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PubMedDate not supplied

Need for dedicated focus on urban health within National Rural Health Mission.

National Rural Health Mission represents an important public health initiative to address essential health needs of the country's underserved population. For the Mission to achieve its goals, urban population needs to be included in its scope. Urban poor population constitutes nearly a third of India's urban population and is growing at three times the national population growth rate. Health status and access of reproductive and child health services of slum dwellers are poor and comparable to the rural population. Efforts to improve the conditions of urban poor necessitate strengthening national policy and fiscal mandate, augmenting and strengthening the urban health delivery system, coordinating among multiple stakeholders, involving private sector, strengthening municipal functioning and building community capacities. National Rural Health Mission should be broadened to National Public Health Mission. This paper discusses issues pertaining to health conditions of the urban poor, present status of services, challenges and suggests options for NRHM to bridge the large gap.

Health Services Accessibility↗
PubMed2005

Evaluating the indoor and outdoor environment: using a simple method.

Housing is the conjunction of the dwelling, the home, the immediate environment and the community. Between 1960 and 1980, the urban population in developing countries more than doubled and is expected to reach 56% of the total population by the year 2025. In many cities, the development of squatter settlements and shanty towns had grown rapidly causing the destruction of green areas. The number of people living in urban slums and shanty towns is an indicator of conditions in the cities and the United Nations had estimated that about one-third of urban dwellers in developing countries live in such settlements. Poverty is highly prevalent among the residents of these areas. Outdoor environmental degradation, together with the social degradation affects the health of the urban population especially the poor causing a burden of ill-health, disability, poor indoor housing, and high maternal and infant mortality. The aim of the present study is to evaluate the indoor and outdoor environment using a simple method and to assess its reliability and validity. The scoring system, which was developed for the assessment of the indoor and outdoor environmental levels included 36 items (18 for the indoor and 18 for the outdoor) using a questionnaire. Results revealed that the proposed scoring system was able to reveal significance difference between served (water, electricity, and sewerage system were available) and unserved areas when using t-test, z-test, and chi-square testing. The proposed scoring system was reliable and valid especially in indoor assessment. Outdoor scores might need more modifications to improve its reliability.

Egypt↗
PubMed2006

[Factors contributing to endemic cholera in Douala, Cameroon].

Cholera has been endemic in Douala, Cameroon since 1971. A number of environmental factors favourize the survival of the Vibrio in Douala including location at the mouth of Wouri delta on the Atlantic Ocean, sandy clay soil, shallow dirty polluted foul-smelling groundwater, presence of vast expanses of swamp, streams/drainage ditches infested with algae, and high temperatures with low rainfall and drought during certain periods of the year. Most outbreaks have started in Bepanda, a slum area built on a garbage dump in a swampy zone fed by drainage ditches carrying the faecal pollution from neighbouring upstream districts. It is a densely overcrowded area of uncontrolled urbanization generated by the influx of poor city new-comers who live without adequate access to clean water or basic sanitary facilities. The most affected areas are those resulting from recent unregulated urban sprawl in polluted swamp zones or garbage dumps. Since access to the public water system is inadequate with only 65000 persons connected for 3 million inhabitants, dwellers in most areas must take water from the 70000 urban wells (estimated in 2004) that are often not more than 1.5 m deep. Sewage facilities are insufficient to provide complete evacuation of solid and liquid waste. The network of rivers, streams and man-made ditches waste are poorly maintained and often overflow during the rainy season. The contents of latrines are often discharged directly into the environment. Social factors such as the reformation of urban tribes and persistence of traditional attitudes toward waste disposal and water use have not only led to high-risk behaviour but also created barriers to sanitation and hygiene education. With an inadequate sanitation inspection system, a large but purely accessible public health system and a highly disorganized private health sector exists, effective preventive measures are difficult to implement. The combination of these factors probably account for the endemicity of cholera in Douala.

Cameroon↗
PubMed2006

[The prevalence of Enterobius vermicularis in schoolchildren and affecting factors].

This study was carried out in order to determine the factors affecting the presence of Enterobius vermicularis in schoolchildren. This investigation was a cross-sectional and analytic study. The dependent variable was the presence of parasites and the independent variables were the characteristics of the children, families, houses, toilets and drinking water. A stool specimen was taken in the morning using the cellophane tape method, and examined the same day by microscopy. Data were evaluated using the Chi square test and logistic regression analysis and p < 0.05 was accepted as being statistically significant. There were 529 students in the kindergarten and 1-5 classes in the Isikkent and Sait Guzelcan primary schools in the region of the Isikkent Health Center in Izmir. However specimens could only be obtained from 477 (90.2%) students. The mean age of children was 8.6+/-2.0 years. The number of residents in their homes averaged 5.4+/-2.0, the average number of children in the homes was 3.2+/-1.9 and 290 (60.8%) houses were single dwellings. The source for piped water in 404 houses (84.7%) was the city network, and there were modern sanitary facilities (toilets) in 377 (70.6%) houses. Enterobius vermicularis was found in 209 (43.8%) children. According to logistic regression analyses, the rate of Enterobius vermicularis was found to be 3.05 times higher in students from the Sait Guzelcan primary school, if there were more than 6 residents in the home 2.05 times even higher and 2.02 times still higher if there were no sanitary facilities at his/her home. When there was a history of parasites in the family, the risk was significantly decreased. The prevalence of Enterobius vermicularis in schoolchildren was higher in slum areas, in crowded homes and in those that lacked modern sanitary facilities.

Animals↗
PubMed2006

Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians.

BACKGROUND: Low vitamin B12 concentration in South Asian Indians is common, but the exact prevalence is not known. AIM: To investigate prevalence and associations of low vitamin B12 concentration and hyperhomocysteinemia in rural and urban Indian men living in and around Pune, Maharashtra. METHOD: We studied 441 middle-aged men (149 rural, 142 slum and 150 urban middle-class residents, mean age 39 y). Data on lifestyle, socio-economic status, nutrition and medical history were obtained. Circulating concentrations of vitamin B12, folate, ferritin, total homocysteine (tHcy), and haematological indices, and cardiovascular risk variables were measured. RESULTS: Median plasma B12 concentration was low (110 pmol/L): Overall, 67% of men had low vitamin B12 concentration (<150 pmol/L) and 58% had hyperhomocysteinemia (>15 micromol/L). Of the urban middle class, 81% had low vitamin B12 concentration and 79% had hyperhomocysteinemia. Low vitamin B12 concentration contributed 28% to the risk of hyperhomocysteinemia (population attributable risk) while low red cell folate contributed 2%. Vegetarians had 4.4 times (95% CI 2.1, 9.4) higher risk of low vitamin B12 concentrations and 3.0 times (95% CI 1.4, 6.5) higher risk of hyperhomocysteinemia compared to those who ate non-vegetarian foods frequently. Urban middle-class residence was an additional independent risk factor of hyperhomocysteinemia (odds ratio 7.6 (95% CI 2.5, 22.6), compared to rural men). Low vitamin B12 concentration was related to lower blood haemoglobin concentration and higher mean corpuscular volume, but macrocytic anemia was rare. CONCLUSION: Low vitamin B12 concentration and hyperhomocysteinemia are common in Indian men, particularly in vegetarians and urban middle class residents. Further studies are needed to confirm these findings in other parts of India.

Adult↗
PubMedDate not supplied

[Experimental antitriatomic program in Santiago].

The rural migration to urban centers occurred since the 40s in many Latin American countries, including Santiago the capital city of Chile, originated a growing belt of premises built with light poor material (the rests of previous rural habitations, mud, pieces of timber, plastic and cardboard for walls, and cane stalks and artificial clinkstones for roofs) giving raise to many types of slums. This situation facilitated the passive transport of the different instars, including eggs, of triatomine bugs. Due to the fact that in the 1959-1960 warm seasons, the Santiago province health institutions had received an increasing reported number of triatomine bugs (Triatoma infestans) in dwellings from different periurban, even urban and rural sections of the province, the central local health authorities with the advise of the University of Chile, Department of Parasitology decided to carry out an experimental program against these vectors of Chagas' disease. The program consisted basically in an spray and thorough application of liquid forms (emulsion, suspension, solution) of 1% lindane (average > or = 500 mg per 1 m2), depending on the material of the constructions, to all the surfaces of walls, ceilings, attics and peridomiciliary structures of all the infested dwellings in a sector and those located less than 100 m around. In order to reach triatomine bugs not affected, for different reasons, in the first spraying, a second application, identical to the first was performed to the total number of premises between 30 and 120 days later. Periodical evaluations were made, and positive dwellings found and neighboring ones were sprayed again. During insecticide applications adequate protection measures for spraying workers, inhabitants, domestic animals, household goods and food were adopted. All the steps of the program were accompanied by health education activities directed to individuals, families, school teachers and community institutions, tending to motivate the people to an active participation, as in the report of the presence or reappearing of triatomines in premises as in cooperating in the sprayings and improving the material conditions of their properties. Thus, in the period 1960-1972 the following goals were achieved: 1) Spraying twice with 1% lindane 32,708 dwellings located in 199 quarters from 26 periurban and rural sections. 2) Protection to 191,090 people against T. infestans bites and the eventual acquired chagasic infection. 3) Percentages of triatomines infested dwellings decreased from to 18.7 to 3.0 according to residents and from 3.0 to 0.3 according insects collection. At present, a significant proportion of the sprayed dwellings has been demolished and replaced by new constructions.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1991

Strategies to maintain health in the Third World.

International cooperation with Third World countries aims at reducing the high morbidity and mortality of the population to a tolerable level. The main health problems are caused by poverty. Thus, the range of diseases in tropical countries can be explained more readily by the socio-economic situation than solely by the climate. Health services, in Africa in particular, have had to reduce drastically their budgets in the last ten years and now have only approximately 1/1000th of the funds usually available in industrialised countries. High population growth reduces the resources available per head, increases infection potential and worsens living conditions. Control strategies must take account of these circumstances in order to achieve the required sustained effect within the framework of primary health care. The example of the control of several infectious diseases, such as schistosomiasis, pneumonia, malaria and AIDS, is used to show that control programmes can be effective but, in the current conditions, can hardly be maintained without outside support. In the future, diseases caused by environmental problems and new life styles as a result of industrialization, urbanization and slum growth will move dramatically into the foreground.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Trial of a screening technique of the developmental assessment of infants and young children (6 weeks-2 years).

Six hundred and nineteen infants and young children from the slums of Jabalpur City were screened by twenty trained paramedical workers using the Woodside Screening Technique. A second screen was given by the author within three days of the first screen on 350 (56.5%) children. The tester/author agreement was 97%. The results of the Woodside Screening Technique were validated against the standard Gesell's Schedules. The specificity and sensitivity rates of 88 and 83%, respectively were better than the original Denver Developmental Screening Test (77% each). Over referral rates which vary between 10-28% were comparable to the original Denver Developmental Screening Test. The under referral rate was 24%. All children tested belonged to the deprived sections of society, having weights below 50th centile of Harvard Standards. Inspite of this 74% of children scored above and at par on the Gesell's Developmental Schedule, only 11% children showing any developmental abnormality. The need to eliminate the cultural bias from the test and draw a new threshold line to separate questionable cases from abnormal ones is highlighted. Recommendations and specific modifications of the Woodside Screening Technique are suggested.

Child Development↗
PubMed1991

A comparison of local handwashing agents in Bangladesh.

The efficacy of handwashing using ash, soap, mud or plain water was tested in a group of 20 women living in a slum of Dhaka in Bangladesh. Each woman was asked to wash her hands using each of the washing agents and the efficacy of handwashing was assessed by comparing estimated faecal coliform counts from post-washing hand samples. Mud and ash were found to be as efficient as soap. Research on appropriate handwashing techniques in the light of the existing practices is suggested.

Bangladesh↗
PubMed1991

Measles control in the urbanising environment.

The relationship between urbanisation and measles control is examined. In urban settings in developing regions measles is a disease of particular importance, since it tends to affect children at a younger age and with greater severity than in rural settings. A further finding in urban areas, especially peri-urban slums, is the lower measles vaccination coverage rates compared with rural regions. Factors identified as determinants of measles vaccination coverage among children under 2 years of age in urban areas include: home delivery; being born outside the urban setting; and length of stay in the city. These factors are probably related to the low socioeconomic status and lack of social integration experienced by new urban immigrants. A number of additional obstacles, such as distance, economic and cultural barriers, and inconvenient clinic hours all prevent parents from gaining easy access to vaccination services. In order to address the problems of measles control in expanding urban settings, a regional approach--with full integration of curative and preventive services--is called for. A more effective use of existing services will probably go a long way towards improving urban vaccination coverage with resultant measles control.

Health Services Accessibility↗
PubMed1990

Age for measles immunization seroconversion after measles vaccination at 6-8 months of age--a randomized controlled trial.

The objective of the study was to compare the effectiveness of measles vaccine by seroconversion in vaccinated children with non-vaccinated children of 6 to 8 months age group in a city slum community so as to study the feasibility of advancing the age of immunization. Live attenuated lyophilized Schwartz strain of measles vaccine was used. Hemagglutination inhibition (HI) antibody was estimated. Seroconversion was defined as either the conversion of negative to positive or a two fold rise in titre. One hundred and thirty two children completed the study. There was no difference in the age, sex and nutritional status between vaccinated and non-vaccinated groups (p greater than 0.7). The seroconversion rate in the vaccinated group was 65% and in the non-vaccinated group was 26%. The age, sex and nutritional status did not significantly affect the seroconversion. Our data suggest that immunization with measles vaccine may be effective as early as 6 months of age. Immunization at 6 months may be needed at least for children in densely populated areas like cities and towns.

Age Factors↗
PubMed1990

Non-nutritive suckling and use of pacifiers.

One hundred and sixteen infants and children with normal development were studied for their non-nutritive suckling habit with special reference to pacifier suckling. The use of pacifier was more common among the lower socio-economic group (83.6%) and those residing in slums (58.6%). In 88.7% of cases it was the mother, family member, friend or relative who was responsible for introduction of pacifier to the baby with the aim to soothe the child. The other indications for use of pacifier were to facilitate dentition (60.0%) and nutritive function (18.1%). The use of pacifier in most of the cases was associated with chronic diarrhea (86.2%), respiratory illnesses (52.5%) and pica (10.2%). Defective dentition was noted only in 5.1% of children. The medical/paramedical staff were against the use of pacifiers.

Child↗
PubMed1990

Kwashiorkor and marasmus: changing hospital incidence of syndromic presentation (1957-88).

This clinico-epidemiological study was undertaken to substantiate the impression that the pattern of clinical presentation of protein-energy malnutrition causing kwashiorkor-marasmus syndrome (KMS) is changing over time. An analysis of data for the period 1964-88, obtained from the specialised Pediatric Clinic of the Calcutta School of Tropical Medicine serving mostly the city slums showed decrease (p less than 0.01) in the incidence of chronic edematous forms of severe KMS, less decrease (p less than 0.05) in the incidence of mild-moderate KMS and increase (p less than 0.01) in the incidence of nutritional marasmus and of chronic very severe forms of KMS characterised by extreme retardation in growth and development. Incidentally, a rising incidence of rickets was observed. In the hospitalised cases (1957-88) these observations were corroborated. Data for 1985-88 of NRS Medical College Hospital, Calcutta, a general hospital serving the city as well as the neighbouring rural areas, showed that among the hospitalised city children edematous KMS was proportionately fewer than marasmus. The situation was reverse in the children from the rural areas. The observations suggested that the syndromic presentation of KMS is changing over the last three decades with some rural-urban differences for which only some recent data could be available.

Child↗
PubMed1990

[Urbanization, poverty and health in Columbia].

A rapid process of urbanisation is recognisable all over the world today. Already 80% of the world's big cities are located in underdeveloped countries. 60% of their city inhabitants are slum-dwellers living under more or less miserable conditions in shanty towns. This paper documents the reality of life of a 60,000-inhabitants shanty town population in Columbia as well as the implications on health by poverty-linked social environment. In addition to disastrous conditions of housing and nutrition, chronic individual and collective psychological stress seem to be the most important risk factors for the health of the population. The international linkups between wealth, poverty and poverty-conditioned disease make it necessary that physicians of industrial nations also become aware of the world's disparity and injustice in order to help in overcoming miserable living conditions by thinking in global terms.

Adolescent↗
PubMed1990

Role of breast-feeding in the prevention and treatment of diarrhoea.

Recent studies have again shown the beneficial effects of breast-feeding in preventing morbidity and mortality from diarrhoea in infants. A case-control study in Brazil has shown that young infants who are not breast-fed have a 25-time greater risk of dying of diarrhoea than those who are exclusively breast-fed. A longitudinal study in the urban slums of Lima, Peru found that exclusively breast-fed infants have a reduced risk of diarrhoeal morbidity when compared with infants receiving only water in addition to breast-milk. Both these studies, along with numerous others in developing countries, point to the need to extend the duration of exclusive breast-feeding to at least 4-6 months. A review of concerned studies throughout the world shows that even in malnourished women, breast-milk output is sufficient to maintain growth of infants up to this age. The addition of early food supplements to infants fed under prevailing environmental conditions in developing countries leads to their increased diarrhoeal attacks and associated reduced food intake. This results in worsened nutritional status of the affected infants. Breast-feeding helps maintain hydration status during diarrhoeal episodes. Studies in Peru, India, and Nigeria have shown that breast-feeding can be continued during diarrhoea when the infants often refuse other foods, specially non-human milk. Thus, breast-feeding is important in providing necessary calories and protein during a time when a loss of appetite for other foods is common. Diarrhoeal disease control programmes need to modify service delivery to ensure that breast-feeding mothers are not separated from their infants while being treated with oral rehydration therapy (ORT) as inpatients or outpatients. Oral rehydration solution (ORS) should be given to infants with cup and spoon rather than bottles, in order not to interfere with suckling. When in a health system bottles are used for treatment, an implicit credibility is given to their role in modern treatment. Programmes also need to include breast-feeding promotion as a part of their activities. This should comprise hospital practices supporting and ensuring breast-feeding immediately after delivery of the infants and subsequently while they are treated in the hospital: immediate breast-feeding after delivery; Mothers and infants rooming together; On demand breast-feeding; No bottle feedings of water or infant formula; No pre-lacteal feeds. In addition, health professionals need to understand the skills for the management of breast-feeding, so that mothers are given appropriate advice on how to breast-feed and counteract breast-feeding problems.

Breast Feeding↗
PubMed1990

Amoebic cases at autopsy and factors that might have contributed to death at Ibadan.

Twenty-one cases of amoebiasis seen at autopsy at the University College Hospital, Ibadan, over a 10-year period are reviewed. They constituted 0.59 percent of 3,556 autopsies performed during this period. Delay in seeking medical advice and in diagnosis and commencement of appropriate therapy were some of the factors contributing to the mortality in 16 (76pc) cases. Furthermore, Chronic renal failure, Cirrhosis, Lymphoma, Pregnancy and Sickle cell disease were also contributory factors to mortality in 7 (33pc) cases. With the progressive deterioration of the economics of Nigeria, urban migration and the increasing size of urban slums with crowded unhygienic conditions, the spread of this infection may accelerate and so result in greater mortality in the future.

Adolescent↗
PubMed1990

Childhood survival in Haiti: protective effect of measles vaccination.

To evaluate the impact of measles vaccination on survival of children residing in a periurban slum in Haiti, a total-population survey was conducted 2.5 years after completion of a one-time study of the serologic response to measles vaccine administered in the same population. Pregnancy histories from the 16,400 women in the population revealed that 1499 children had been born during a 7-month interval that would have made them eligible for participation in the measles vaccine program. Of these children, 1381 (92.1%) survived to 9 months of age, the median age that measles vaccine had been administered. Seventy-three infants had died between 9 and 39 months of age. Mortality of infants who were seronegative before receiving measles vaccine was significantly lower (P = .0013) than that of unvaccinated infants (3/235 vs 70/1056, respectively). Other factors positively associated with survival between 9 and 39 months of age included socioeconomic status (P = .0002), maternal literacy (P = .0020), maternal knowledge and use of oral rehydration solution (P = .0002), and an interval of greater than 24 months to the birth of the next younger sibling (P = .0012). Multivariate stepwise logistic regression analysis was used to evaluate the independent association of measles vaccination by adjusting for other factors that also correlated with survival and that might have been associated with maternal seeking of vaccinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1990

HIV-1 in Haitian women 1982-1988. The Cite Soleil/JHU AIDS Project Team.

Pregnant Haitian women (n = 4,474) residing in a periurban slum were interviewed to identify risk factors for sexually transmitted diseases and sera were tested to identify antibodies to HIV-1 and syphilis. The seroprevalence rates for antibodies to HIV-1 increased from 8.9% in 1986 to 9.9% in 1987 and 10.3% in 1988. Sera obtained in 1982 from 533 mothers of young infants in the same community revealed that 7.8% were HIV-1 seropositive. Of women pregnant for the first time in 1986-1988, 6.6% were HIV-1 seropositive and 6.0% had a positive VDRL. The highest seropositivity rates (greater than 15%) were noted in women 20 to 29 years of age with a history of two or more sexual partners in the year prior to pregnancy. Factors independently associated with HIV-1 seropositivity in pregnant women by logistic regression analysis included being unmarried, age 20-29 years, having had more than one sex partner in the year prior to pregnancy, a positive serologic test for syphilis, and smoking. A dose-response effect was noted in the association between HIV-1 seropositivity and smoking. The association between smoking and HIV-1 infections could be confounded by unrecognized behavioral factors or due to a biologic effect of smoking. The continuing high HIV-1 seropositivity rates in pregnant women indicate that current preventive measures are insufficient and increased control efforts are urgently needed.

Blotting, Western↗