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PubMed2004

Day-care centre supplementary feeding effects on child nutrition in urban slum areas of Nepal.

We compared the nutritional status of children aged 1-5 years from slums attending two day-care centres (DCCs) in Nepal (one in an urban slum area) with that of non-attendees to evaluate the impact of supplementary feeding. We measured the anthropometrics of 23 children attending two DCCs and 23 matched controls from the same neighbourhood and interviewed their mothers. We found a better nutritional status, particularly the height-for-age Z-score, among the attendees of the DCC with children's longer attendance, but no difference at the other, although attendees who had been fed for longer tended to show better nutrition. Our study indicates that in the least developed countries good quality day-care of sufficient duration has the potential to improve child nutrition.

Anthropometry↗
PubMed2005

Neonatal hypothermia detection by ThermoSpot in Indian urban slum dwellings.

OBJECTIVE: To look at the performance of ThermoSpot liquid crystal thermometry in detecting neonatal hypothermia. DESIGN: A comparison was made between skin temperatures taken by ThermoSpot and axillary temperatures taken by digital electric thermometry. Non-medically trained local volunteers performed daily paired recordings on infants on days 1, 2, 3, 4, 5, 6, and 7 of life. SETTING: This is a non-hospital based study set in the homes of neonates in an underprivileged urban slum community in the developing world. SUBJECTS INCLUSION CRITERIA: babies born at home. EXCLUSION CRITERIA: hospital admission; parental refusal. INTERVENTIONS: The ThermoSpot was stuck to the neonate's abdomen over the liver area on day 1 and removed on day 7. MAIN OUTCOME MEASURES: Fixed test properties of ThermoSpot. RESULTS: Over 180 paired observations, the fixed test properties of ThermoSpot in the detection of hypothermia were: sensitivity 88%; specificity 97%; positive likelihood ratio 29; negative likelihood ratio 0.13. CONCLUSIONS: ThermoSpot performed well when used by non-medically trained volunteers for the detection of neonatal hypothermia in the homes of an urban slum community.

Axilla↗
PubMed1996

Blood lead in pregnant women in the urban slums of Lucknow, India.

OBJECTIVES: To determine the concentrations of blood lead (PbB) in pregnant women in the slums of Lucknow, north India. METHODS: Of the 203 designated municipal slums in Lucknow, 70 were randomly selected for study and a cohort of 500 pregnant women was enrolled. Each participant was interviewed with questions on possible sources of exposure to lead, surrogates of nutritional status were measured, and PbB was measured. RESULTS: The mean PbB was 14.3 micrograms/dl and 19.2% of women had PbB > or = 20 micrograms/dl. PbB was not associated with age, height, weight, gestation, or history of abortions, although higher PbB was associated with higher parity. Women living inner city neighbourhoods near heavy vehicular traffic had PbB 2.2 micrograms/dl higher (95% confidence interval (95% CI) 0.8 to 3.6) than those living in other neighbourhoods. The PbB was not associated with reported use of piped water or the presence of paint in homes, and increasing PbB was unexpectedly associated with decreasing use of eye cosmetic "surma" and the duration of gestation. CONCLUSIONS: The high PbB found in this population raises concern about fetal development and points to the urgent need to reduce exposure to lead.

Adult↗
PubMed1998

Family expenditure on sickness episodes of pre-school children in urban slums of Lucknow, north India.

This study investigated family expenditure on the sickness episodes of pre-school children in 32 urban slums of Lucknow, North India. Between July 1995 and January 1996, 396 children between the ages of 1.5 to 3.5 years were contacted. The main objective was to discover the direct medical cost of illness incurred by their families in the preceding months. Point prevalence of major morbidities, in the preceding month, were as follows: 17.2% respiratory and 6.3% diarrhoeal. A health care provider saw 31.4% [95% confidence interval (CI): 26.9-36.01] children. In > 95% of the cases, the health care provider was a self-employed, non-governmental dispenser (NGD). More than half of NGDs did not have a recognized medical degree. The mean family expenditure on sickness in 1 month was RS 12.27 [standard deviation (SD): RS 23.81], approximately 1% of their income (1 US $ = RS 32). Respiratory illness was the primary cause of financial burden to the community. The isolated symptoms of fever was the most expensive to treat, with diarrhoea and dysentery costs being similar. Immunizing a child saved money. We conclude that since the NGDs are the predominant health care providers in the urban slums, and since neither the nature of medicines dispensed by them nor their additional costs can be ascertained, steps must be taken to monitor their dispensing practices and to educate them about rational drug therapy.

Analysis of Variance↗
PubMed2003

Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia.

OBJECTIVE: To determine the status of iron deficiency anaemia (IDA) and malnutrition in lactating women. DESIGN: A cross-sectional study. SETTING: Six urban slum communities in Teklehaimanot district, Addis Ababa. SUBJECTS: One thousand and seventeen lactating women were enrolled and assessed for their haemoglobin (Hgb), serum ferritin level and body mass index (BMI) during the month of March 2001. Iron deficiency anaemia was considered when Hgb and serum ferritin concentrations were less than 12gm/dl and 12 microg/l respectively, whereas, a BMI less than 18.5% kg/m2 was considered malnourished. MAIN OUTCOME MEASURES: Determinations of haemoglobin, serum ferritin and BMI measurements. RESULTS: The overall prevalence of iron deficiency anaemia (IDA) and protein energy malnutrition in the slum communities was 22.3% and 27.1% respectively. The mean age of mothers (28.4 +/- 6.12 years) indicates that prevalence of malnutrition and iron deficiency anaemia was higher among younger mothers than among older mothers. The prevalence of malnutrition was positively correlated with the serum ferritin concentration status, of the mothers (r=0.12, p=0.2, RR=1.03). CONCLUSION: It is observed that malnutrition and IDA are major health problems and therefore, an appropriate nutrition intervention package to improve the nutrition situation of the communities is recommended.

Adolescent↗
PubMed2006

Health care utilization for diarrhea and fever in 4 urban slums in Karachi.

OBJECTIVE: To estimate the fraction of fever and diarrhea patients making use of private practitioners, self-treatment, hospital care, drug vendors, community health centers and traditional healers. DESIGN: A cross-sectional survey. PLACE AND DURATION OF STUDY: Four slums in and around Karachi during October and November, 2001. PATIENTS AND METHODS: A sample of 1842 households was selected with probability proportional to size of the slum. The household head or a representative was asked regarding the treatment providers for diarrhea and cases of fever persistent for 3 days or more. Only households with an actual case of fever and/or diarrhea were included in the analysis. RESULTS: The study found that more than half of diarrhea and fever cases are seen by private practitioners. Self medication with medicines available in the home or specifically purchased for the disease episode from a drug vendor combined provides 13% to 18% of health care. Only between 11% and 13% of patients are seen by the public sector, hospitals and community health centers. There was no significant difference between the choice of health care provider for diarrhea and fever cases. CONCLUSION: In this survey, the majority of fever and diarrhea patients presented first to private practitioners and not to drug vendors or the public sector. Successful passive surveillance of febrile or diarrheal illness in these communities has to integrate private practitioners.

Adolescent↗
PubMed2000

Adult mortality in slums of Karachi, Pakistan.

OBJECTIVE: Cause-specific death rates are rarely available to guide health interventions for adults in South Asia. We report mortality patterns among Karachi's urban poor. METHODS: We conducted verbal autopsies for adult deaths under active surveillance during 1990-1993 in five urban slums of Karachi. Two physicians assigned underlying cause of death by consensus. Analysis included cause- and category-specific rates, 45Q15s and comparison with 1991 Japanese national statistics. RESULTS: All 345 adult deaths (15-59 years) in the 5 slums (total population 45,389) were included. Male mortality exceeded female (4.4 vs 3.3/1000, p = .02). Noncommunicable diseases claimed 59% of deaths, communicable and reproductive 27% and injuries, 15%. The leading identified death rates (/100,000) among women were: circulatory disorders (66), maternal causes (33), tuberculosis (30), and burns (23); and among men they were: circulatory disorders (124) tuberculosis (30) and road traffic accidents (30). Overall Karachi adult mortality was 3.7 times Japanese rate. Compared to Japan, adults in Karachi had one to two orders of magnitude excess mortality due to maternal causes, tuberculosis and burns. Circulatory disorders and tuberculosis accounted for 47% of excess male mortality; these plus maternal causes and burns accounted for 55% of excess female mortality. CONCLUSION: These mortality levels and patterns compel interventions and research for poor urban adults beyond maternal health. Women's health would equally benefit from tuberculosis control or burn prevention. Men need safer travel. Both need improved cardiovascular health.

Adolescent↗
PubMed2000

Health seeking and hygiene behaviours predict nutritional status of pre-school children in a slum area of Addis Ababa, Ethiopia.

A cross-sectional study was done from March to May 1997 in four selected slum kebeles (villages) of Addis Ababa in which nutritional status of 758 children aged 6 to 36 months was examined and stratified into malnourished and well nourished groups. Analysis of hygiene and health seeking practices of randomly selected households of the two sets of children determined practices that significantly exacerbate childhood malnutrition. The rates of immunization for the malnourished (80.2%) and well nourished households (77.6%) were practically the same. No significant difference was found in the prevalence of home treatment or food withholding habits at times of diarrhoea episodes between the two groups. The study established six variables to predict childhood malnutrition in the slum section of Addis Ababa: 1) presence of child waste inside house (Odds Ratio = 7.44; p < 0.0001), 2) diarrhoea treatment at the hospital (OR = 0.47;p < 0.05), 3) prolonged storage of cooked foods (OR = 2.86;p < 0.05), 4) feeding with washed hands (OR = 0.44; p < 0.01), and 5) poor handling of drinking water (OR = 3.18; p < 0.01) and 6) foods (OR = 3.52; p < 0.01). Hence strong and sustainable advice with a view of changing the behaviours of households towards good personal and household hygiene practices, and increased utilization of health settings is recommended as these may limit the overall success of public health programmes.

Adult↗
PubMed1999

Growth and residential conditions of a slum community in Colombo, Sri Lanka.

Based on the authors' fieldwork, this article examined the spatial and demographic growth of a slum community in Colombo, Sri Lanka, in association with the inhabitants' socioeconomic conditions. In this slum community, which is near the industrial and commercial centers and has developed especially since the early 1970s, most dwellers are migrants from other parts of Colombo. The increase of dwellers resulted in a high-density residential condition, represented by an extremely small floor area per person, despite an income level that is not extremely low.

Humans↗
PubMed1992

[The demographic structure and fertility levels of the population in the new and old slum areas of a "gecekondu" settlement in Antalya Province center].

"The demographic structure and fertility level of the population in two slum areas [in Turkey's Antalya Province]...were investigated with a cross-sectional study in 1989. It was found that the distribution of population by age groups differed and especially the fertility measurements were high in the new area in relation to various social and demographic characteristics. In order to facilitate and accelerate the transition period of slum communities, it is necessary to provide health education, mother and child health and family planning services." (SUMMARY IN ENG)

Age Distribution↗
PubMed1975

[Lead poisoning in childhood: a silent epidemic in the slums of the United States (author's transl)].

While leadpoisoning has been with mankind since the dawn of civilization, only in recent years this disease was recognized as a serious public health problem. It has been estimated that more than half a million children are suffering from lead intoxication in the U.S.A. In most instances this disease is caused by eating lead containing peeling paint or plaster crumbs which are abundantly found in run-down neighborhoods of the slums. Children, often unsupervised, develop a craving for these toxic substances and their parents are usually unaware of the inherent dangers of such activities. Education of parents, early recognition and appropriate treatment of affected children and -- most important -- eradication of slum living supported by legislative action and governmental financial aid comprise the ingrediences to a rational approach to overcome the presenting dilemma in childhood lead poisoning.

Child↗
PubMed2003

Role of health-seeking behaviour in child mortality in the slums of Karachi, Pakistan.

The role of family health-seeking behaviour in under-five-year child mortality was explored through the combined approach of examining health-seeking behaviour regarding treatment generally, and in specific in relation to illness before death. A population-based case control study was carried out during the period 1993-1994 using 222 deaths from diarrhoea and acute respiratory illness (ARI) in children under five years of age in six slums of Karachi as cases, and 419 controls matched on age, disease (diarrhoea and ARI) and slum. Factors significantly associated (p<0.05) with child mortality in the multivariate analysis were: mothers changing healers quickly, using a traditional healer or an unqualified doctor and mothers to whom doctors did not explain the treatment, even when maternal education was controlled for. Seeking effective medical services is highly influential on whether the child survives or succumbs to ARI or diarrhoea. As mothers are the first providers of care, an attempt should be made to try and improve their skills through health education so that they can use simple and effective treatments for minor illnesses. They should also be taught to recognize potentially life-threatening conditions, to seek care early and to persist with treatment.

Acute Disease↗
PubMed2003

Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi.

AIM: To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season. METHODS: Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001. RESULTS: Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies. CONCLUSIONS: This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.

Fever↗
PubMed2003

Sexual behaviors and opinions on sexuality of adolescents in a slum community in Bangkok.

This study was a survey research aiming to investigate sexual behaviors and opinions on sexuality of adolescents in a slum community. The study group comprised of 377 adolescents aged 12-22 years in a slum community in Bangkok randomly selected, and data were collected using self-administered questionnaires. Results indicated that 18.8% of the adolescents were sexually experienced with the average age of 15 years old at first intercourse. 63.1% of the adolescents had unprotected sexual intercourse with lovers or friends. Almost one-third of the population believed that premarital sexual activity was acceptable. One-sixth of the adolescents agreed that having sexual intercourse with a lover is safe, assuming that they had trustworthy partners and that having sexual intercourse was the best way to prevent their lover from having sexual activities with other partners. In addition, gender and age range were found to be the factors that significantly related to the adolescents' opinions that premarital sexual activity was acceptable and having sexual intercourse with a lover was safe (p < 0.05), whereas the relationship between the opinions and education level was statistically insignificant. It is recommended that familial, academic, community and public health support are necessary in educating the adolescents on reproductive health and family planning in order to reduce high risk behaviors associated with acquiring HIV and other STDs.

Adolescent↗
PubMed2003

Prevalence & etiology of nutritional anaemia among school children of urban slums.

BACKGROUND & OBJECTIVES: The prevalence of anaemia has been well studied particularly on etiology of nutritional anaemia in children of age group 5-10.9 yr in India. The present study was carried out to find out the prevalence and etiology of nutritional anaemia among 5 to 10.9 yr old corporation school children from urban slums. METHODS: Urban Delhi slums were divided into four areas and one corporation school from each area was randomly selected. A total of 406 children from 4 each school were randomly selected over a period of one yr and prevalence of anaemia was estimated. Another subset of 95 anaemic children admitted to the hospital during the same period were evaluated for the etiology of nutritional anaemia. RESULTS: Prevalence of anaemia as judged by WHO recommended cut-off values of haemoglobin among these children was 41.8 per cent. Pure or mixed iron deficiency anaemia was the commonest type of anaemia noted in 68.42 per cent (65 of 95) children followed by pure or mixed B12 deficiency noticed in 28.42 per cent (27 of 95) anaemic children. Of the pure variety, iron deficiency was the commonest cause occurring in 41.05 per cent (39 of 95) children. INTERPRETATION & CONCLUSION: Childhood anaemia continues to be a significant public health problem in school children aged 5 to 10.9 yr and iron deficiency either alone or in combination is the commonest nutritional cause of anaemia. Pure or mixed vitamin B12 deficiency is an important but yet not commonly recognized cause of anaemia among these children.

Anemia↗
PubMed2003

Determinants of childhood mortality and morbidity in urban slums in India.

The large and continuous increase in India's urban population and the concomitant growth of the population residing in slums has resulted in overstraining of infrastructure and deterioration in public health. The link between urbanization, a degraded environment, inaccessibility to healthcare and a deteriorating quality of life is significant and particularly evident in the sharp inequities in IMR if one looks at urban specific studies. It is hence, germane to address the appalling inequalities in the distribution and access to basic amenities and health services with a focus on enhanced service coverage, improved sanitation and water supplies and mobilization of community action for effectively mitigating the childhood death and disease burden in urban slums.

Cause of Death↗
PubMed2003

Urban slum-specific issues in neonatal survival.

Urbanization is rapidly spreading throughout the developing world. An urban slum poses special health problems due to poverty, overcrowding, unhygienic surroundings and lack of an organized health Infrastructure. The primary causes of neonatal mortality are sepsis, perinatal asphyxia and prematurity. Home deliveries, late recognition of neonatal illness, delay in seeking medical help and inappropriate treatment contribute to neonatal mortality. Measures to reduce neonatal mortality in urban slums should focus on health education, improvement of antenatal practices, institutional deliveries, and ensuring quality perinatal care. Success of a comprehensive health strategy would require planned health infrastructure, strengthening and unification of existing health care program and facilities; forming a system of referral and developing a program with active participation of the community.

Adolescent↗
PubMed2004

Outbreak of measles amongst vaccinated children in a slum of Chandigarh.

BACKGROUND: An outbreak of measles was reported from a slum, UT, Chandigarh in April 2003. Similar outbreak was also reported in less than three years from the same and adjoining areas. The present study was conducted to investigate and assess various epidemiological features associated with measles outbreak. MATERIAL AND METHODS: Three cases of measles were admitted in Dept. of Paediatrics, Govt. Medical College & Hospital, Chandigarh and were reported to the Dept. of Community Medicine for an outbreak investigation. A trained team investigated the slum having a population of 25,000 and studied various features associated with epidemic between the period of April 22 to May 10, 2003. RESULTS: The study covered 484 houses having 1130 children. Among the children who developed measles 32.76% were vaccinated ones. In them attack rate was 3%. Attack rate in vaccinated children went on increasing as age increased. An overall attack rate of 5.13% (Peak incidence 6% in 1-4 years age group) was recorded. Among measles cases, one-fifth had post measles complications. As much as 32.76% children with measles had received measles vaccination in the past. Therefore something more than immunization by single dose of vaccine is required. Measles was reported to be higher amongst the children without Vitamin A supplementation (P < 0.001). CONCLUSION: There is need to store vaccine properly and to strengthen routine immunization coverage, Vitamin A supplementation and health infrastructure in underprivileged population. Serological studies among vaccinated children against measles should be undertaken to explore the possibility of second dose of measles in older children.

Adolescent↗