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PubMed1993

Comparable seropositivity for ascariasis and toxocariasis in tropical slum children.

The seropositivities for infection by Ascaris lumbricoides and Toxocara canis were determined in children (1-15 years old) of a slum area of Caracas, Venezuela, and the levels that indicate the presence of active infection were defined. In children aged from 1 to 3 years, approximately 10% were positive for either parasite, and this figure increased to about 30% in 4- to 6-year-olds. For toxocariasis, the percentage of positivity remained at this level up to the age of 15 years. Whilst the positivity in children 10-15 years of age was comparable for Ascaris and Toxocara, a peak of positivity (50%) was found for Ascaris at 7-9 years of age. These results indicate that for these urban slum children, infection by Toxocara is essentially as common as that by Ascaris and, thus, that toxocariasis represents a potential public health problem in the tropical environment that is largely overlooked.

Adolescent↗
PubMed2005

The prevalence of psychiatric disorders among 5-10 year olds in rural, urban and slum areas in Bangladesh: an exploratory study.

BACKGROUND: No previous epidemiological studies of child mental health have been conducted in Bangladesh, partly due to lack of suitable measures. METHODS: A Bangla translation of a standardised child psychiatric interview, the Development and Well-Being Assessment (DAWBA), was validated against routine clinical diagnoses on a consecutive series of 100 referrals to a child mental health service. A two-phase study of prevalence was applied to random samples of 5- to 10-year-olds (N=922) drawn from three contrasting areas: a rural area, a moderately prosperous urban area, and an urban slum. RESULTS: There was substantial agreement between the DAWBA and the independent clinic diagnosis (kappa=0.63-0.94). The estimated prevalence of any ICD-10 diagnosis was 15% (95% CI 11-21%). The rate of obsessive-compulsive disorder was higher than in previous studies. Children from the slum area were significantly more likely to have serious behavioural problems, and marginally more likely to have post-traumatic stress disorder. CONCLUSION: A conservative extrapolation is that around 5 million Bangladeshi children and adolescents have psychiatric disorders. In a country with very few child mental health professionals, there is a vast gap between need and provision that must be addressed.

Adolescent↗
PubMed1993

Effect of anthelmintic treatment on the allergic reactivity of children in a tropical slum.

It is well known that helminthic infection can cause a polyclonal stimulation of the synthesis of IgE, which is dependent on interleukin-4 (IL-4) production, and it has been suggested that this can modulate the expression of allergic reactivity in tropical populations. We evaluated the effect of regular anthelmintic treatment, for a period of 22 months, on certain aspects of the allergic reactivity of children in a slum area of Caracas, Venezuela, where helminths are endemic. The treatment (Oxantel-Pyrantel; Quantrel) effectively eliminated intestinal helminthic infection and resulted in a significant decrease in the initially elevated total serum IgE levels. IL-4 was detectable in the serum, and a significant reduction in IL-4 was also observed after treatment. In contrast, both the immediate-hypersensitivity skin-test reactivity and serum levels of specific IgE antibody against environmental allergens were markedly increased in the treated children. In a group of children who were also evaluated in the same slum, but who declined treatment, a substantial increase in helminthic infection occurred, which was related to an acute deterioration of the socioeconomic conditions of Venezuela over the course of our study period. This was paralleled by a considerable increase in total IgE levels in these children and a decrease in the skin-test reactivities and specific IgE levels. The application of Prausnitz-Küstner passive transfer tests and analysis of specific IgE antibody levels indicated that the polyclonal stimulation of IgE synthesis by helminthic parasites results in mast cell Fc epsilon receptor saturation and suppression of specific IgE antibody synthesis. This inhibition of allergic reactivity is reversible by anthelmintic treatment.

Adolescent↗
PubMed1990

The prevalence of obesity, risk factors and associated diseases in Klong Toey slum and Klong Toey government apartment houses.

The epidemiological study in low socioeconomic area of Bangkok, Klong Toey slum residents (n = 976) and apartment house residents (n = 906) of both sexes revealed the prevalence rates of overweight of 25.5% and 30.5%, obesity 10% and 11.1%; hypertension 17.3%; and 14%; diabetes 4.5% and 5.9%; IGT 6.1% and 4.4%; total abnormal GTT 10.6% and 10.3%; hypercholesterolemia 14.1% and 12%; hypertriglyceridemia 24.8% and 22.7%; low HDL-C 3.1% and 1.8%; hyperuricemia 7.7% and 10.4% respectively. The prevalence rates of the related diseases and conditions were increased when BMI was over 25 in both populations except for those with abnormal GTT and hyperuricemia in the slum residents. Concerning risk factors, discriminant analysis disclosed diastolic blood pressure (DBP) and atherogenic index as the first two factors significantly associated with overweight and obesity (BMI greater than 25) in both populations. Restructuring of the health service delivery system and care-taker re-educating together with production of meaningful mass communication media are needed for promotion of health care, prevention of these non-communicable diseases and their sequelae by non-pharmacological approach.

Adult↗
PubMed2005

Condom-promotion programme among slum-dwellers in Chandigarh, India.

This study describes high-risk behaviour and condom usage in inhabitants of an urban slum in the Union Territory of Chandigarh, which has a population of about 20,000. A cohort of 375 participants was followed-up before and after an intervention. Half of the married but only one-eighth of the unmarried slum dwellers were using condoms regularly. One-quarter of the study subjects practised high-risk behaviour and this was higher among unmarried (44.88%) than married participants (18.7%). An intervention involving education on condom use and provision of free condoms increased the condom usage rate from 31.73% in the pre-intervention phase to 60% in the postintervention phase.

Adult↗
PubMed2006

Cohabitation, marriage, and 'sexual monogamy' in Nairobi's slums.

The current study investigates the extent to which sexual exclusivity--the restriction of one's sexual engagements to a single partner--prevails across various marital status, union type, and co-residence categories among Nairobi's poorest residents, slum dwellers. This question is central to the spread of HIV in the increasingly urban and poor, high prevalence countries of sub-Saharan Africa, where transmission is primarily via heterosexual sex. In many circles, sexual exclusivity is considered a prominent feature of the marriage institution. Yet, marriage and cohabitation are often not easily distinguishable in sub-Saharan Africa, meaning that the frequent use, as a proxy, of the "in union" category, which includes married as well as cohabiting persons can, at best, be considered tenuous. Using the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), this paper confirms that marriage is associated with higher reports of sexual exclusivity even in settings where poverty provokes risky behavior. The finding, here, is of lower risk of HIV infection for married respondents, with a smaller effect observed among non-married cohabiters. Converse to the implied benefits of marriage, though, women with co-wives are more likely to report multiple partners. The implications of these findings are discussed.

Adolescent↗
PubMed2006

Prevalence of mental disorders in children and adolescents from a Spanish slum.

This paper reports rates of psychopathology in a population of 9- and 13-yr olds from a Spanish slum. Two cohorts of all the children born in 1989 and in 1993 and registered in the census of a municipality in 2001 were assessed over a 3-yr period with structured diagnostic interviews and functional measures. In the first year of the study 79 (53.7%) children of the adolescent 13-yr-old population and 72 (59.5%) of the pre-adolescent 9-yr-old population participated. Between 30% and 60% of preadolescents and between 30% and 50% of adolescents presented some mental disorder. Anxiety and disruptive behavior disorders were the most frequent disorders in both cohorts. For both genders, the highest risk for any psychopathology was at 10 yr. We found that, psychopathology and functional impairment decreased with age, and that the psychopathology of children in a peripheral slum of a big city is 3 times higher than the median of the general population. This information should be useful for administrators providing services for children from the most disadvantaged segment of the population.

Adolescent↗
PubMed1999

Postpartum health in a Dhaka slum.

This study examines the health, nutritional status, and health care seeking behaviour of a community based sample of 122 postpartum women from an urban slum in Dhaka, Bangladesh. It describes a physically impoverished environment in which malnutrition is serious, and non-trivial morbid episodes as a consequence of childbirth are very common. Malnutrition was found to be widespread: about one-quarter of the study mothers were short in stature, measuring 145cm or less in height; over two-thirds of the women weighed <45 kg; and a similar proportion had a BMI of <20. Based on mid-upper arm circumference, an overwhelming majority (96%) suffered from some degree of malnutrition. During the first 6 weeks postpartum over three-quarters of the women reported a non-trivial illness. The frequency of reported illnesses was significantly associated with both increasing age and parity. Despite severe poverty, most of the women reporting illnesses (71%) received some form of health care from a wide range of western and traditional health care providers, with Traditional Birth Attendants (TBAs) and unqualified western care providers being the most frequently utilised. This study highlights the plight of these women in a precarious environment and shows how their health is compromised by cultural and political constraints. We conclude that while the burden of postpartum morbidity is very high, the incorporation of traditional practitioners and unqualified western care providers into maternal health training programs, together with efforts to empower women, could be effective in improving the health status of mothers in this marginalised and fragmented community. To achieve this outcome, a clearly articulated and integrated approach to development in slum communities is required.

Adolescent↗
PubMed2001

Adverse profile of dietary nutrients, anthropometry and lipids in urban slum dwellers of northern India.

OBJECTIVES: The intra-country rural to urban migrant populations undergo radical socio-economic and lifestyle changes in a developing country. Therefore, it is an interesting sample in which to study nutrition pattern, anthropometry and metabolic profile. The aim of this study was to assess nutrient profile and its association with the anthropometry, percentage body fat (%BF) and blood lipids in the urban slum dwellers in northern India. DESIGN: A cross sectional epidemiological descriptive study. SETTINGS: The study was conducted in urban slum colony of Gautam Nagar, situated in a southern area of New Delhi. SUBJECTS: The data was recorded in 227 subjects (52 males and 175 females). RESULTS: The diets averaged approximately 59-60% of energy from carbohydrates, 12-13% energy from protein, and 24-27% energy from dietary total fat. Lower intake of monounsaturated fatty acids (MUFA), a low ratio of n-6/n-3 fatty acids, a high ratio of polyunsaturated and saturated fatty acids, a high intake of erucic acid, and a low consumption of fibre and vitamin E intake were significant observations. Although their mean body mass index (BMI) was in a low range (20.5+/-4.2), %BF was high in females (26.7+/-8.6%; P=0.001), and a high prevalence of abdominal obesity was observed in both males (22%) and females (16%). Moreover, there was high prevalence of hypercholesterolemia, hypertriglyceridemia and, in particular, low levels of high-density lipoprotein cholesterol. Those consuming a high-fat diet (>30%) also consumed high MUFA, n-3 fatty acids, saturated fat and dietary cholesterol. Carbohydrate intake as percentage energy was a significant predictor of the levels of triacylglycerol in males, while in females significant predictors for triacylglycerol include intake of carbohydrate as percentage energy, age, %BF and BMI. CONCLUSION: In this economically deprived population, now constituting approximately 30-50% of the urban population of major cities in India, such adverse dietary, anthropometric and metabolic factors are predictors of early and accelerated atherosclerosis. SPONSORSHIP: This study was fully supported by a financial grant from the Science and Society Division, Department of Science and Technology, Ministry of Science and Technology, Government of India.

Adipose Tissue↗
PubMed2002

Determinants of growth failure in 12-24-month-old children in a high-density urban slum community in East London, South Africa.

OBJECTIVE: The study's main objectives were the identification of determinants of growth failure in 12-24-month-old children from an urban slum community attending a day hospital as well as the identification of focus areas for intervention. DESIGN: The research was executed as a case-control study with a one-to-two design. A hypothetical causal model was developed for the undernutrition situation in Duncan Village. A questionnaire to assess the direct and underlying causes of growth failure in the study population was developed from this model. SUBJECTS: One-hundred and fifty children were selected for the study, with 100 children in the control group and 50 children in the growth-failure group. Each child in the growth-failure group was matched with two children in the control group based on age and sex. The children were chosen according to anthropometric indices and p-albumin levels. SETTING: The research was conducted at a primary health care centre in Duncan Village, an overpopulated urban slum area in East London, a small city on the east coast of South Africa. RESULTS: No significant differences were found between the two groups for the occurrence of disease and infection. Dietary intake seemed to be generally poor in all the children. No significant differences were found between the two groups for the indicators of household food security, health service utilization and environmental conditions. The most important underlying determinants of growth failure that were identified in the study population seem to be related to the caring capacity, and the resultant caring behaviours of mothers. The risk for growth failure is increased when a child has a mother who is not the head of the household (relative risk) (RR=4.3), who is not involved with the discipline of her children (RR=2.2), who is not the guardian of the child (RR=8), who was not born in Duncan Village or in a city (RR=2.16), who is not able to write (RR=2.7) or read Xhosa (RR=2.53), who has a school education of <or=grade 9 (RR=2.9), who did not receive nutrition education (RR=2.2), who smokes (RR=10) and drinks beer regularly (RR=10), who has a BMI <25 (RR=2.7), who was subjectively judged to show little interest in her child (RR=4) as well as an inadequate caring attitude towards her child (RR=3.61), and whose clothing was dirty (RR=2.7) and not tidy (RR=2.9). Further determinants included the following: a child who weighed <2500 g at birth (RR=4.96), who had not received supplemental milk while still breast-fed (RR=2.00), who did not receive baby cereal as first food (RR=2.6), whose clothes (RR=2.7) were dirty and whose hands were infrequently washed (RR=10). CONCLUSIONS: The results of this research suggest that initiatives to address the problem of growth failure in 12-24-month-old children attending the Duncan Village Day Hospital should focus mainly on improving the caring capacity of mothers in the study area.

Case-Control Studies↗
PubMed2006

Epidemiology of undernutrition in adults in Dhaka slum households, Bangladesh.

OBJECTIVES: To identify socioeconomic, demographic and environmental factors that predict undernutrition in adults in a Dhaka slum population. DESIGN: A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socioeconomic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed. SETTING: Dhaka slums in Bangladesh. SUBJECTS: A total of 1097 adults surveyed during September-December 1996. MAIN OUTCOME MEASURES: Body mass index (BMI) less than 18.5 kg/m(2). RESULTS: There was a sex difference with female subjects having a significant odds ratio for low BMI compared with male subjects (P<0.03). There was no difference by age for males, but there was a difference by age for female subjects, with women aged 30-39 and 40-49 years having the worst BMI (P<0.04; P<0.04). The Beri Bahd area of residence had the worst BMI (P<0.001). Deficit situation as the self-reported financial situation had the worst BMI (P<0.03). Casual wage workers, unskilled and dependent self-employed individuals had the worst BMI (P<0.005; P<0.003). Not being involved in credit organizations and NGO credit organizations was associated with worst BMI (P<0.008; P<0.03). Those households that had an income of 2000-2499 Taka had the worst BMI (P<0.07). Households with a floor area of 5 m(2) or more per consumption unit had the best BMI (P<0.01). Households without electricity had the worst BMI (P<0.007). Households with tube well water had the worst BMI compared with those with tap water (P<0.001). CONCLUSIONS: Under nutrition was related to demographic, economic, social and environmental factors.

Adult↗
PubMed2003

Parasitic skin diseases: health care-seeking in a slum in north-east Brazil.

Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.

Adolescent↗
PubMedDate not supplied

Factors affecting nutritional status in female adults in Dhaka slums, Bangladesh.

This study looks at women from the slums in Mohammadpur, Dhaka, Bangladesh, where 54 percent of women's BMI was less than 18.5. Fifty percent of the Dhaka slum population lived below the poverty line. Logistic regression showed that women with income above 1,500 taka per capita were 1.78 times more likely to have a higher BMI (odds ratio 1.7863; CI = 0.671-3.639). Women with their own savings were 1.89 times more likely to have higher BMI (odds ratio 1.879; CI = 0.01163-1.6431). Women were 4.5 times more likely to have a higher BMI when food expenditure per capita above 559 taka per month (odds ratio 4.55; CI = 1.0302-8.0799). Women were 1.82 times more likely to have higher BMI when there was a break even situation in financial status (odds ratio 1.8212; CI = -015709-3.6285). Female headed households were 3.3 times more likely to have a higher BMI compared to women living in male headed households (odds ratio 3.2966; CI = 0.33711-6.25620). Women who work 15-23 days per month were 2.3 times more likely to have a higher BMI (odds ratio 2.33; CI = 0.1133-4.5600). Women who are the budget manager are 1.12 times more likely to have a higher BMI (odds ratio 1.125; CI = 0.29296-2.0966). Where as a husband who beats his wife is 1.83 more likely to have a poorer BMI (odds ratio 1.8312; CI = -3.72596-0.17508). Women who have no marriage documents and women who take days off due to illness less than 11 days per month were more likely to have a poorer BMI (odds ratio 0.5567; CI = -0.049339-2.8379; odds ratio 0.7569; CI = 0.183167-2.0002). Women's nutritional status and well being can influence their ability to provide for themselves and their families and the demonstration of a relationship between measures of women's autonomy and control in the household and women's nutritional status is an important indication of the importance of these sociological constructs. Women's participation in work outside the home may be a factor increasing their autonomy. The identification of relationships between women's autonomy and control and their physical well being should provide further leverage for policy change that will enable women to escape some traditional roles and to contribute as more equal partners with men in the future of Bangladeshi society.

Adult↗
PubMed1986

Child health interventions in urban slums: are we neglecting the importance of nutrition?

During the early part of the twentieth century, there were dramatic falls in the mortality rates in many cities in the West. The reasons for this improvement are of considerable relevance today because the conditions which prevailed at that time in cities such as New York are comparable to those prevailing in many slums of the Third World today. Some early studies linked the improvements in health, as measured by mortality rates, to a better level of nutrition. The importance of nutrition is now widely accepted and there are many studies which show the association between nutrient intake and both mortality and morbidity, and in particular between breast feeding and infant mortality rates. It is sometimes assumed that, because nutrition indicators for city populations have improved, there is no longer a major problem of malnutrition in urban areas. However, it is likely that the figures hide disparities through aggregation, and studies in slums rather than cities as a whole give a much less encouraging picture. Poverty is at the root of many of the nutritional and associated health problems, but the children who will be born over the coming decades cannot afford to wait for a new economic order to provide the solution. Through the promotion of breast feeding, education, growth monitoring and food supplementation, necessary help can be targeted at this vulnerable population.

Africa↗
PubMed2002

Building for the future: influence of housing on intelligence quotients of children in an urban slum.

INTRODUCTION: Interventions on behalf of the marginalized in society can assume many formats. In an urban slum the Government of Delhi built one-room houses for some of the residents in what is termed a 'plot area'. Not all residents could be accommodated in the project and the remainder continued to live next door in shanty houses of the slum. Nineteen years later, young children who had migrated with their parents, have grown up and have children of their own. We looked at the development of the children living in the two types of accommodation. METHODS: A total of 373 children were studied. All children (n = 200) between the ages of 3.5 and 5.5 years in a cluster of five residential blocks in the plot area were studied. As a control, children in two large clusters of shanty houses (n = 173) were also studied. For development assessment the Central Institute of Education (CIE) Test was performed. This is an Indian adaptation of the Standford-Binet Test. Multiple regression analysis was utilized to determine the factors that influenced IQ most. RESULTS: The mean IQ of the children in the plot area was 92.5 (s.d. 13.38) and in the shanty houses 89.5 (s.d. 12.9) (p = 0.05). Analysis showed that the most significant factors affecting IQ were malnutrition in the first 6 months of life and attendance of the child at pre-school. For nutrition in the first 6 months, there was no difference between the groups. For attendance at pre-school, 110 of 200 in the plot area and 47 of 173 in the shanty houses were attending pre-school (p < 0.01). CONCLUSION: We find that children living in the permanent houses had a significantly better IQ than those in shanty houses. A review of the literature did not reveal a comparable study.

Child, Preschool↗
PubMed1989

The prevalence and risk factors of hypertension in Klong Toey slum and Klong Toey government apartment houses.

We have investigated the prevalence and factors associated with hypertension in 976 residents of Klong Toey Slum and 909 residents of government apartment houses, aged 30 and above, selected by probability sampling after systematic household surveys with an average response rate of over 80%. Hypertensives were those who had, on at least three measurements, average diastolic blood pressure equal to or above 95 mmHg and/or systolic blood pressure equal to or above 160 mmHg or had blood pressure below 160/95 mmHg but were currently on antihypertensive medication. The prevalence of total hypertensives were found to be 17.3% and 14.0% for residents of slum and government apartment houses respectively. Men and women had more or less equal mean blood pressure and similar prevalence of hypertension. The mean systolic blood pressure increased with age while the mean diastolic blood pressure, after an initial rise with age in lower age groups, tended to level off from the age group 55-64 years upwards. Only one quarter to one third were aware of their illness and less than 15% were receiving treatment. Significant risk factors include age, duration of smoking, duration of alcohol intake, high body mass index, high Cholesterol, high Triglyceride, high Low Density Lipoprotein Cholesterol (LDLC), low High Density Lipoprotein Cholesterol (HDLC), high Total Cholesterol (TC) to High Density Lipoprotein ratio (TC/HDLC), high LDLC to HDLC ratio and diabetes mellitus. The data suggested that hypertension was an important public health problem in low socioeconomic groups in Bangkok. Some of the risk factors were related to an unhealthy lifestyle which should receive due consideration in planning for appropriate control.

Adult↗
PubMed2002

Hymenolepis nana: a common cause of paediatric diarrhoea in urban slum dwellers in India.

The prevalence of intestinal parasitic infections was studied for a period of 5 years (April 1996-April 2001) among urban slum dwellers. All age groups were represented in the study. Parasitological examinations were performed on 939 faecal specimens collected on a household basis. The total prevalence of pathogenic parasites was 33.6 per cent. No significant age and sex differences in pathogenic parasites were observed. The prevalence of intestinal helminths and pathogenic protozoa was as follows: Hymenolepis nana (9.9 per cent), Ascaris lumbricoides (8.5 per cent), Giardia lamblia (8.4 per cent) and Entamoeba histolyticaldispar (3.7 per cent). Thirty-four E. histolytica/dispar positive samples were cultured and speciation was done using polymerase chain reaction (PCR). The predominant isolate was E. dispar compared to E. histolytica. The notable finding of the present study was high prevalence of Hymenolepis nana compared with other parasitic infections in slum dwellers.

Adolescent↗
PubMed2003

Blood lead levels and risk factors for lead toxicity in children from schools and an urban slum in Delhi.

This cross-sectional study was conducted to estimate the mean blood lead levels (BLL) and prevalence of lead toxicity in a representative sample of schoolchildren and children residing in an urban slum. In addition, the association of potential environmental risk factors with elevated BLL was studied. Children aged 4-6 years were selected from schools of the South zone of Delhi (n = 125) and from an urban slum (n = 65). Risk factors were recorded using a pre-tested questionnaire and blood lead and zinc protoporphyrin (ZPP) levels were estimated. The mean BLL was 7.8 microg/dl (SD 3.9) and the proportion of children with blood lead > or = 10 microg/dl was 18.4 per cent. Distance of the residence or school from a main road appeared to be associated with higher blood lead concentrations, but these differences were not statistically significant. In our setting, vehicular pollution may be a major contributing factor in lead contamination of the environment.

Child↗