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PubMed1988

Comparison of Gomez and Waterlow classifications in a follow-up study among pre-school children.

Two classifications, widely used for assessing malnutrition, those of Gomez and Waterlow, were examined for concordance in a follow-up study. Unlike in cross-sectional studies, the classifications should reflect the changes in the nutritional status of individuals over a period of time. A method of cross-classification is illustrated for assessing these changes. Data were collected on 95 children from a village and on 74 children from an urban slum. Children were measured twice for weight and height, at an interval of 17 months in the village and 12 months in the slum. The usual way of comparing estimates of malnutrition in the initial and final rounds of a follow-up study would not reveal the shifts of individuals from one grade to another grade of malnutrition. The method illustrated in this paper, on the contrary, is able to identify individuals who improve, deteriorate or show no change in their nutritional status. It was found in this follow-up study that identical conclusions were reached by both classifications in only about 17 per cent of the children, whereas about 40 per cent showed only partial concordance (ie, between Gomez and either wasting only or stunting only).

Age Factors↗
PubMed1983

Dapsone compliance in an urban field project.

Available reports both from rural and urban leprosy centres prove beyond any doubt that dapsone is not being consumed regularly by all those who show regular clinic attendance. No reports are available from urban field projects where SET programme is being operated. In this study surprise urine samples of 294 patients of all types (smear positive 53%) mainly on dapsone monotherapy attending (1) leprosy treatment centres in slum clinics situated in the field areas adopted for SET work by Bombay Leprosy Project and (2) general hospital clinics situated predominantly outside the project area were analysed for dapsone/creatinine ratio to judge the extent of drug compliance. 201 out of 294 (68%) were regular and 82 out of 294 (28%) were irregular in consuming DDS as judged by urine examination. 67% of smear positive cases were regular. No difference was found in regularity between patients living within the project area (intensive follow up is done in this group to remind about treatment) and outside project area patients (no reminder followup is done). Similarly no difference was observed in regularity amongst the patients attending slum clinics and general hospital clinics. It could be stated that facilities for treatment offered at general hospitals or dispensaries and encouraging voluntary reporting could be quite fruitful and economical for obtaining better drug compliance in urban areas.

Dapsone↗
PubMed1982

Child-to-Child programme in Malaysia.

Even though Malaysia is a relatively prosperous country amongst the developing nations, it is still be set by problems of a rapidly increasing population. The economic cake is also unevenly distributed and there are pockets of poverty in the slums surrounding the towns as well as in the rural areas. Added to that is the problem of ignorance and superstition especially amongst its adult population. It is due to these problems that the Child-to-Child programme has found special application in Malaysia. The Child-to-Child has been introduced through either the government agencies or the voluntary organizations. Through the Ministry of Education, the concept has found its ways through the schools and the state department of education. The Ministry of Information and Broadcasting has also introduced the concept of Child-to-Child in the media. The voluntary organizations have also introduced the concept of Child-to-Child in their projects. The Sang Kancil project has to some extent used the idea in the running of its activities. The Health and Nutrition Education House have found that by applying the concept and using older children to help in running its activities, its over all objective which is the improvement of the health of the children in the slums could be reached more easily.

Child↗
PubMedDate not supplied

Psychiatric morbidity in displaced leprosy patients.

One hundred confirmed leprosy patients, all of them migrated from elsewhere, were examined for psychiatric co-morbidity. Forty-six of them were from an 'ashram' and the others were from a slum area. 76% of the patients were found to be having psychiatric illness. Of these, 55% were having neurotic depression and 21% had anxiety neurosis. Single, unemployed, socio-economically backward and patients with physical deformities were suffering significantly more often with psychiatric symptoms. Psychiatric morbidity was found to be more frequent in the patients staying in slum than in those in the 'ashram' where they had some security.

Adult↗
PubMed1993

Prevalence of rheumatic heart disease in school children.

A total number of 8449 school children, in the 5-15 years old, group were examined clinically for evidence of valvular lesions and confirmed by roentgenographic electrocardiographic and echocardiographic findings. Twelve children (0.14%) were suffering from rheumatic heart disease (RHD). The disease was significantly more (p < 0.05) prevalent in the higher age group of 11-15 years as compared to younger children. Boys (0.18%) were affected more than girls (0.09%). The disease was more frequent among children belonging to economically backward group (0.34%) and those living in large families (0.28%). Children living in the slums had significantly (p < 0.05) higher prevalence (0.41%) than those residing in urban areas (0.06%). Only 3 out of 12 (25%) were previously diagnosed cases and remaining were diagnosed for the first time. Past history of rheumatic activity was seen in 41.67% cases. Mitral valve involvement was most frequent, being detected in 10 (83.33%) cases. Majority of cases (58.33%) had the development of symptomatic RHD within 2 years of having suffered from RF. Our study helped to detect the hitherto undiagnosed cases of RHD and showed that its prevalence was higher in older children and those from urban slums.

Adolescent↗
PubMed1993

Possible relationship between allergic disease and infection by Giardia lamblia.

In order to better understand the possible relationship between allergic reactivity and infection with G. lamblia, specific IgE responses and skin test reactivity were evaluated in allergic or nonallergic Venezuelan children, with or without G. lamblia infection. Two groups of children were studied: one from our Allergy Clinic and the other from a slum area of Caracas. The total serum IgE levels in children from the slum area were significantly higher in those with intestinal helminthic parasites and giardiasis, compared with those with helminthiasis only (P < .001). In atopic children with giardiasis we also found an enhanced IgE antibody response to common environmental allergens (P < .05). As G. lamblia produces intestinal mucosal damage, we also studied the reactivity to cow milk and found that 22% of the children belonging to the low socioeconomic level demonstrated the presence of significant levels of specific IgE against this antigen. Of these milk-positive subjects, 40% were infected by G. lamblia in contrast to only 21% of the milk-negative children (P < .05). These results suggest that children with giardiasis may be exposed to greater amounts of intestinally absorbed antigens. We also studied the specific allergic response to G. lamblia, and found that in an unselected group of children of low socioeconomic level, 25% had positive skin tests, as did 50% of persons with symptomatic giardiasis. The presence of serum anti-Giardia IgE was also demonstrated in 22% of patients with giardiasis.

Animals↗
PubMed1997

Lung function parameters of Bangladeshi male subjects in different living conditions.

The "standard" values of pulmonary function tests obtained from Western populations do not agree with that of people of Bangladesh. The present survey was conducted with a view to determining the values of three lung functions parameters, viz., vital capacity, forced vital capacity, and forced expiratory volume in healthy Bangladeshi male population. 250 non-smoker male subjects of age 20-40 years were selected for the study. Of these 150 were university students and employees and 100 were low income group slum dwellers. All three values correlated positively with height and weight and negatively with age. There was a definite effect of aging on the lung function showing a declining trend from age 35 years onwards. The slum dwellers showed lower values (-12.5% in young adults) of lung functions than the university students and employees. The difference decreased with age. Prediction equations were set up using height, weight, and age as parameters. In general the lung function values were found to be 80% of the European Standards.

Adult↗
PubMed1998

Incidence of low birth weight in three selected communities of Bangladesh.

This prospective study was conducted in urban affluent, slum and rural communities of Bangladesh during Feb '94 to Feb '95. From each community, 250 pregnant mothers were recruited in the study and at the end total 660 live births were studied to determine the incidence and risk factors of low birth weight. Incidence of low birth weight was highest in urban slum (36.8%) followed by rural area (20.9%) and lowest in urban affluent community (18.3%). The area of residence had a significant influence on birth weight suggesting that environmental stress had detrimental effect on birth weight. Age, weight and height of mothers were also risk factor for low birth weight of their babies. Mothers of less than 20 years and more than 35 years, weighing less than 40 kg and having height less than 140 cm had the higher risk of giving birth to low birth weight babies. Incidence of low birth weight was highest (73.2%) among the primigravidae mothers and 36.8% among the mothers who had no antenatal check-up, but it was 15.9% among those who had check-up more than 7 times. The distribution of low birth weight babies was higher (48.2%) among the mothers who had never gone to school. To reduce the incidence of low birth weight, upliftment of socio-economic condition has got no alternative which is very much related to education level of the people. Emphasis should be given on mothers' education which is one of the influencing factors of birth weight of babies.

Adolescent↗
PubMedDate not supplied

Relation of childhood malnutrition to parental education and mothers' nutrition related KAP.

Severely malnourished children (26), weight for age 55.27 +/- 3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P less than 0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.

Attitude to Health↗
PubMed1997

Risk factors for diarrheal duration.

To identify child feeding behavior and household hygiene practices that are risk factors for prolonged diarrheal illness, a longitudinal community study was conducted over a 14-month period among 920 children aged 3-37 months who lived in an urban slum settlement in Nairobi, Kenya. Morbidity surveillance was done by home visits every third day in the absence of diarrhea and daily during diarrheal illness until termination of the episode. In-home observations were made to characterize maternal hygiene, cooking, and child feeding practices. Overall, 1,496 episodes of diarrhea were detected. The average diarrheal incidence was 3.5 episodes/child-year, and the incidence of diarrhea > 14 days was 3 episodes/100 child-years. Cox regression was used to examine the independent effects of covariates on time to recovery from a diarrheal episode. Adjusted behavioral factors that were observed to influence recovery from diarrhea included: uncovered water containers (rate ratio (RR) = 0.77, 95% confidence interval (CI) 0.64-0.94); giving no fluids (as opposed to oral rehydration solutions (ORS)/sugar salt solutions (SSS)) (RR = 1.42, 95% CI 1.14-1.77); and administration of diluted cow's milk during the first 3 days of an episode (RR = 1.23, 95% CI 1.00-1.52). These associations remained significant after adjusting for diarrheal severity. The authors recommend, among other measures, improvement of water storage and promotion of continued feeding with cereal-milk mix during diarrhea.

Age Distribution↗
PubMed1997

Impact of health education on mothers' knowledge of preventive health practices.

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group (P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group (P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 (P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 (P < 0.05).

Adult↗
PubMed1994

Health practices and indices of a poor urban population in Indonesia. Part II: Immunization, nutrition, and incidence of diarrhea.

This second section in a two-part study of health indices and practices among a poor urban population in Indonesia focuses on problems related to immunization, nutrition, and incidence of diarrhea. Through a survey of 690 mothers and 593 children in two slum communities in Jakarta, we found that 1) 65% of the children were mildly to severely malnourished according to Gomez criteria, with malnutrition most prevalent among the poorest; 2) 75% of the mothers reported exclusive breastfeeding of their infants during the first four months after birth, but breastfeeding decreased sharply with increasing socioeconomic status; 3) of the 19% of one- to three-year-old children who were incompletely immunized, most were likely to be missing their measles and DPT3 immunizations; and 4) 28% of the mothers reported that at least one of their under-three-year-old children had diarrhea in the last month, with frequency of reporting highest among poor mothers and those using water from vendors. We concluded that selective interventions should be accompanied by development of a comprehensive health infrastructure that permits uninterrupted service delivery and follow up of those identified as high risk. Such a comprehensive primary health care system should be part of a multisectoral development strategy.

Breast Feeding↗
PubMed1994

Household epidemiology of Cryptosporidium parvum infection in an urban community in northeast Brazil.

OBJECTIVE: To examine the transmission of Cryptosporidium infection in households with an identified person with cryptosporidiosis. DESIGN: Prospective cohort study. SETTING: An urban slum in Fortaleza, Brazil. PARTICIPANTS: Thirty-one households with a child less than 3 years of age (index case) who was positive for Cryptosporidium parvum using acid-fast and auramine-stained stool smears. MEASUREMENTS: Three stool samples (at 0, 2, and 6 weeks after identification of the index case) and two serum samples (0 and 6 weeks) were collected from each family member in households with an index case of Cryptosporidium infection. RESULTS: Forty-five percent of index cases of Cryptosporidium infection were associated with persistent (> 14 days) diarrhea. Secondary cases of Cryptosporidium infection were identified either by stool examination or seroconversion in 18 (58%) of 31 households involving 30 persons, yielding an overall transmission rate of 19%. Of the 202 persons in this study with at least one serum sample available for analysis, 191 (94.6%) had evidence of antibodies (either IgM or IgG) to Cryptosporidium. CONCLUSIONS: Cryptosporidium parvum is highly transmissible and infective in the family setting, with transmission rates similar to other highly infectious enteric pathogens such as Shigella species. These data are cause for added concern because of the rapidly increasing rate of seropositivity for human immunodeficiency virus.

Adolescent↗
PubMed1992

Vector-borne disease problems in rapid urbanization: new approaches to vector control.

Owing to population growth, poor levels of hygiene, and increasing urban poverty, the urban environment in many developing countries is rapidly deteriorating. Densely packed housing in shanty towns or slums and inadequate drinking-water supplies, garbage collection services, and surface-water drainage systems combine to create favourable habitats for the proliferation of vectors and reservoirs of communicable diseases. As a consequence, vector-borne diseases such as malaria, lymphatic filariasis and dengue are becoming major public health problems associated with rapid urbanization in many tropical countries. The problems in controlling these diseases and eliminating vectors and pests can be resolved by decision-makers and urban planners by moving away from the concept of "blanket" applications of pesticides towards integrated approaches. Sound environmental management practices and community education and participation form the mainstay of some of the most outstanding successes in this area. On the basis of these examples, it is argued that the municipal authorities need to apply a flexible methodology, which must be based on the possibilities of mobilizing community resources, with minimal reliance on routine pesticidal spraying. In this way, vector control becomes a by-product of human development in the city environment. This is now a true challenge.

Animals↗
PubMed1991

Urbanization and health in developing countries.

In developing countries the level of urbanization is expected to increase to 39.5% by the end of this century and to 56.9% by 2025. The number of people living in slums and shanty towns represent about one-third of the people living in cities in developing countries. This article focuses upon these poor urban populations and comments upon their lifestyle and their exposure to hazardous environmental conditions which are associated with particular patterns of morbidity and mortality. The concept of marginality has been used to describe the lifestyle of the urban poor in developing countries. This concept is critically examined and it is argued that any concept of the urban poor in developing countries being socially, economically or politically marginal is a myth. However, it can certainly be claimed that in health terms the urban poor are marginal as demonstrated by some of the studies reviewed in this article. Most studies of the health of the urban poor in developing countries concentrate on the environmental conditions in which they live. The environmental conditions of the urban poor are one of the main hazards of the lifestyle of poor urban residents. However, other aspects of their way of life, or lifestyle, have implications for their health. Issues such as smoking, diet, alcohol and drug abuse, and exposure to occupational hazards, have received much less attention in the literature and there is an urgent need for more research in these areas.

Developing Countries↗
PubMed1991

Strategies to improve immunization services in urban Africa.

The urban poor constitute a rapidly increasing proportion of the population in developing countries. Focusing attention on underserved urban slums and squatter settlements will contribute greatly to immunization programme goals, because these areas account for 30-50% of urban populations, usually provide low access to health services, carry a large burden of disease mortality, and act as sources of infection for the city and surrounding rural areas. Improvement of urban immunization programmes requires intersectorial collaboration, use of all opportunities to vaccinate eligible children and mothers, identification of low-coverage neighbourhoods and execution of extra activities in these neighbourhoods, and community mobilization to identify and refer persons for vaccination. Improved disease surveillance helps to identify high-risk populations and document programme impact. New developments in vaccines, such as the high-dose Edmonston-Zagreb vaccine, will allow changes in the immunization schedule that facilitate the control of specific diseases. Finally, operational research can assist managers to conduct urban situation assessments, evaluate programme performance at the "micro" level, and design and monitor interventions.

Africa↗
PubMedDate not supplied

A study on some diarrhoea related practices in urban Mirzapur.

In an operational research on the improvement of sanitation and water supply by an Indo-Dutch project at Mirzapur, UP, diarrhoeal morbidity was taken as an intermediate outcome variable for measuring the impact of the proposed intervention. In this study 350-410 under-five children were selected from 200 urban families of 3 slums and surveyed during 3 different seasons for 2 weekly recall of morbidity, treatment and feeding practices during diarrhoea. The prevalence of diarrhoea varied between 8.7% to 33%. Breast feeding was not restricted while other forms of feeding was continued in 57.1% to 66.3% of cases. Use of ORT increased significantly from 0% to 39.62% possibly as a result of health education. Reorientation of private practitioners to avoid use of unnecessary drug is suggested.

Child, Preschool↗
PubMed1989

Parasitic, bacterial and viral pathogens isolated from diarrhoeal and routine stool specimens of urban Bangladeshi children.

Few data exist in Bangladesh on longitudinal, community-based studies of bacterial or parasitic pathogens identified in routine and diarrhoeal stools of urban dwelling children. We undertook the following study on 343 children of age less than 6 years who resided in one of 51 slum settings in Dhaka, Bangladesh, between October 1984 and February 1986. Specimens from diarrhoeal episodes and from routine stools obtained at 3-monthly intervals were examined for parasites, rotavirus and pathogenic bacteria. Parasites were isolated from 509 (51%) of the 1006 routine stools and from 95 (42%) of the 225 diarrhoeal stools. Isolation rates steadily increased with age. Ascaris lumbricoides and Trichuris trichiura accounted for approximately 80% of all parasitic isolates in routine and diarrhoeal stools. Giardia lamblia was isolated from 11% diarrhoeal stools. Entamoeba histolytica was an uncommon isolate (less than 1%). Bacterial pathogens were identified in 55 (24%) of the diarrhoeal stools but were identified in only 164 (16%) of the 1028 routine stools examined (P less than 0.01). Toxigenic Escherichia coli, Shigellae and Campylobacter were the most frequent isolates from diarrhoeal and routine specimens. This pathogen profile appears to be more in keeping with that from urban settings in other developing countries than from rural Bangladesh, suggesting that extrapolations from rural-based data should not be made for urban settings.

Age Factors↗