Prevalence of xerophthalmia in pre-school children in an urban slum.
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Age Factors↗
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Treating sick young infants in urban slum setting.
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Hospitalization↗
[The life of Lucio of the slums].
Lucio is one of the many brasilian boys who die of the normal violence of misery. His funeral is proposed as a case story on the essential components of "death with dignity".
Adolescent↗
[India--with Mother Teresa in Calcutta's slums].
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Delivery of Health Care↗
Validation of revised prescreening Denver Questionnaire in preschool children of urban slums.
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Child, Preschool↗
Knowledge, attitude and practices related to dengue in rural and slum areas of Delhi after the dengue epidemic of 1996.
To assess the knowledge and attitudes about dengue and practice of prevention followed by the residents of a rural area and an urban resettlement colony of East Delhi, an interview based cross sectional KAP study was undertaken in Jan 97 to Feb 97, a few months after the dengue epidemic in rural area and urban areas of East Delhi. A pre-structured and pre-tested format containing the relevant questions was administered to the subjects. A total of 687 subjects (334 rural and 353 urban) were interviewed. Nearly four fifth (82.3%) of these were aware of Dengue. Audiovisual media was the most common source of information in both the areas. Knowledge about the disease was fair to good. Fever was the commonest symptom of the disease known to 92% urban and 83% rural respondents followed by symptoms of bleeding and headache. Mosquito was known to spread the disease to 71% rural and 89% urban respondents. More than two third respondents in urban and two fifth in rural areas had used some method of mosquito control or personal protection during the epidemic.
Cross-Sectional Studies↗
Parental sex preference and its effects on fertility intention and contraceptive use in Calcutta.
This study investigated parental sex preference and its effects on fertility intention and contraceptive use in Calcutta. It also investigated the socioeconomic differentials of these effects. Data on 4536 married women of childbearing age came from a cross-sectional survey of slum and non-slum areas conducted in 1970. Desired numbers of sons and daughters in the slum area were 1.89 and 1.30, respectively, and in the non-slum area, 1.63 and 1.17, respectively. 35% of slum women and 30% of non-slum women wanted to have more children, and 22% of slum women and 45% of non-slum women were reported to use contraceptives. The authors estimate that in the absence of parental sex preference, 11% fewer slum women and 12% fewer non-slum women would desire more children. On the other hand, 20% more slum women and 8% more non-slum women would use contraceptives in absence of parental sex preference.
Asia↗
Impact of national immunization days on polio-related knowledge and practice of urban women in Bangladesh.
Bangladesh began to hold National Immunization Days (NIDs) from 1995 as part of the country's goal to eradicate poliomyelitis by the turn of the century. The NIDs brought together government agencies, the media, voluntary organisations and individual volunteers in social mobilization and service delivery activities. This paper assesses the impact of the first two polio NIDs in terms of the immunization coverage and change in knowledge about the disease among women living in Dhaka city, the capital of the country. Data were collected through pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. Knowledge data were collected from 525 women with at least one child aged less than five years. The oral polio vaccine (OPV) coverage during NIDs was obtained from 720 children. Knowledge of polio as a vaccine preventable disease increased after NIDs among both slum and non-slum women. The knowledge gap between the two groups was significantly reduced. Field workers, who regularly visit women at their homes to promote health and family planning services, were the main source of information for the slum women while television was cited as the most important source of information by non-slum women. The study revealed that 88% of children under five years received at least one dose of oral polio vaccine (OPV) during NIDs, and 67% received two stipulated doses with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. The study suggests that strategies like NID can be effectively used to tap into community resources and to generate political commitments for health programmes.
Adult↗
Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study.
CONTEXT: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions. OBJECTIVE: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. METHODS: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison. RESULTS: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups. CONCLUSION: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.
Aged↗
Soluble inter-cellular adhesion molecule-1 in urban Asian north Indians: relationships with anthropometric and metabolic covariates.
BACKGROUND: High prevalence of diabetes, obesity, and dyslipidemias in people belonging to poor socio-economic strata in urban slums of northern India has been recorded recently. To assess whether this population has high levels of soluble intercellular adhesion molecule-1 (sICAM-1), a cytokine involved in the pathogenesis of atherosclerosis, we investigated subjects belonging to poor socio-economic strata in urban slums and compared them to healthy control subjects from non-slum urban areas of New Delhi. DESIGN: Cross-sectional study. METHODS: Subjects from a previously carried out cross-sectional study, Delhi Urban Slum Project (DUSP) were divided into two groups: Group-1 (n = 56) included subjects dwelling in slum area, having at least one risk factor (hypertension, hyperglycemia, hypertriglyceridemia and hypercholesterolemia), while group-2 (n = 60) consisted of subjects without any risk factor dwelling in the slum area. A third group (n = 29) of non-obese subjects without any risk factor living in non-slum urban area was included for comparison. Measurements included; body mass index (BMI), waist-hip ratio (W-HR), four skinfolds, percentage body fat, fasting plasma glucose (FPG), serum lipids, and serum levels of sICAM-1. RESULTS: Though statistically not significant, mean level of sICAM-1 was higher in group-1 (718.5 +/- 232.8 ng/ml) as compared to the other groups. Of note, 35% of subjects in group-1 (p < 0.05 as compared to other two groups), and 25.3% of all subjects had levels of sICAM-1 in uppermost quartile (> 850 ng/ml). Partial correlation coefficients (R) of sICAM-1 levels with various parameters adjusted for age were statistically significant for BMI (R = 0.27, p < 0.05) in group-1; W-HR (R = 0.26, p < 0.05) and BMI (R = 0.19, p < 0.05) for group-2; and FPG (R = 0.17, p < 0.05) for all the subjects considered together. For females, the levels of sICAM-1 were significantly higher in the following: BMI > OR = 25 kg/m2 (p = 0.04) and FPG > 7 mmol/l (p < 0.05). Multiple linear regression analysis suggests that an increment in BMI by one kg/m2 would correspond to an increase in the levels of sICAM-1 by 8.5 units controlling for the influence of age and W-HR in the pooled data of all subjects. CONCLUSIONS: High percentage of subjects had levels of sICAM-1 in the upper quartile in the study, particularly those dwelling in the slum area and having coronary risk factor (s). The levels of sICAM-1 strongly correlated to the anthropometric and metabolic parameters, particularly in females. These observations are of potential importance for the pathogenesis of atherosclerosis in this population, though further studies are needed to predict those prone to the complications of atherosclerosis, based on sICAM-1 levels, as has been observed in other ethnic groups.
Adult↗
Early child health in Lahore, Pakistan: V. Feeding patterns.
The feeding practices of children (n = 1476) from birth to 24 months, as determined in a longitudinal study, in Lahore, Pakistan, are presented. Four socioeconomic groups at various levels of urbanization were included; a village, periurban slum, urban slum and an upper middle class. Initiation of breastfeeding was delayed in all the neonates. Sixty-five percent of the periurban slum mothers and 45% of the village mothers had not started breastfeeding at 48 hours after the birth of the infant. Prelacteal feedings, especially of herb water and honey, were the norm. Breastfeeding was highly prevalent. Eighty-seven to 98% of the infants in all the areas were breastfed at one month of age. Exclusive breastfeeding was rare, with 9% at one month, declining rapidly with age and being highly influenced by season. Partial breastfeeding was the most common mode of feeding. Water in addition to human milk was given by 45-73% of the mothers living in the urban slum, village and periurban slum at one month of age. Fresh animal milk and/or commercial formula was already being given at 1 month by 22-64% of the mothers in all areas. Commercial formula was the preferred food in the upper middle class, while in the other three areas it was rare and fresh animal milk was mainly used. More than 50% of the mothers in the village and in the periurban slum gave diluted animal milk even beyond the age of 10-15 months. In the upper middle class 50% of the infants were fed semisolids at the age of four months, while in the village, the periurban and the urban slum at 6 months of age only 10%, 12% and 47% of the infants received semisolids. The results of this study indicate that breastfeeding was highly prevalent in the three poorest areas. However, in all the areas initiation of breastfeeding was delayed and prelacteal feeding was the norm. Exclusive breastfeeding was rare, feeding bottles were used by 82-100% of the mothers to feed supplements and human milk substitutes, in the four areas.
Breast Feeding↗
Growth and health status of street children in Dhaka, Bangladesh.
The purpose of this study was to assess the effect of street life on the growth and health status of poor children who live and work full-time on the streets of Dhaka, Bangladesh (street children), independent of the effects of poverty. This was accomplished by comparing 142 street children with 150 poor children who live and work on the streets of Dhaka but who return to their families at night (slum children). Children between 7-14 years old were recruited at locales where street and slum children are typically found. Weight and upper arm circumference did not differ significantly between street and slum children (P > 0.05), but energy reserves, as assessed by skinfolds, were significantly larger in street than in slum children (P < 0.05). There was no wasting in either street or slum children. Although the majority of children in both groups were stunted and underweight, there were no significant differences between groups (P > 0.05). The prevalence of disease symptoms tended to be slightly higher in street children than in slum children, but few of the differences were statistically significant (P < 0.05). These data do not support the contention that street children are a particularly high-risk group. The greater-than-expected growth and health status of street children, compared to other poor children, may be due to biologically fitter children being more likely to permanently move to the streets and/or to remain on the streets once the move has been made.
Adolescent↗
Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India.
BACKGROUND AND AIM: An adverse coronary risk profile has been reported amongst rural-to-urban migrant population living in urban slums undergoing stressful socio-economic transition. These individuals are likely to have low intakes of folic acid and vitamin B12, which may have an adverse impact on serum levels of homocysteine (Hcy). To test this hypothesis, we studied serum levels of Hcy in subjects living in an urban slum of North India and healthy subjects from urban nonslum area. METHODS: Group I consisted of 46 subjects (22 males and 24 females) living in an urban slum, while group II consisted of healthy subjects (n = 26, 13 males and 13 females) living in the adjacent non-slum area. Anthropometric measurements, biochemical profile (fasting blood glucose, total cholesterol, serum triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and fasting serum levels of Hcy were measured. Dietary intakes of folic acid, vitamin B12, vitamin B1, and iron were calculated by the 24-hour dietary recall method. Serum levels of Hcy were correlated with dietary intakes of nutrients, anthropometry, and metabolic variables. RESULTS: Sex-adjusted serum levels of Hcy in micromol/L (Mean +/- SD) were high, though statistically comparable, in both the groups (group I: 20.8 +/- 5.9 and group II: 23.2 +/- 5.9). Overall, higher than normal serum levels of Hcy (> 15 micromol/L) were recorded in 84% of the subjects. A substantial proportion of subjects in both groups had daily nutrient intakes below that recommended for the Asian Indian population (folic acid: 93.4% in group I and 96.7% in group II, vitamin B12: 76.1 % in group I and 88.4% in group II). However, between the two groups, average daily dietary intakes of both the nutrients were statistically comparable. As compared to non-vegetarians, vegetarians showed lower intakes of folic acid (p < 0.01) and vitamin B12 (p < 0.01) in both groups. On multivariate linear regression analysis with serum Hcy as the response variable and vegetarian/non-vegetarian status and sex (male/female) as predictor variables, higher serum levels of Hcy were observed in vegetarians vs non-vegetarians (1 = 4.6, p < 0.05) and males vs females (beta = 5.3, p < 0.01). CONCLUSIONS: Low intakes of folic acid and vitamin B12, and hyperhomocysteinemia, in both the healthy population living in urban slums and adjacent urban non-slum areas, are important observations for the prevention of nutritional and cardiovascular diseases in the Indian subcontinent.
Adult↗
Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil.
BACKGROUND: Pediculosis capitis and scabies are common parasitic skin diseases, especially in resource-poor communities, but data on epidemiology and morbidity are scanty. OBJECTIVES: To assess the prevalence, seasonal variation and morbidity of pediculosis capitis and scabies in poor neighbourhoods in north-east Brazil. METHODS: The study comprised cross-sectional surveys of a representative population of an urban slum (n = 1460) in Fortaleza, the capital of Ceará State (Brazil) and a fishing community 60 km south of the city (n = 605). Study participants were examined for the presence of scabies and pediculosis capitis. In a longitudinal study in the slum, variation of prevalence in different seasons of the year was assessed. RESULTS: Prevalence of pediculosis capitis was 43.4% in the slum and 28.1% in the fishing community. Children aged 10-14 years and females were most frequently affected. Scabies was present in 8.8% of the population in the slum and in 3.8% of the population in the fishing community. There was no consistent pattern of age distribution. Superinfection was common in patients with scabies, and cervical lymphadenopathy in patients with pediculosis capitis. Multivariate analysis showed that age < or = 15 years, being of female sex and living in the urban slum were independent factors contributing to the simultaneous coinfestation with pediculosis capitis and scabies. The longitudinal data from the urban slum showed a characteristic seasonal variation of pediculosis capitis, but no fluctuation of scabies. CONCLUSIONS: Pediculosis capitis and scabies are hyperendemic in the study areas and are associated with considerable morbidity. There is an urgent need to develop control measures for these parasitic skin diseases in resource-poor communities. This is the first community-based study describing in detail the epidemiology and morbidity of scabies and head lice infestation in Brazil.
Adolescent↗
Prevalence and aetiology of congenital birth defects, infant mortality and mental retardation in Lahore, Pakistan: a prospective cohort study.
AIM: To study the health and development of children in a developing and low-income country. METHODS: The health and development of children in Lahore in northern Pakistan have been studied since 1981 in a collaborative project between Pakistani and Swedish university institutions and the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The study described in this paper comprised four different areas in Lahore with different degrees of urbanization and different social conditions. All pregnancies in the four areas were registered during the period March 1984 to July 1986 and were followed up from the 5th month of pregnancy. All 1476 children born after 1 September 1984 were followed up from birth to 12 y of age. RESULTS: The perinatal mortality in the whole material was 5.4%. It was highest in the periurban slum (7.5%) and lowest in the upper-middle class cohort (3.3%). Overall infant mortality was 10%. It was highest (14%) in the periurban slum and lowest (2%) in the upper-middle class group. Overall incidence of serious birth defects was 5%. It was highest in the periurban slum community (7%) and lowest in the upper-middle class cohort (3%). The overall cumulative incidence of severe mental retardation per 100 live births was 1.1. It was highest (2.2) in the periurban slum and lowest (0.4) in the upper-middle class group. The overall prevalence of mild mental retardation among 6-10-y-old children was 6.2 per 100. It was highest in the periurban slum (10.5) and lowest (1.3 per 100) in the upper-middle class group. Poverty, malnutrition, birth trauma and consanguinity were common causes of infant mortality and mental retardation in Lahore, Pakistan. CONCLUSION: Preventive measures with provision of obstetric and health services, services for genetic information and risk evaluation, vaccination programmes and identification of children with retarded development for specific stimulation and habilitation measures, e.g. organized play activities, are important in developing and low-income countries.
Child↗
Prevalence of visual impairment and blindness in a Nairobi urban population.
OBJECTIVE: To determine the prevalence and causes of visual impairment and blindness among Kibera slum dwellers. DESIGN: Population based Survey. SETTING: Kibera Slums, Kibera Division, Nairobi, Kenya. SUBJECTS: One thousand four hundred and thirty eight randomly selected slum dwellers. RESULTS: The prevalence of blindness and visual impairment was 0.6% (95% CI: 0.21 to 1.0), and 6.2% (95% CI: 4.95 to 7.15) respectively. 37.5% of those found blind were due to cataract followed by refractive errors 25.0%. 58.1% of those with visual impairment had refractive errors while 35.5% had cataracts. Females had a higher prevalence of visual impairment compared to males but the difference was not statistically significant (P = 0.104). CONCLUSIONS: Prevalence of blindness in Kibera slums is slightly lower than the estimated national average (0.7%) while that of visual impairment is almost three times higher. The leading causes of blindness are cataract followed by refractive errors. For visual impairment, refractive error was the leading cause followed by cataract. RECOMMENDATION: Kibera slum dwellers are in need of comprehensive eye care services offering cataract surgery and low cost spectacles.
Adolescent↗
Seroepidemiological study of toxoplasmosis in different sections of population of Union Territory of Chandigarh.
Infections with Toxoplasma gondii in humans are usually asymptomatic or in the form of mild febrile illness. Primary infection in pregnant women may result in congenital toxoplasmosis while infection in immunocompromised subjects like AIDS patients may cause potentially fatal toxoplasma encephalitis. In India, only a few studies in hospital based patients have shown prevalence of toxoplasmosis to be between 1.5 and 21%. No field study involving general population is available. The present study investigates the prevalence of toxoplasmosis in subjects from rural, urban and urban slum populations of Union Territory, Chandigarh. Serum samples from 500 subjects from each group were collected and antitoxoplasma IgM and IgG was detected by conventional micro ELISA technique using soluble Toxoplasma gondii tachyzoite antigen. Overall 5.4% subjects were positive for IgM while 4.66% showed IgG antitoxoplasma antibodies. Amongst the three groups, significantly higher number of subjects in slum area (7.8%) showed IgM antibodies as compared to urban and rural areas (4.2% each). There was no significant difference in IgG positivity between three study areas. Prevalence of T. gondii specific IgG antibodies was significantly higher amongst females of both slum (7.31%) and rural area (8.44%) as compared to the males (2.85% and 3.27% respectively) in the same areas (p<0.05) and also to females of the urban area (2.98%, p<0.05). Prevalence of IgM antibodies was significantly higher (p<0.05) in females in the slum area (10.5%) as compared to females in the urban area (2.55%). In both urban and slum areas, highest IgM seropositivity was observed in age group 6-12 years (10% and 13.3% respectively), while in the rural area the highest IgM seropositivity was seen in the age group > or = 5 years (17.7%). These data indicate that majority of children are exposed to toxoplasma before 12 years of age and particularly in rural areas higher number of subjects acquire Toxoplasma gondii infection early in childhood probably as a result of higher exposure due to farming, poor hygiene and handling of animals.
Adolescent↗
The role of universal distribution of vitamin A capsules in combatting vitamin A deficiency in Bangladesh.
Vitamin A deficiency is a major public health problem among preschool-aged children in many developing countries. In Bangladesh, a national nutritional surveillance system was initiated in 1990 to monitor 1) the occurrence of vitamin A deficiency by history of night blindness and 2) the routine coverage of national twice-yearly prophylactic vitamin A capsule (VAC) distribution. This study comprised data collected from June 1990 to August 1994. The VAC distribution had a mean coverage rate of 48.7% (95% confidence interval (CI) 48.4-49.0) in the rural areas; the coverage rate in the urban slums was 93.7% (95% CI 93.4-94.0). In the rural areas, the mean prevalence of night blindness was 0.86% (95% CI 0.81-0.91) and the bimonthly prevalence of night blindness ranged from 0.50% (95% CI 0.32-0.77) to 1.48% (95% CI 1.19-1.85), while in the urban slums the mean prevalence was 0.22% (95% CI 0.18-0.28) and the bimonthly prevalence ranged from zero to 0.62% (95% CI 0.27-1.37). The efficiency of VAC distribution was 27% (95% CI 17.6-35.3) in the rural areas and 77.8% (95% CI 61.8-87.1) in the urban slums. After adjustment for multiple potentially confounding factors, VAC receipt by individual children reduced the risk of night blindness in both rural and urban areas (rural areas: odds ratio (OR) = 0.74, 95% CI 0.63-0.87; urban slums: OR = 0.39, 95% CI 0.19-0.82). Breastfeeding was a protective factor for night blindness in both rural (OR = 0.53, 95% CI 0.42-0.67) and urban (OR = 0.32, 95% CI 0.15-0.66) areas. Night blindness was inversely related to the level of routinely attained coverage, and the degree of protection was associated with the time interval between the moment of VAC receipt and the moment of data collection. Although the prevalence of vitamin A deficiency in Bangladesh has been considerably lower in the 1990s than it was in the 1980s, it is still prevalent at all socioeconomic levels. Supplementation with high-dose VACs is an effective strategy for reducing night blindness, but the efficiency of the program will improve when coverage in the rural areas increases.
Bangladesh↗