritional status.

Anthropometry↗
PubMed2006

Child's gender and household food insecurity are associated with stunting among young Pakistani children residing in urban squatter settlements.

BACKGROUND: The nutritional status of children is a good indicator of the overall well-being of a society and reflects food security as well as existing health-care and environmental conditions. In Pakistan, it is estimated that nearly 40% to 50% of children under the age of five are stunted. Due to greater economic opportunities available to the urban population as compared to the rural, it was believed that economic resources existed in poor urban Pakistani households but that the households lacked the skills and knowledge to translate their resources into good care and feeding practices. OBJECTIVE: This study aimed 1) to assess the prevalent care and feeding practices among children aged 6 to 18 months residing in the squatter settlements of Karachi and 2) to identify care and feeding practices, as well as any other underlying factors, associated with stunting. METHODS: A cross-sectional survey was conducted in eight settlements between October and December 2000. A total of 433 mothers of eligible children were interviewed with the use of structured questionnaires. Final analysis using multiple logistic regression was conducted on 399 mother-child pairs. RESULTS: Female children were nearly three times more likely to be stunted than male children. Households that were food insecure with hunger were also three times more likely than other households to have a stunted child. Lack of maternal formal schooling (adjusted prevalence odds ratio, 2.9; 95% confidence interval, 1.4 to 3.8) and large household size (adjusted prevalence odds ratio, 1.7; 95% confidence interval, 1.0 to 3.8) were also associated with stunting. Even though certain care and feeding practices were significant at the univariate level, they were not significant in the final multivariate analysis and so were excluded from the final model. CONCLUSIONS: In households where food insecurity exists, knowledge of care practices may not be sufficient, and interventions such as food subsidies must precede or accompany educational efforts. Further follow-up is required to explore the effect of gender differences on child care.

Body Height↗
PubMed2006

Lessons and implications from a mass immunization campaign in squatter settlements of Karachi, Pakistan: an experience from a cluster-randomized double-blinded vaccine trial [NCT00125047].

OBJECTIVE: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. METHODS: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented. RESULTS: The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage. CONCLUSION: This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future.

Journal Article↗
PubMed2006

Socio-demographic correlates of betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan.

BACKGROUND: Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. RESULTS: Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. CONCLUSION: Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.

Journal Article↗
PubMed1991

Maternal mental health in a squatter settlement in Rio de Janeiro.

The literature on household-based measures of mental health in developing countries is limited. Much emphasis is currently placed on the physical well-being of mothers in relation to child care, yet their mental well-being receives little attention. The present study measures maternal mental health in the largest squatter settlement of Rio de Janeiro, Brazil. The proportion of mothers who were probable cases of mental ill-health was 36%.

Adult↗
PubMed1998

Health profile of two social groups living in a squatter settlement in Calcutta.

Health and well-being of individuals largely depend on socioeconomic and environmental conditions. The low socioeconomic groups face the highest health burdens. In the present study an attempt has been made to compare and contrast the health related traits prevalent in two social groups (Hindu and Muslim), living in a squatter settlement in Calcutta, India. The study has been conducted on women between 20 to 40 years of age. The results show that the Muslims are more frequently affected with respect to most of the traits than the Hindus, but the difference is significant with respect to only a few traits. Thus, micro-cultural traits associated with religion do not seem to have much effect on the health related traits considered in this study.

Female↗
PubMed1999

Perceived gynecological morbidity among young ever-married women living in squatter settlements of Karachi, Pakistan.

BACKGROUND: Community-based information on obstetric and gynecological morbidity in developing countries is meager and nearly non-existent in Pakistan. OBJECTIVES: To estimate the prevalence of specific gynecological morbidities and investigate the predictors of pelvic inflammatory disease. METHODS: Users [404] and non-users [313] of modern contraceptives were identified from eight squatter settlements of Karachi, Pakistan and detailed information on basic demographics, contraceptive use, female mobility, decision-making and gynecological morbidities were elicited. RESULTS: The perceived prevalence of menstrual disorders were 45.3%, uterine prolapse 19.1%, pelvic inflammatory disease 12.8% and urinary tract infection 5.4%. The magnitude of gynecological morbidity was high with about 55% of women reporting at least one gynecological morbidity though fewer [20%] reported at least two gynecological morbidities. Significant predictors of pelvic inflammatory disease were intrauterine contraceptive device users (OR = 3.1; 95% CI 1.7-5.6), age < or = 20 years (OR = 2.3; 95% CI 1.1-4.8) and urban life style (OR = 2.1; 95% CI 1.0-4.6). CONCLUSION: There is an immense burden of reproductive ill-health and a significant association between ever users of intrauterine contraceptive device and pelvic inflammatory disease. We therefore suggest improvement in the quality of reproductive health services generally, but specifically for family planning services.

Adolescent↗
PubMed1999

Economic development and health status among the poor in squatter settlements of Karachi.

OBJECTIVE: Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor. SETTING: Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996. METHODS: A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets. RESULTS: Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p = 0.02) have lower contraceptive usage (CI; 2.11-2.64; p < 0.001) and childhood immunization rates (CI; 2.08-2.40, p < 0.001). No significant association was observed between economic levels and prevalence of diarrhea. The housing, literacy and employment status was consistently better in the higher economic stratum who were more likely to be Pushto-Punjabi speaking as compared to the Sindhi speaking population. CONCLUSION: To have sustainable improvement in the health status of the poor, those who are most vulnerable need to be identified and programs aiming to improve health should also undertake broader development initiatives like raising family income.

Child↗
PubMed1999

Views about women's mental health: study in a squatter settlement of Karachi.

OBJECTIVE: Mental health of women is globally receiving particular attention. This study assessed community's view on certain aspects of women's mental health prior to introducing an intervention. SETTING: The study was conducted in an urban squatter settlement located in District West of Karachi in 1997 where the Aga Khan University has set up a Primary Health Care program in partnership with the communities. METHODS: Using convenient sampling, door to door household survey was conducted by medical students. RESULTS: Two hundred and eighty one residents were interviewed. Respondents were asked to list contributory factors which lead to mental distress in women. Two hundred and ten (75%) were able to list certain factors. The factors listed were; low family income (40%), dispute amongst spouses (30%), verbal abuse by in-laws (25%) and too many children (5%). When asked what women in the community did while they were mentally distressed 35% respondents reported that women talked to their husbands and 18% said counselling from a health provider was sought. Main channels of social support desired were; revenue generation (67%), membership of a women's group (11%) and training of local community women in counselling skills (10%). CONCLUSION: Signs of awareness about mental health issues are present even in marginalized communities of Pakistan. In order to improve the mental health of women interventions should primarily focus on raising family income.

Adolescent↗
PubMed2000

The minds of mothers: maternal mental health in an urban squatter settlement of Karachi.

BACKGROUND: Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan. OBJECTIVE: To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health. METHODS: With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity. RESULTS: The proportion of probable cases of mental disorder was 28.8% (n = 75). Reviewing the gradient of responses the most frequently expressed psychiatric symptoms were "being worried" and "crying". Amongst somatic complaints the most frequently reported was headache. Study also suggests that women in the older age group (OR 2.30, CI 1.27-4.19, p = 0.0031) and those with longer duration of marriage (OR 1.80, CI 1.01-3.22, p = 0.032) are more likely to be mentally distressed. Arguments with husband (OR 5.0, CI 2.19-11.52, p = 0.00001) or in-laws (OR 2.43, CI 1.22-4.85, p = 0.0059), husband's unemployment (OR 4.1, CI 1.27-13.6, p = 0.0058), not having permanent source of income and lack of autonomy in making decisions significantly contributed towards mental illness. CONCLUSION: Approximately 1 out of 4 women suffer from mental illness. This is alarmingly high. Besides counseling in cases of matrimonial disharmony, community-based interventions should aim to improve the socioeconomic status of households.

Adolescent↗
PubMed2002

Child labour a reality: results from a study of a squatter settlement of Karachi.

INTRODUCTION: Pakistan's exports have suffered heavy losses due to its denunciation for use of children in the industry on the premise that it destroys their childhood and desires for progress. The international community has not realized the root cause of child employment and imposed harsh economic sanctions that have harmed Pakistan's economy leading to further deterioration of health and well being of these unprivileged children. OBJECTIVES: To identify the reasons behind child labour and to asses the occupational, health and related problems faced by the working children. METHODS: This study was done in a section of a squatter settlement Bhutta village near the seaport called Accora with a population of 10000 (approx.). It was a cross-sectional study using a structured questionnaire with questions regarding occupation, eating habits, health, hopes and aspirations. Respondents were 150 male working children permanent residents of Bhutta Village (Accora) selected by systematic sampling. RESULTS: The children were between the ages of 12-14 years (mean = 13.91 yrs). The average family size of these children was 7.4 members and the average family income was Pak Rupees 2,884/month. Fifty seven percent said they get no time to rest whereas the remaining got half to one hour of rest during the day. The usual foods consumed included pulses (46%), vegetables (39%) and meat (15%). Eighty seven percent were not suffering from any disease at the time of interview. The children had an average income of Pak Rupees 615/month (range: 200-1200). Forty five percent were helpers in shops the rest were employed in other businesses. The reasons given for job included family support (89%), parent's pressure (5%), fond of work (4%), learning skills (1%) and self support (1%). The majority (56%) was working for more than 7 hours per-day and 79% said that they do not like to work. Majority of the children wanted to study, play, be born in another family and become doctors, engineers and officers. CONCLUSION: The children in this area were deprived and were trapped between work for family and the desire of living the life of a child with hopes dreams and aspiration for a better future. Making them jobless is only going to aggravate their health and financial problems and will not improve their social and economic status. A policy for supporting these children has to be worked out which caters to their need for financial support and at the same time provides them with learning opportunities.

Adolescent↗
PubMed2003

Factors affecting utilization of antenatal care among reproductive age group women (15-49 years) in an urban squatter settlement of Karachi.

OBJECTIVES: To describe the socio-demographic characteristics and utilization pattern of antenatal care of reproductive age group women (15-49 years) in an urban squatter settlement of Karachi and to assess and compare the knowledge on antenatal care between women who received and those who did not receive antenatal care. METHODS: A community-based cross sectional survey was conducted and a sample of 323 women was taken through systematic sampling. Two hundred ninety five (295) women were interviewed and 28 were excluded, as they never experienced a pregnancy. Socio-demographic characteristics and knowledge about antenatal care were compared on the basis of having received and not having received antenatal care, utilizing bivariate and multivariate analysis. RESULTS: Multivariate logistic regression analysis showed that higher income women were twice likely to use antenatal care services (AOR = 2.11 95% CI 1.14-3.89) than those of lower income. Women receiving antenatal care were more knowledgeable about the importance of dietary protein (AOR = 1.97 95% CI 1.16-3.33), intake of green leafy vegetables for the prevention of anemia (AOR = 2.34 95% CI 1.33-4.11), and reporting danger signs (AOR = 2.25 95% CI 1.07-4.74). CONCLUSION: Women of reproductive age need to recognize the importance of receiving antenatal care in the community. Uplifting the socio-economic status and literacy rate of women is required to provide community based education. There is a potential need to increase nutrition education, highlighting the importance of iron supplementation, appropriate food during pregnancy and recognition of signs and symptoms and danger signs in pregnancy.

Adolescent↗
PubMed2001

Reproductive health of married adolescent women in squatter areas in Alexandria, Egypt.

Through a house-to-house survey, 455 married adolescent women (< 20 years) and 455 married women aged 20-45 years from squatter areas in Alexandria were interviewed. Determinants of early marriage were consanguinity, illiteracy and unawareness of reproductive health. Of the currently pregnant adolescents, 22% were receiving antenatal care compared with 40% of the older women. Family planning methods were currently being used by 39% of the adolescents and 63% of the older wives. Determinants of non-use were: adolescence, illiteracy and previous miscarriage/stillbirth. There is a need to increase public awareness of reproductive health and change the behaviour of both groups of women in this under-privileged sector.

Adolescent↗
PubMedDate not supplied

Chewing of betel, areca and tobacco: perceptions and knowledge regarding their role in head and neck cancers in an urban squatter settlement in Pakistan.

The link of betel, areca and chewable tobacco with head and neck cancers is clearly established. Fifty eight percent of the global head and neck cancers occur in South and Southeast Asia, where chewing of betel, areca and tobacco are common. This study was carried out to establish the pattern of use of Paan, Chaalia, Gutka, Niswar, Tumbaku and Naas among population of squatter settlement of Karachi and to determine the perceptions and knowledge regarding their role in the etiology of head and neck cancers. It was a cross-sectional study, performed at Bilal colony in Karachi. Through systematic sampling, 425 subjects [a male and female from a household] were interviewed with a structured questionnaire. Knowledge regarding etiology of head and neck cancers was classified in ordinals of "good", "some" and "poor", for each substance separately, while practices were classified into "daily user", "occasional user" and "never user". About 40% of the participants were chewing at least one item [betel, areca or tobacco products] on daily basis. This prevalence was 2.46 times higher among males than females and 1.39 times higher among adolescents than adults. At least 79% of the participants were classified as having poor knowledge about the carcinogenicity of each of these items. Knowledge increased with age and level of education. Health hazards of these items were poorly recognized and about 20% perceived at least one of these items to be beneficial. Positive attitudes were seen regarding the steps to curb the production, business and consumption of these substances. In conclusion, prevalence of chewing of betel, areca and tobacco among adults and adolescents is high. Deficiency in knowledge and wrong perception of favorable effect of chewing products is common. Besides curtailing the availability of chewing products, correct knowledge regarding its ill-effects should be inculcated among population to decrease the burden of head and neck cancers.

Adolescent↗