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PubMed2003

Environmental surveillance system to track wild poliovirus transmission.

Eradication of poliomyelitis from large metropolis cities in India has been difficult due to high population density and the presence of large urban slums. Three paralytic poliomyelitis cases were reported in Mumbai, India, in 1999 and 2000 in spite of high immunization coverage and good-quality supplementary immunization activities. We therefore established a systematic environmental surveillance study by weekly screening of sewage samples from three high-risk slum areas to detect the silent transmission of wild poliovirus. In 2001, from among the 137 sewage samples tested, wild poliovirus type 1 was isolated from 35 and wild poliovirus type 3 was isolated from 1. Acute flaccid paralysis (AFP) surveillance indicated one case of paralytic poliomyelitis from the city. Phylogenetic analysis with complete VP1 sequences revealed that the isolates from environmental samples belonged to four lineages of wild polioviruses recently isolated from poliomyelitis cases in Uttar Pradesh and not to those previously isolated from AFP cases in Mumbai. Wild poliovirus thus introduced caused one case of paralytic poliomyelitis. The virus was detected in environmental samples 3 months before. It was found that wild polioviruses introduced several times during the year circulated in Mumbai for a limited period before being eliminated. Environmental surveillance was found to be sensitive for the detection of wild poliovirus silent transmission. Nucleotide sequence analysis helped identify wild poliovirus reservoir areas.

Base Sequence↗
PubMed2005

Domestic violence and its mental health correlates in Indian women.

BACKGROUND: Domestic spousal violence against women has far-reaching mental health implications. AIMS: To determine the association of domestic spousal violence with poor mental health. METHOD: In a household survey of rural, urban non-slum and urban slum areas from seven sites in India, the population of women aged 15-49 years was sampled using probability proportionate to size. The Self Report Questionnaire was used to assess mental health status and a structured questionnaire elicited spousal experiences of violence. RESULTS: Of 9938 women surveyed, 40% reported poor mental health. Logistic regression showed that women reporting 'any violence' -- 'slap', 'hit', 'kick' or 'beat' (OR 2.2, 95% CI 2.0-2.5) -- or 'all violence' -- all of the four types of physically violent behaviour (OR 3.5, 95% CI 2.94-3.51) -- were at increased risk of poor mental health. CONCLUSIONS: Findings indicate a strong association between domestic spousal violence and poor mental health, and underscore the need for appropriate interventions.

Adolescent↗
PubMed2006

Determining risk for severe leptospirosis by molecular analysis of environmental surface waters for pathogenic Leptospira.

BACKGROUND: Although previous data indicate that the overall incidence of human leptospirosis in the Peruvian Amazon is similar in urban and rural sites, severe leptospirosis has been observed only in the urban context. As a potential explanation for this epidemiological observation, we tested the hypothesis that concentrations of more virulent Leptospira would be higher in urban than in rural environmental surface waters. METHODS AND FINDINGS: A quantitative real-time PCR assay was used to compare levels of Leptospira in urban and rural environmental surface waters in sites in the Peruvian Amazon region of Iquitos. Molecular taxonomic analysis of a 1,200-bp segment of the leptospiral 16S ribosomal RNA gene was used to identify Leptospira to the species level. Pathogenic Leptospira species were found only in urban slum water sources (Fisher's exact test; p = 0.013). The concentration of pathogen-related Leptospira was higher in urban than rural water sources (approximately 10(3) leptospires/ml versus 0.5 x 10(2) leptospires/ml; F = 8.406, p < 0.05). Identical 16S rRNA gene sequences from Leptospira interrogans serovar Icterohaemorrhagiae were found in urban slum market area gutter water and in human isolates, suggesting a specific mode of transmission from rats to humans. In a prospective, population-based study of patients presenting with acute febrile illness, isolation of L. interrogans-related leptospires from humans was significantly associated with urban acquisition (75% of urban isolates); human isolates of other leptospiral species were associated with rural acquisition (78% of rural isolates) (chi-square analysis; p < 0.01). This distribution of human leptospiral isolates mirrored the distribution of leptospiral 16S ribosomal gene sequences in urban and rural water sources. CONCLUSIONS: Our findings data support the hypothesis that urban severe leptospirosis in the Peruvian Amazon is associated with higher concentrations of more pathogenic leptospires at sites of exposure and transmission. This combined quantitative and molecular taxonomical risk assessment of environmental surface waters is globally applicable for assessing risk for leptospiral infection and severe disease in leptospirosis-endemic regions.

Environment↗
PubMed2003

Prevalence of Toxocara infection in schoolchildren from the Butantã region, São Paulo, Brazil.

Visceral larva migrans syndrome by Toxocara affects mainly children between 2 and 5 years of age, it is generally asymptomatic, and the seroprevalence varies from 3 to 86% in different countries. A total of 399 schoolchildren from 14 public schools of the Butantã region, São Paulo city, Brazil, were evaluated by Toxocara serology (enzyme-linked immunosorbent assay). Epidemiological data to the Toxocara infection obtained from a protocol were submitted to multiple logistic regression analysis for a risk profile definition. Blood was collected on filter paper by finger puncture, with all samples tested in duplicate. Considering titers > or = 1/160 as positive, the seroprevalence obtained was 38.8%. Among infected children, the mean age was 9.4 years, with a similar distribution between genders. A significant association was observed with the presence of onychophagia, residence with a dirty backyard, living in a slum, previous wheezing episodes, school attended, and family income (p < 0.05). All data, except "living in a slum", were considered to be determinant of a risk profile for the acquisition of Toxocara infection. A monthly income > or = 5 minimum salaries represented a protective factor, although of low relevance. Toxocara eggs were found in at least one of the soil samples obtained from five schools, with high prevalence of Toxocara infections, indicating the frequent soil contamination by this agent.

Adolescent↗
PubMedDate not supplied

[Income inequality and health: the case of Rio de Janeiro].

This ecological analysis addresses the association between income inequality and health status in the municipality of Rio de Janeiro. Data were analyzed using geo-processing and multiple regression techniques. The following health indicators were used: infant mortality rate; standardized mortality rate; life expectancy at birth; and homicide rate among 15-29-year-old males. Patterns of income inequality were assessed through income distribution indicators: Gini index, Robin Hood index, and top 10 %/bottom 40% average income ratio. The results indicate significant correlations between income distribution indicators and health indicators, providing additional empirical evidence of the association between health status and income inequality. For the homicide rate, the effect of the indicator "density of slum residents" was also relevant, suggesting that further deterioration in health standards may be due to social disruption of deprived communities and the resultant increase in criminal activity. The geo-epidemiological analysis presented here highlights the association between adverse health outcomes and residential concentration of poverty. Social policies focused on slum residents are needed to reduce the harmful effects of relative deprivation.

Adolescent↗
PubMed2003

Aspects of meaning of life in different subcultures in Peru.

The categorization system for perceptions of meaning of life developed by Ebersole, et al. was applied in four different Peruvian subsamples (middle/upper-class university students, lower-class night students, slum dwellers who had emigrated from the South Andes and settled in the capital, and Highland Indians), totaling 168 participants. Analysis showed most answers could be satisfactorily fitted into the eight categories, although slight modifications had to be made and two more categories had to be created. For middle/upper-class students, lower-class night students, and slum dwellers, Growth was the most important category followed by Relationships. In contrast, the major topic within the Indian sample of the South Andes was Relationships, whereas Growth turned out to be irrelevant. More educated subjects described meaning of life in a more abstract way than less educated subjects. The discrepancies between the subsamples suggest that individual concepts of meaning of life contain culture-specific as well as universal elements.

Adolescent↗
PubMed1996

Protein-energy malnutrition in low income elderly Nairobi women.

Nutritional data for two groups of low income elderly women (chi = 64, range 57-74 years) in Nairobi, Kenya were compared. Group I (n = 113), slum dwellers, had an income of < or = $20 Cd per month; Group II (n = 88), poor urban area inhabitants, had an income of < or = $170 Cd per month. Dietary intakes were assessed quantitatively by four 24-h dietary recalls; anthropometric and biochemical data were obtained. Twenty-one women (16% of Group I; 3% of Group II) were classified as having protein-energy malnutrition (PEM) based on abnormal anthropometric measurements or low serum albumin concentration. The malnutrition was marasmic-like; the anthropometric measurements (body weight, triceps, skinfold thickness (TSF), mid-arm muscle circumference (MAMC) of the PEM Group were lower (P < or = 0.05) than those of Groups I and II. The PEM Group was older (chi = 68 years), had lost more teeth, and had more subnormal values than Groups I and II for: serum albumin, hemoglobin, hematocrit, MCHC, MCH, serum transferrin and serum iron. Inferior diets were a contributing factor. Mean energy and protein intakes of the PEM Group were low: 1471 kcal day(-1) (26 kcal kg(-1)) and 42 g day(-1) (0.79 g kg(-1)) respectively. The main protein sources were vegetables (48%) and cereals (36%); only 6 g protein was of high quality. Group II mean protein and energy intakes were greater (P < or = 0.05, P < or = 0.01) than those of the PEM Group and mean dairy product intake was higher (P < or = 0.001). The PEM Group and Group I had low mean energy intakes and an unsatisfactory dietary pattern; they consumed less meat (P < or = 0.01) and less fat (P < or = 0.001) than Group II. For the PEM Group dietary intakes of energy, fat and sugar were significantly correlated with TSF and MAMC; for the PEM Group monthly income was significantly correlated with weight, BMI, TSF and MAMC. Data suggest that elderly women living in Nairobi slums are at high risk of malnutrition, one of the factors contributing to the problem is inadequate food intake.

Aged↗
PubMed1988

Evaluation of community-based rehabilitation in Punjab, Pakistan: II: The prevalence of diseases, impairments, and handicaps.

A health survey using the impairment and handicap classifications from the ICIDH was carried out in conjunction with a study of the WHO community-based rehabilitation programme in a village and a slum area in Pakistan. The prevalence of handicaps defined in this way was about half that of impairments, the most common handicaps being with mobility, occupation, and social integration. There was a slightly higher degree of handicap in the village. In both areas diseases of the musculoskeletal system, the ear, and the respiratory tract were common, but the frequency of infectious, respiratory, endocrine, blood, and digestive diseases was higher in the slum area.

Community Health Services↗
PubMed2000

Epidemiology of cholera outbreak in Kampala, Uganda.

OBJECTIVE: To provide epidemiological description of the cholera outbreak which occurred in Kampala between December 1997 and March 1998. DESIGN: A four-month cross-sectional survey. SETTING: Kampala city, Uganda. MAIN OUTCOME MEASURES: Number of cases reported per day, attack rate per age group and per parish, case fatality ratio. RESULTS: The cholera outbreak was due to Vibrio cholerae O1 El Tor, serotype Ogawa. Between December 1997 and March 1998, 6228 cases of cholera were reported, of which 1091 (17.5%) were children under five years of age. The overall attack rate was 0.62%, similar in the under-fives and five and above age groups. The case fatality ratio among hospitalised patients was 2.5%. The peak of the outbreak was observed three weeks after the report of the first case, and by the end of January 1998 (less than two months after the first case), 88.4% of the cases had already been reported. The occurrence of cases concentrated in the slums where the overcrowding and the environmental conditions resembled a refugee camp situation. CONCLUSION: The explosive development of the cholera outbreak in Kampala, followed by a rapid decrease of the number of cases reported is unusual in a large urban setting. It appeared that each of the affected slums developed a distinct outbreak in a non immune population, which did not spread to contiguous areas. Therefore, we believe that, a decentralised strategy, that would focus the interventions on each heavily affected area, should be considered in these circumstances.

Adolescent↗
PubMedDate not supplied

Nutritional status of pavement dweller children of Calcutta City.

Pavement dwelling is likely to aggravate malnutrition among its residents due to extreme poverty, lack of dwelling and access to food and their exposure to polluted environment. Paucity of information about nutritional status of street children compared to that among urban slum dwellers, squatters or rural/tribal population is quite evident. The present study revealed the magnitude of Protein Energy Malnutrition (PEM) and few associated factors among a sample of 435 underfives belonging to pavement dweller families and selected randomly from clusters of such families, from each of the five geographical sectors of Calcutta city. Overall prevalence of PEM was found almost similar (about 70%) to that among other 'urban poor' children viz. slum dwellers etc., but about 16% of them were found severely undernourished (Grade III & V of IAP classification of PEM). About 35% and 70% of street dweller children had wasting and stunting respectively. Severe PEM (Grade III & IV) was more prevalent among 12-23 months old, girl child, those belonged to illiterate parents and housewife mothers rather than wage earners. It also did increase with increase of birth rate of decrease of birth interval.

Child, Preschool↗
PubMed1975

Obstacles to family planning practice in urban Morocco.

Sixty in-depth interviews with mothers living in a urban slum of Morocco probed resistances to practicing modern methods of fertility control and began to shed light on some of the reasons family planning programs often fail to reach illiterate target populations. Economic insecurity and the disintegration of the support networks of the traditional extended family complicate the difficult lives of young mothers in the urban slum. While such factors tend to encourage smaller families, the uncertainties and complexities of the socioeconomic structure contribute to the problems blocking access to modern methods of fertility control.

Abortion, Induced↗
PubMed2002

[Vitamin A deficiency and the anthropometric nutritional status of urban and rural marginalized children in the state of Zulia, Venezuela].

The present transversal study was carried out to estimate the prevalence of both vitamin A deficiency (VAD) and protein-energy malnutrition among children (24 to 85 months) from three urban slums (n = 173) in Maracaibo city, Zulia State, Venezuela and a rural slum area (n = 34), vieinal to Maracaibo, by measuring serum retinol and z score of anthropometric indices Height//Age (H//AZ); Weight//Age (W//AZ) and Weight//Height (W//HZ), compared to NCHS-WHO reference values. The Graffar's methodology adapted to Venezuela by Méndez Castellano (1986) confirmed the underprivileged socio-economic condition of the children population. For serum retinol analysis, peripheral venous blood was drawn and serum was treated according to the Bieri et al. (1979) technique and HPLC procedure. Values were recorded in microgram/dL. Statistical analysis was done by using Epi Info 2000, release 1.0 and SAS release 6.0 (1996) computer programs. The prevalence of VAD (serum retinol < 20 micrograms/dL) in the total children population (n = 207) was 22.2%, being higher in urban children than in rural children (22.5% vs 20.5%). No clinical signs of VAD were detected in the children. The nutritional status analysed by Z score of anthropometric indices revealed that 27.4% of children suffered from undernutrition (Z score = -2 to > -3 SD), being 15.4% stunted, 9.6% wasted and 2.6% with acute protein-energy malnutrition. Neither severe malnutrition nor overweight were detected. According with the H//AZ index, 54.6% of children had adequate nutrition. However 23% of them suffered from VAD. In children at risk of developing undernutrition (Z score = -1 to > -2 SD), 20.9% had VAD and of the stunted children, 21.9% presented VAD. With W//AZ, 60.3%, 29.9% and 9.1% of children were with adequate nutrition, at risk, or wasted respectively; of each group, 25.6%, 17.7% and 15%, respectively had serum retinol values below 20 micrograms/dL. The Z score of W//HZ indicator revealed that 87.4%, 10.4% and 2.4% of children were in good nutrition, at risk, or with acute protein-energy malnutrition, respectively. In the three groups 22.1%, 23.8% and 20%, respectively were affected by VAD. These results indicate that VAD coexists indistinctly in healthy, adequately nourished children, as in those malnourished ones. Our VAD prevalence results and others from Venezuela, are higher than the criteria laid down by WHO and PAHO which warrant wide community intervention. This public health problem becomes more significant because children are apparently healthy and, if timely vitamin A supplementation is not given, any intercurrent infection is likely to worsen the vitamin A status, increasing the widely known consequences.

Body Height↗
PubMed2002

Breeding habitats and larval indices of Aedes aegypti (L) in residential areas of Rajahmundry town, Andhra Pradesh.

Entomological studies on relative prevalence and distribution of adults and immatures of Aedes aegypti were conducted in Rajahmundry town of Andhra Pradesh from December 1998 to November 1999. Adults and immature stages of Aedes aegypti were found in all the 22 localities viz; posh area (8), mixed area (8) and slum area (6) of the town. Larval indices were found to be higher in slum areas as compared to mixed or posh areas of the town. However, the larval habitats were observed to be similar in all localities. The larval indices were highest during monsoon and post-monsoon months. The breeding preference ratio (BPR) was highest for cement tubs followed by discarded tyres and barrels. The high larval indices of Aedes aegypti in these areas warrant intensification of vector surveillance activities along with source reduction and health education.

Aedes↗
PubMed1992

Nutritional situation of Dhaka.

The paper presents the nutritional situation of Dhaka. Dhaka is the capital city of Bangladesh with an area of 414 square Km. The population size of Dhaka city is about 7 millions of which nearly 3 millions live in the slums. Socio-economic and socio-cultural situation has been discussed. In the pre-school children, protein-energy malnutrition (PEM) appeared to be a serious problems. A high rate of advanced vitamin A deficiency along with severe PEM has been demonstrated. A recent survey showed that slum children below five years of age had higher prevalence of acute (11%) and chronic (50%) malnutrition. This paper also discussed the nutritional status of school children and pregnant women. A national nutrition survey revealed that average energy intake by the industrial laborers was only 74% of the daily requirement. To date no data is available on the nutritional situation of the adolescent and elderly people. Poverty, lack of knowledge, illnesses, lack of sufficient services and socio-cultural barriers are the major causes of nutritional problem. There are several Government and Non-Government organizations in Dhaka city working for improving community health and nutritional status through a number of interventions; such as health and nutrition education, vitamin A capsule distribution, immunization, growth monitoring and feeding through rehabilitation centers. A positive impact of vitamin A oral dosing has been demonstrated and improved nutritional status by nutrition education and feeding through the centers have been reported. Community participation and sustainability of the program have also been discussed.

Aged↗
PubMed2004

Early childhood development in deprived urban settlements.

Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. Examples from countries, across the globe provide evidence of improved early child development, made possible through integrated slum improvement programs, are few in numbers. The observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, the presence of risk factors for developmental delay like low birth weight, birth asphyxia, coupled with poor environment of home and alternate child care services, highlights the need for simple cost effective community model for promoting early child development. This review on early child development focuses on the developmental status of children in the deprived urban settlements, who are yet to be on the priority list of Governments and international agencies working for the welfare of children, the contributory nature-nurture factors and replicable working models like infant stimulation, early detection of developmental delay in infancy itself, developmental screening of toddlers, skill assessment for preschool children, school readiness programs, identification of mental sub-normality and primary education enhancement program for primary school children. Further, the review probes feasible intervention strategies through community owned early child care and development facilities, utilizing existing programs like ICDS, Urban Basic Services and by initiating services like Development Friendly Well Baby Clinics, Community Extension services, Child Development Referral Units at district hospitals and involving trained manpower like anganwadi/creche workers, public health nurses and developmental therapists. With the decentralization process the local self-government at municipalities and city corporations are financially equipped to be the prime movers to initiate, monitor and promote early child development programs, to emerge as a part and parcel of community owned sustainable development process.

Child↗
PubMed2004

Injection practices in a metropolis of North India: perceptions, determinants and issues of safety.

BACKGROUND: At least 50 percent of the injections administered each year are unsafe, more particularly in developing countries, posing serious health risks. An initial assessment to describe injection practices; their determinants and adverse effects can prevent injection-associated transmission of blood borne pathogens by reducing injection frequency and adoption of safe injection practices. AIMS: To assess the injection practices in a large metropolitan city encompassing varied socio-cultural scenarios. STUDY SETTING AND DESIGN: Field based cross sectional survey covering urban non-slum, slum and peri-urban areas of a large metropolitan city. METHODS AND MATERIAL: Injection prescribers, providers and community members selected by random sampling from the study areas. Pre tested questionnaires assessed knowledge and perceptions of study subjects towards injections and their possible complications. Observation of the process of injection and prescription audit also carried out. STATISTICAL ANALYSIS: MS Access for database and SPSS ver 11 for analysis. Point estimates, 95% confidence intervals, Chi Square, t test, one-way ANOVA. RESULTS: The per capita injection rate was 5.1 per year and ratio of therapeutic to immunization injections was 4.4:1. Only 22.5%of injections were administered with a sterile syringe and needle. The level of knowledge about HIV and HBV transmission by unsafe injections was satisfactory amongst prescribers and community, but inadequate amongst providers. HCV was known to a very few in all the groups. The annual incidence of needle stick injuries among providers was quite high. CONCLUSION: A locally relevant safe injection policy based on multi disciplinary approach is required to reduce number of injections, unsafe injections and their attendant complications.

Adolescent↗
PubMed2005

Screening for cognitive impairment in older adults attending an eye clinic.

PURPOSE: We conducted a cross-sectional study examining potentially modifiable factors associated with cognitive impairments (mild or severe) in older whites, African Americans and Hispanics attending an outpatient eye clinic. METHODS: In-clinic interviews and physical examinations assessed social, demographic and health information from 100 consecutive Hispanic, African-American and white adults aged > or = 55. Our primary outcome was presence of any cognitive impairment (mild or severe) using the St. Louis University Mental Status Examination (SLUMS) scale. RESULTS: Of the 100 subjects, 65 screened positive for cognitive impairments on the SLUMS cognitive instrument: 46 with mild cognitive impairment and 19 with severe impairment (possible dementia). African-American and Hispanic adults (nonwhites) were significantly more likely to have cognitive impairment compared to white adults (OR 2.80: 95% CI = 1.05-7.44), independent of age, years of education and systolic blood pressure. Subjects with diabetes also had increased odds of cognitive impairments (OR 3.28, 95% CI = 1.21-8.90) even after adjusting for relevant confounders. There was a nonsignificant trend between visual acuity impairment and cognitive impairment (p = 0.059). CONCLUSIONS: Sixty-five percent of adults aged > or = 55 attending the eye clinic screened positive for cognitive impairments, with higher rates among nonwhites and adults living with diabetes.

Black or African American↗
PubMed2004

A study of ocular infections amongst primary school children in Delhi.

The present study of ocular infections was conducted amongst primary school children residing in an urban slum and rural area of Delhi. A total of four schools were selected, two from urban slum in Central Delhi Rouse Avenue and two from a peripheral village on the outskirts of Delhi. All the children studying in the above mentioned schools and residing in the same area were covered. All the study subjects were interviewed, clinically examined and given a proforma to be filled by their parents. Of the total 775 subjects only 91 (11.74%) had ocular infections. Conjunctivitis was the most prevalent infection followed by trachoma, stye, blepharitis and chalazion. The type and prevalence of infection was similar, in both sexes and both areas, rural and urban. There was a significant rising trend of ocular infection with increase in age. A significant association was found between ocular infections and religion but the association with per capita income was not significant.

Adolescent↗