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PubMed2003

Food insecurity in metropolis of the developing world--observations from central district of Karachi, Pakistan.

OBJECTIVE: To assess the prevalence of household food insecurity at various income levels in urban areas of Karachi. METHODS: A cross sectional survey of different localities in the central district of Karachi was carried out. The data was collected through household interviews of housewives conducted by trained nutritionist. Housewives were interviewed about food security status of the household. RESULTS: A total of 797 families were visited from the central district of Karachi. Mean Food Security Score increased with income level. The difference was statistically significant (ANOVA) between 1st and second (P=0.000) and 2nd and 3rd group (P=0.000) but not between 3rd and fourth group. At the very low and low income levels 83% & 51% families respectively were food insecure in any degree, while this percentage was very low at the middle (6.3%) and high income level (1.8%). The difference in prevalence of food insecurity between the VLI and LI, and, LI and MI income groups was statistically significant (chi.sq. test, p<0.001 in each case). Hunger (because of lack of money) was experienced in the preceding year only by "very low income" (37%) and "low income" families (17%). Use of coping strategies was most frequently mentioned for parents and then for children and only occasionally for infants or grand parents. Females were more likely to be effected by food insecurity than males. Meat, milk and fruits were the food groups which were preferred and considered healthy but were avoided because of lack of money by a majority (51%-86%) of families. CONCLUSIONS: In spite of having an impression of being an affluent city of Pakistan, the prevalence of food insecurity with and without hunger is rampant not only among very low income (slum dwellers) but also among low income families of Karachi.

Cross-Sectional Studies↗
PubMed1992

A new EPI strategy to reach high risk urban children in Bangladesh: urban volunteers.

Many community based outreach programs in low income countries utilize illiterate women to provide health services. However, illiteracy may present special problems in immunization or other programs requiring extensive record-keeping and follow-up. In a trial involving twenty-nine volunteers from urban slum communities in Dhaka, Bangladesh, a community-based referral and record-keeping system for use by semi-literate and illiterate volunteers in immunization outreach activities was evaluated over a thirteen month period. The women were uniformly, regardless of literacy, able to use the system to effectively refer and follow-up clients. Although volunteer performance as measured by numbers of referrals was below initial targets, completion rates were high; 87% of children and 96% of women referred completed the full series of immunizations. By facilitating active community participation, the system provides a feasible approach to reducing the high drop-out rates currently associated with immunization programs.

Bangladesh↗
PubMedDate not supplied

Role of the family in drug abuse.

A simple random survey of 9863 population out of the total 70,000 population is one slum pocket of Bombay revealed drug dependence in 104 persons. Out of 104, 83.65% smoked 'brown sugar' 10.68% used cannabis and 5.77% opium. Most of the addicts (95.2%) belonged to large families. Family history of alcoholism and drug abuse was present in 41.35%. Parental deprivation was additional contributing factor in 30.7%.

Child of Impaired Parents↗
PubMed2004

[Domestic violence as a women's health issue--activities of health professionals in Thailand].

OBJECTIVES: This paper reports the results of a qualitative study on domestic violence (DV) and interventions against DV in Khon Kaen province in northeastern Thailand. We analyzed the roles of health professionals for identifying, treating and supporting abused women, and examined a network model of DV interventions in developing countries. METHODS: We interviewed abused women, health professionals, staff of the government and legal authorities, community health workers and other relevant people in Khon Kaen city and surrounding areas. We analyzed the health consequences of DV, and the roles of health professionals and other actors regarding care and assistance for abused women. We also visited and observed homes of the victims and health facilities where those women were treated. RESULTS AND DISCUSSION: We interviewed 4 abused women in a slum area. One of the women was identified by a nurse of a nearby health center and a social worker when they visited homes in the area. Another woman was successfully supported by nurses of the health center, a community leader and a Buddhist monk. Health professionals played important roles in identifying, treating and protecting abused women. The Khon Kaen provincial hospital established an One-Stop Crisis Center (OSCC) to provide counseling, care and protection for physically or sexually abused women, with a team consisting of doctors, nurses and social workers who were trained in the care of abused women. The Nampol community hospital in a suburban area also established an OSCC to work together with health centers and communities for effective intervention. OSCC team members pointed out several problems: insufficient mental care, shortage of staff, and the difficulty of caring for women coming to the hospital at night or early in the morning. In Thailand, a legal framework against DV has yet to be established and government agencies are not greatly involved in DV interventions. Health professionals play leading roles in identifying, treating and supporting abused women in Thailand. It is important to provide relevant training for health professionals and to develop cooperation networks with government staff and legal authorities, community health workers, and community leaders. Legal frameworks for protecting and supporting DV victims are often insufficient in developing countries, while health care systems tend to be more reliable. Taking into account the social background, health professionals in developing countries can be expected to continue to play the most important role in looking after abused women.

Adolescent↗
PubMed2004

Effective subsidies in developing countries.

During the last decades, significant subsidies have been allocated to government-owned water and sewerage enterprises in developing countries. However, water and sewerage coverage is still far from desirable and the poor are particularly affected by the shortage of these services. The truth is that a considerable part of these subsidies have been used up to build huge infrastructure works that would make some construction firms happy, while often decreasing the service costs for the richer. The costs associated of delivering water and sanitation services to the poor are significantly higher, as they often live in slums or irregular urban developments without urban infrastructure. It is possible, and desirable, to improve government's effectiveness through the use of appropriate economic incentives. The Brazilian River Basin Pollution Abatement Program, based on the "output-based aid" concept, is a good example of how this can be achieved. The Program is a success story that shows that the quality of expenditures on sanitation can be considerably improved if governments of developing countries refrain from contracting sanitation infrastructure works and start paying for results, not for promises.

Brazil↗
PubMed2004

Census survey for a primary health care programme.

OBJECTIVE: To describe the process of gathering information from a census survey as a preliminary step for supporting the working of a primary health care center. It also presents briefly the results of the survey and its broader implications on the health needs of the local population. METHODS: A questionnaire was used to obtain basic information regarding the ethnicity/area of origin, number of household members and their breakdown according to gender, age and marital status. The medical students of different batches were involved in the data collection process, as part of their Survey Methodology course of Community Health Sciences (CHS) in first year. RESULTS: Data was obtained from 2,033 houses, having a total population of 16,118 persons. Fifty three per cent of the population was under fifteen years, 42% were between 15-49 and 5% were over 50 years of age. The overall percentage of males was 52% and females 48%. Approximately 79 percent people were Pushto speaking. CONCLUSION: Sikanderabad is a typical slum settlement, with an emigrant population being mostly of Pathan and Afghan refugees. The fertility rate in Sikanderabad is much higher than that of Karachi. This highlights the need for education and availability of family planning facilities. At the same time, due to the fact that there is a major portion of the population aged under five years, so facility for treating children must be appropriately provided. The Primary Health Care center established in Sikanderabad is based on the above information. The emphasis is on maternal and childcare, including antenatal and postnatal care; family planning and nutritional counseling.

Adolescent↗
PubMed2004

Mercy in action. Philippine birth center statistics.

I studied 7,565 women admitted for labor and delivery in two free-standing charity birth centers that I established in the Philippines. The births occurred between February 8, 1996, and December 31, 2003. Midwives conducted all of the deliveries that occurred in the birth centers. The midwives were certified professional midwives (CPM) or licensed midwives (LM) from the USA, Canada and the Philippines. They supervised student midwives enrolled in the Mercy In Action College of Midwifery & Primary Health Care and dual-enrolled in the National College of Midwifery's Associate of Science in Midwifery program. These students were from all around the world. The birthing women were at higher than average risk of a poor pregnancy outcome because of demographic factors: most were poor, often malnourished and living in crowded urban slum conditions. Ninety-two percent of the women and 34% of their spouses were unemployed, and only a little over half were married. In spite of the poverty, 95% of the women had spontaneous vaginal birth; 83% had blood loss less than 500 ml; 85% of the babies required no resuscitation effort; 67% of the labors were without fetal distress or meconium staining; and 90% of the babies were of normal birth weight. Transfers to a hospital after admission occurred 7% of the time, with half taking place before delivery and half after delivery. Neonatal mortality was 4.1 per 1000.

Adolescent↗
PubMed2004

[Serum values of cytokines in children with vitamin A deficiency disorders].

Vitamin A Deficiency Disorders (VADD) have been associated with alterations of cellular differentiation, regulatory functions of the immune system and increased children morbidity and mortality rates due to acute respiratory and intestinal infections. The aim of the present study was to determine serum concentrations of Thl-Th2 cytokines in VADD children. The sample consisted of 138 children (F=72; M=66; 4-7 y old) living in slums in Maracaibo, Venezuela, with an adequate nutrition assessed by clinics and anthropometry. Vitamin A status was assessed by the Conjunctival Impression Cytology (CIC) technique following the ICEPO methodology, which determines Normal CIC = control or Abnormal CIC = VADD. The cytokines IL-10, IL-4 and IFN-gamma (pg/mL) were analyzed by the ELISA method; and IL-2 (U/mL) by the EAISA method. The Student's t test was applied to detect differences between values (p<0.05). No one child presented clinical evidence of VADD; 71 children (51.40%) exhibited normal CIC (control), whereas 67 children (48.60%) presented abnormal CIC indicative of sub-clinical manifestation of VADD. The prevalence was higher, although non significant, in females, 5-6 y old children and amerindians (51.39%, 64.18% and 60.40%, respectively). A diminished serum concentration of IL-10 was detected in VADD children, in comparison with the control group (4.41 +/- 1.27 pg/mL vs. 6.03 +/- 3.90 pg/mL) (p<0.03). The rest of studied cytokines were not significantly different with respect to control. The IL-10 diminution in VADD children would be related to the alteration of the inflammatory response at the level of respiratory and intestinal epithelia affected by infections.

Child↗
PubMed2003

Exploring possibilities of achieving sustainability in solid waste management.

The solid waste management scenario in the recent years has shifted towards a more sustainable approach. This paper brings in to focus the waste management methods that can be adopted using Bangalore as case study, in order to achieve economic viability and explores the sustainable options that conserves both natural and man-made resources and averts ecological risks. Bangalore, the Garden City of India with a population of 6 million is facing the daunting task of handling 3613 tonnes of municipal solid waste per day. Added to this are the constraints that are faced by the authorities such as poor political back up, inadequate infrastructure, insufficient funds and lack of public support. Attempts have been made to clear wastes by door to door collection method, introduction of push carts, which separate biodegradable wastes from non biodegradable wastes, deployment of auto tippers to clear slum wastes etc. under the guidance of Bangalore Agenda Task Force (government appointed body) and Bangalore Mahanagara Palike (city municipal corporation). Integrated waste management system is proposed as an option, which include collection, transport and processing of wastes in an environmentally sound way. The methods to overcome constraints in waste management and the future plans and actions that will bring about a significant change in the current waste management practices are also discussed in the paper.

Community-Institutional Relations↗
PubMed2004

[Reform of Japan's NTP and its technical perspectives].

The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. The law is also challenged with the shift of the paradigm for the National Tuberculosis (TB) Programme. In order to respond properly to these changes, the Tuberculosis Panel of the Health Science Council of the Ministry of Health, Labor and Welfare submitted its report for the amendment of the law in March 2002. Based on this report, a new Tuberculosis Control Law was passed in Parliament last June, and related decrees of the Cabinet and the Ministry are now being revised in preparation for it's enactment in April 2005. In this special lecture, the main points and framework of the revisions were discussed with the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation. 1. Case detection. There will be a shift from the current "indiscriminate" screening scheme to a selective one regarding periodic mass health examination. Only subjects aged 65 or older will be eligible for the screening, supplemented with selected occupational groups who are considered to be at a higher risk of TB, or may be a danger to others if they develop TB, such as health-care providers and school teachers. In addition, local autonomies are responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses. This means that the efforts of the autonomies are critical for the new system to be effective. The extra-ordinary examination will be limited to only the patient's contacts, and will be mandatory for those contacts so they cannot refuse to be examined by the Health Center. The public services used in the contact investigations will be greatly facilitated by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection using whole-blood interferon-gamma determination (QuantiFERON). The quality of clinical diagnosis and monitoring of treatment should also be improved by introducing an external quality assurance system of commercial laboratory services. 2. Chemoprophylaxis. Although not explicitly defined in the new legislation, the expansion and improvement of chemoprophylaxis to cover anyone with any risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. These technical innovations in diagnosis of TB infection will be very helpful. Development of new drug regimens for the preventive treatment is also badly needed. 3. Immunization. Prior to the amendment of the Law, the BCG vaccination of students entering primary and junior high schools has been already abandoned. In order to encourage the early primary vaccination for infants, the new Law will adopt the direct vaccination scheme in which babies will be given the BCG vaccine without tuberculin testing. This program will be implemented safely, only if it is given to young babies, e.g., less than one year old, as defined by the decree. It is essential to maintain the high level of vaccination coverage under the new program. The autonomy may encounter difficulty mobilizing client babies shortly after their birth (only one year, as compared with the current four years). To avoid the possible, though very rare, adverse health effects due to the vaccination of infected babies, careful questioning should be conducted regarding the risk of exposure to infection prior to vaccination. A ready course of treatment and examinations for abnormal reactions after vaccination (Koch's phenomenon) is also warranted. 4. Treatment and patient care: The revised Law clearly states the governmental responsibility for treating TB patients in close cooperation with a doctor. This is an important legal basis for the expansion of the DOTS Japan version. While the development of new anti-tuberculosis drugs will be realized in the near future, Japan still has to overcome the issue of improper practice of treatment, as well as the government's slow process for approving new drugs to be used for multi-drug resistant TB and non-tuberculous mycobacterioses. 5. Prefectural TB Control Plan: In order to resolve the problems specific to the respective prefectures in terms of epidemiological parameters or available resources, the new Law requests every prefecture to develop its own TB control plan. In order for the new TB Control Law to be effective, strong government commitment supported by technological innovation is mandatory. It is for that reason that the Japanese Society of Tuberculosis should aggressively join the global movement to stop TB along with the general public of Japan.

Antitubercular Agents↗
PubMed2005

Seasonal variation of tungiasis in an endemic community.

Tungiasis (caused by the sand flea Tunga penetrans) is hyperendemic in many resource-poor communities in Brazil. To understand transmission dynamics of this parasitic skin disease in a typical endemic area, a longitudinal study was carried out in a slum in Fortaleza in northeastern Brazil. In a door-to-door survey, the population of a randomly selected area (n = 1,460) was examined on four occasions for the presence of embedded sand fleas. Prevalence rates were 33.6% in March (rainy season), 23.8% in June (end of the rainy season), 54.4% in September (peak of the dry season), and 16.8% in January (begin of the rainy season). Tungiasis was more common in males than in females. The intensity of infestation was correlated with the prevalence. The study shows that prevalence of tungiasis and parasite burden vary significantly during the year with a peak in the dry season. These findings have important consequences for the design of control measures.

Adolescent↗
PubMedDate not supplied

Housing and health transition in Thailand.

Over the past half-century, Thailand's health profile has been undergoing an epidemiologic transition in association with various fundamental societal changes, shifting from one with a predominant burden of communicable disease to one in which noncommunicable diseases and accidents now predominate. The primary question is why have the disease rates in the Thai population changed? Answering this question requires an examination of the underlying transitions in social and contextual factors. This paper explores, using published data, how housing conditions, as one set of environmental health risks, have undergone transition in recent years and how this change maps on the health-transition process. A combination of economic development, urbanization, modernization, and increased health literacy resulted in a range of health-protecting changes in housing design and materials. Pre-eminent among such changes are improvements in household sanitation and in equipment, ventilation, and fuel pertaining to indoor cooking and heating. In tropical countries like Thailand, gains have been made in mosquito-proofing houses and in minimizing open pools of water to combat the risks of malaria, dengue fever, and other mosquito-borne infections. Meanwhile, the growth in shantytown and slum housing around the urban fringe, often in precarious environmental settings, introduced a negative dimension to the evolving profile of housing-related health risks, whereas the urban sprawl of modern residences creates health risks that are due to traffic crashes and the lack of walking in daily transport.

Accidents↗
PubMedDate not supplied

Housing, urban development and health in Latin America: contrasts, inequalities and challenges.

Since the outset of the 20th century, growing urbanization and its contingent waxing populations in Latin America, including Brazil, have come to have alarming effects on the conditions of life, especially in the areas of housing and healthcare for such populations. In this paper, we present data describing and qualifying the process of urbanization and its consequences for Latin American countries and certain Brazilian cities. Arguments are presented about the effects of the urbanization process and the development of low-income human settlements (slums known as favelas and squatting in tenement housing) on health conditions, diseases, and the death rate. The first part of the paper is based on secondary and quantitative data about urbanization, housing, and health in Brazilian and other Latin American cities. Governmental and nongovernmental data are used to structure the problematic landscape of the Latin American region. In the second part of the paper, we focus on a case study of a Brazilian coast city that has registered an intense population growth. This study demonstrates that urban policy (housing, environmental, sanitation, and urban transportation) requires an integration of health and environmental public policy and demonstrates the importance of the role of popular participation in urban public policy-making, and the potential importance of the Bertiioga Healthy City Project from the perspective of a better integration of actions, policies, and programs.

Brazil↗
PubMed2005

Salmonellosis and the food chain in Khon Kaen, northeastern Thailand.

Non-typhoidal salmonellosis is a major cause of food-borne illness in Thailand. Specific serotyping of Salmonellae, linked with certain foods, can be used to identify outbreaks, transmission, and for surveillance. We aimed to identify the chain of non-typhoidal Salmonella transmission from food to humans in five slums, two open markets, four supermarkets and an abattoir in the municipality of Khon Kaen. During three months representing the cool-dry, hot-dry, and rainy seasons of 2002, culture samples were collected from water, food, pork, and chicken. Stool cultures of food venders, and others in the same area, were performed. Serological typing was done by the WHO National Salmonella and Shigella Center in Thailand. Of the food, drinking water, and stool samples from food handlers and healthy persons, 18, 7, 11, and 5%, respectively, were positive for Salmonella. Nearly all (96-98%) of the fresh pork and chicken, both from the open markets and supermarkets, were positive for Salmonella. The major Salmonella serovars were S. Anatum, S. Rissen, S. Virchow, S. Enteritidis and S. Panama, similar throughout the food chain and to the other reports that year. To reduce the incidence of human salmonellosis, several preventative measures must be taken where animals are produced, slaughtered and processed, and at home and in eateries. Vulnerable groups, such as infants, the elderly and the immuno-compromised, should be made aware of their increased susceptibility to food-borne disease.

Adult↗
PubMed2005

An approach to addressing ethical issues in a community-based risk assessment for HIV: a case from Chennai, India.

Community-based assessment of HIV prevalence and behavioural risk factors is the basis for deciding priorities of prevention and care programmes. Here, upholding the human rights of participants in assessment is of utmost importance. The objective of the paper was to describe the process of implementation of an epidemiological survey to assess HIV-related behavioural and biological factors in Chennai city in South India and to suggest an ethical framework for conducting similar assessment activities in developing-country settings. A survey was conducted with participation from residents (n=1,659) of low-income urban communities (slums) as part of a community-based HIV/STD-prevention trial. Administration of the survey was preceded by extensive community contact and household visits to inform community members about the trial and assessment activities. Formative research further strengthened rapport with community, highlighted community concerns, and identified HIV-related risk behaviours that informed questionnaire design. The process of obtaining informed consent began before assessment activities and provided an opportunity for individuals to discuss participation with their families and friends. Privacy during assessment, comprehensive follow-up care for those who tested positive for HIV/STDs, such as nutritional and prevention counselling, referral services for opportunistic infections, and antenatal-care options for pregnant women increased trust and credibility of the project. The sustained availability of trial staff to facilitate access to resources to address non-HIV/STD-related felt-needs further strengthened participation of the community members. These resources included liaison services with local government to obtain public services, such as water and electricity and resources, to address concerns, such as alcohol abuse and domestic violence. Based on this experience, an ethical framework is suggested for conducting HIV epidemiological risk assessment in developing countries. This framework discusses the role of community participation, transparent and comprehensive informed consent, timely dissemination of results, and access to follow-up care for those living with HIV/STDs.

Adolescent↗
PubMed2005

Effect of iron supplementation on serum zinc status of lactating women in Addis Ababa, Ethiopia.

OBJECTIVE: To evaluate the impact of daily and weekly iron supplementation on serum zinc status among anaemic lactating mothers. DESIGN: A randomised iron intervention controlled trial. SETTING: Seven urban slum communities of Addis Ababa. SUBJECTS: Phase one of the study involved 207 anaemic lactating women assigned into two intervention groups; the daily (N=71) and weekly (N=71) Iron supplemented and the control group (N=68). Supplementation with 60 mg tablet containing 300 microg ferrous sulphate and 400 microg folic acid was done for three months while the control group was n otsupplemented. Phase two involved 53 participants systematically drawn from phase one. MAIN OUTCOME MEASURES: Haemoglobin from all subjects and serum zinc and ferittin levels following three months supplementation. Zinc status based on serum zinc value of less than 10.7% micromole/L. RESULTS: The mean baseline characteristics and serum zinc of the women at baseline were similar, overall marginal zinc deficiency prevalence was 11.3% and no zinc deficiency was detected. Following supplementation, zinc deficiency was detected in the supplemented groups but not in the control group. The mean serum zinc significantly changed in both supplemented groups while no change was observed in the control group. The reduction in the mean serum zinc was significantly higher in the daily than in the weekly supplemented group. CONCLUSION: Iron supplementation impacts negatively on serum zinc status (exacerbates zinc deficiency) and hence, its contribution to zinc deficiency deserves further investigation especially in the context of the on-going promotion of double fortification strategies that involve iron.

Administration, Oral↗
PubMed2005

Sanitation: a call on resources for promoting urban child health.

Poor sanitation is known to increase the risk of morbidity and mortality from diarrhea among children. Several studies have found a high correlation between childhood morbidity and availability of sanitation services. It has been estimated that 1.7 million deaths each year, or 3.1 percent of all deaths are attributable to inadequate access to water, sanitation and hygiene. The urgency for sanitation in the urban environment stems from the fact that the urban poor live in crowded slums and informal settlements where sanitation facilities are particularly important for children's health and personal dignity. Demand for sanitation services has remained low, as livelihood priorities have been more pressing. There is a pressing need to get Governments and society to recognize the appalling toll created by poor sanitary conditions in urban poor settlements. Serious efforts should be made to develop local, national and international campaigns which promote convergence among programs aimed at urban health infrastructure, community development and education; motivate people to demand and maintain better sanitation; and place sanitation to the forefront of development and political dialogue.

Child↗
PubMedDate not supplied

Comparative study of knowledge about different Child Survival and Safe Motherhood intervention in two groups of mothers.

A cross-sectional study was conducted in an urban field practice slum area served by Urban Health Centre (UHC) attached to the Dept. of Preventive and Social Medicine, T. N. Medical College and Nair Hospital, Mumbai, to compare the knowledge about different Child Survival and Safe Motherhood interventions in two groups of mothers. 152 mother who regularly attended antenatal check-up in UHC constituted study group and 153 mothers selected by individual matching constituted the control group. Significant differences in the knowledge of study and control groups of mothers were observed about some interventions like time of initiation of breast feeding, duration of exclusive breast feeding, age of starting weaning and number of OPV and DPT doses to be given till 1 year of age.

Breast Feeding↗