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PubMedDate not supplied

Entamoeba histolytica and Entamoeba dispar infections as detected by monoclonal antibody in an urban slum in Fortaleza, Northeastern Brazil.

In this study the authors used the Elisa-based antigen detection tests that distinguish E. histolytica from E. dispar to examine the prevalence of E. histolytica infection in individuals from an urban slum in Fortaleza, Northeastern, Brazil. This test has a sensitivity and specificity that is comparable to PCR and isoenzyme analysis, which is the gold standard. Single stools samples were obtained from 735 individuals. The prevalence of E. histolytica infection was 14.9% (110/735) and 25.4%(187/735) for E. dispar-E. histolytica complex. The most affected age group for E. histolytica /E. histolytica-E. dispar infection was the 1-5 year olds but there was no remarkable decrease with age. There was no significant difference in colonization rates between males and females. The results from this survey demonstrate that E. histolytica is highly prevalent in the Community studied. Furthermore, it offers promise for the antigen detection test as a sensitive and technically simple tool for detecting E. histolytica infection in the field.

Adolescent↗
PubMedDate not supplied

Human leptospirosis in a slum area in the city of Rio de Janeiro, Brazil--a serological and epidemiological study.

A serologic survey was carried out on slum dwellers in the city of Rio de Janeiro. A total of 259 serum samples from male and female individuals of different age groups were tested for the presence of antileptospire antibodies by microagglutination. Prevalence data were analyzed in relation to the major risk factors present at the site, mainly represented by the presence of carrier animals and the occurrence of frequent floods. Of the samples tested, 25% reacted with antigens of different serogroups at titres ranging from 1:100 to 1:6400, with a predominance of titres less than or equal to 1:400; 35% of positive sera reacted with leptospirae of the Icterohaemorrhagiae serogroup. Reactions with Djasiman, Panama, Javanica, Canicola, Pyrogenes, Australis, Ballum, Sejroe, Bataviae, Grippotyphosa, Autumnalis and Cynopteri were also detected, though at lower frequencies. There was no statistically significant difference between sexes, but higher prevalence rates were found to be associated with increasing age. A focus of infection was characterized, in which social and economic factors contribute to the persistence of leptospirae by favoring the proliferation of the main reservoir.

Adolescent↗
PubMedDate not supplied

[Trends in HIV/AIDS-related knowledge, attitudes, and practices in a Rio de Janeiro slum population].

The study aims to evaluate the present stage of knowledge, attitudes, and behavior related to HIV/AIDS in the population of Rio de Janeiro's Rocinha slum, the target of a control program over the last 6 years. We interviewed two hundred and ten people of both sexes, ranging from 13 to 49 years of age, and the results were compared with those of a study conducted in 1990 with the same methodology and sample size. The analysis showed an association between single males and more preventive behavior. Misconceptions about the role of mosquito bites and blood donation in the transmission of HIV persist, almost in the same proportion. Comparing the two samples, there was a significant increase in the role of HIV/AIDS education provided by schools, and the study also identified an increase in the rates and regularity of condom use. More efforts should be made to reduce misconceptions about HIV transmission and the vulnerability of couples. The study also highlights the need for more consistent policies related to condom distribution to the general population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Dengue study in a slum area in Rio de Janeiro: preliminary analysis].

This study is part of a program to control and prevent dengue in a slum bordering on the grounds of the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. The results obtained from a questionnaire and entomological survey called attention to problems pertaining to the information transmitted by public health campaigns and its interpretation, since many practices result from misunderstanding or forgetting preventive messages. Dengue-related data include most frequent vector breeding sites, people's knowledge, and dengue-related habits. The study's conclusions in terms of dengue prevention point to the need for drafting messages not only about ideal preventive practices but also teaching possible solutions: disseminating frequent messages throughout the year and not only seasonally and planning health education to join health professionals and the population in the search for sustainable dengue control alternatives.

Aedes↗
PubMed2006

[Obesity and poverty: the apparent paradox. A study among women from the Rocinha slum, Rio de Janeiro, Brazil].

In recent decades the Brazilian population has undergone intense changes in its nutritional conditions, especially with an increase in obesity. According to the National Survey on Health and Nutrition in 1989, 32.0% of adults were overweight. However, distribution of the problem is not homogeneous. The highest prevalence occurs among poor women in the Southeast. Understanding this apparent paradox requires the search for approaches capable of overcoming simplistic interpretations about eating practices. Thus, the objective of this study was to understand obesity combined with poverty, focusing beyond economic determinants on constraints of a cultural and symbolic nature. From this perspective, the study analyzed the daily lives of poor women who used a Municipal Health Center and resided in the Rocinha slum in Rio de Janeiro. The results showed the complexity of the relationship between obesity and poverty. Cultural and material life aspects as well as different concepts of eating and the body proved to be fundamental elements for the analysis of the multiple facets of obesity in Brazil.

Adult↗
PubMed1997

Relationships between soil-transmitted helminthiases and growth in urban slum schoolchildren in Ujung Pandang, Indonesia.

This study examined the relationship between intestinal helminthiases and growth in urban slum schoolchildren. Children (n = 330) who received single doses of either pyrantel, albendazole, or placebo at baseline and again at 6 months were followed and examined fully at 0, 3, 6, and 12 months for helminth infections and anthropometry. Results of treatments indicated that all groups reduced their prevalence and intensity toward the period of the study. Reductions in intensity of both infections in the treatment groups were observed large in 3 and 12 months, whereas at 6 months reached mostly the initial level of infection. There was no significant difference in growth changes between the dewormed (once and twice) and the placebo groups. However, after controlling for some potential confounding factors, there was a significant relationship between reduction of A. lumbricoides infection and height gain at 3 and 12 months (both P < 0.05). In addition, there was a significant association between reduction in T. trichiura infection and increased midarm circumference at 3 and 12 months (P < 0.002 and P < 0.08, respectively). We conclude that treatment of helminth infections in school-age children may improve growth in areas where malnutrition and helminth infections are prevalent.

Animals↗
PubMed2005

Bacteremic typhoid fever in children in an urban slum, Bangladesh.

We confirmed a bacteremic typhoid fever incidence of 3.9 episodes/1,000 person-years during fever surveillance in a Dhaka urban slum. The relative risk for preschool children compared with older persons was 8.9. Our regression model showed that these children were clinically ill, which suggests a role for preschool immunization.

Adolescent↗
PubMed1993

Vitamin A status of children in the urban slums of Karachi, Pakistan, assessed by clinical, dietary, and biochemical methods.

We assessed the vitamin A status of 532 children with an age range of 6-60 months who were living in slum areas of Karachi, Pakistan, using three methodologies: clinical eye examination, dietary vitamin A intake, and serum retinol level. No definite clinical signs of xerophthalmia were observed in any of these children. The mean +/- SD vitamin A intake estimated from a food frequency questionnaire for the group with inadequate (low and deficient) serum retinol levels (< 20 micrograms/dl) was 362 +/- 332 retinol equivalents (RE) compared with 431 +/- 332) RE in the group with adequate serum levels (P < 0.005). Deficient serum retinol levels (< 10 micrograms/dl) were present in 12 children (2%); two of these had a healed corneal scar. Low serum retinol levels (10-19 micrograms/dl) were present in 46%, while 51% children had adequate levels (> or = 20 micrograms/dl). The mean +/- SD serum retinol level for the inadequate (< 20 micrograms/dl) and adequate groups were 15.3 +/- 2.8 and 26.6 +/- 6.7 micrograms/dl, respectively. These results suggest that a significant number of children in these communities have low vitamin A levels and thus may constitute an at risk group. These results also suggest that the dietary intake method may be a simple and inexpensive screening tool for assessment of vitamin A status in communities.

Anthropometry↗
PubMed1993

Environmental sources of Cryptosporidium in an urban slum in northeastern Brazil.

Cryptosporidium is an important cause of diarrheal disease in children worldwide. To elucidate the environmental sources of this parasite, we selected an urban slum in Fortaleza, Brazil, a community with a known high incidence of cryptosporidiosis, and examined both stool smears from household animals (n = 127) and filtrates from local water sources (n = 18) for Cryptosporidium oocysts. Because previous work in this community has demonstrated the seasonal nature of human infection with Cryptosporidium, collections were made separately for the dry and rainy seasons. Of the 64 stools collected during the dry season (September-December 1990), four (6.3%) were positive by acid-fast staining for Cryptosporidium. Of the 63 rainy season samples (March-May 1991), nine (14.3%) were positive. Overall, oocysts were detected in 13 (10.2%) of 127 animal stool samples. Freshwater samples were obtained from a variety of sources including open and closed wells, and running city water and then processed. Four of 18 samples (22.2%), including a sample from city water were positive by at least one of two staining techniques (acid-fast and immunofluorescence). In summary, animals may serve as a reservoir of Cryptosporidium, with potential for the contamination of immediate household water sources. These findings may help to explain the high incidence of cryptosporidiosis among infants in this impoverished community.

Animals↗
PubMed1996

Seroepidemiology of Entamoeba histolytica in a slum in northeastern Brazil.

Infection with the human pathogenic parasite Entamoeba histolytica has not been well-characterized in northeastern Brazil. In this study, the prevalence of E. histolytica infection in a slum in northeastern Brazil was assayed using an enzyme-linked immunosorbent assay (ELISA) for antibodies against the galactose/N-acetyl-D-galactosamine (Gal/GalNAc)-inhibitable adherence lectin of E. histolytica. Sera from a total of 335 individuals were examined for anti-Gal/GalNAc lectin antibodies. The overall seropositivity was 24.7%; 29.4% of females and 19.4% of males were positive. Among different age groups there was a peak of 40% positivity in the 6-14-year-old age group. There was also familial clustering of seropositivity. To examine colonization, stool samples from 155 people were examined microscopically for the presence of the parasite. Fourteen of 155 stools (9.0%) were identified as containing E. histolytica or nonpathogenic E. dispar. These 14 positive stools were analyzed with an ELISA that detects Gal/GalNAc lectin antigen and can distinguish between E. histolytica and E. dispar. Four stools (29%) were positive for E. histolytica and the remaining 10 were identified as E. dispar-positive. Although the overall colonization rate by microscopy was only 9%, with a third identified as E. histolytica, up to 40% of older children develop serologic evidence of having experienced pathogenic E. histolytica infection. The results of this study demonstrate that this community in northeastern Brazil is highly endemic for E. histolytica with infection rates similar to other developing nations.

Adolescent↗
PubMed2004

Missed opportunities and inappropriately given vaccines reduce immunisation coverage in facilities that serve slum areas of Nairobi.

OBJECTIVES: To quantify missed opportunities for immunisation, document reasons for their occurrence and evaluate the extent of inappropriately given vaccine doses. DESIGN: A cross sectional study of children under two years of age attending health facilities. SETTING: Six health facilities predominantly serving the slums of Nairobi. METHODOLOGY: Information on vaccination was extracted from child immunisation cards as well as from mothers or guardians of children. RESULTS: Effective immunisation coverage for Bacille-Callmette Guerin (BCG) was 91%. Coverage for the birth dose, first, second, and third doses of oral polio vaccine (OPV0, OPVI, OPV2, and OPV3) was 44%, 83%, 79% and 75% respectively. Effective coverage for first, second and third doses of diphtheria-pertusis-tetanus (DPTI, DPT2 and DPT3) vaccine was 88%, 87% and 85% respectively. Measles coverage was 80%. Immunisation coverage for all antigens except OPV0 and OPV3 would have been increased to over 90% had missed immunisation opportunities and inappropriately administered vaccination been avoided. There would have been an 11% increase in OPV3 coverage to 86%. Increases in coverage for OPVI and OPV2 would have been 16% and 18% respectively. Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate was 3%. The proportions of missed opportunities were higher for the OPV series than DPT series. CONCLUSION: Missed immunisation opportunities among clinic attendees in Nairobi occur and routine supervision should be strengthened in these health facilities in order to minimise such missed opportunities and inappropriately administered vaccines.

Cross-Sectional Studies↗
PubMed2005

Child nutritional status and maternal factors in an urban slum in Nairobi, Kenya.

OBJECTIVE: To assess the relationship between maternal factors and child nutritional status among children aged 6-36 months. DESIGN: Cross sectional descriptive survey. SETTING: Urban slum settlement in Nairobi, Kenya. SUBJECTS: This study included a random sample of 369 households of mothers with children aged 6-36 months at the time of the study. RESULTS: Maternal factors which showed a positive significant association with at least one of the three child nutritional status indicators (height for age, weight for age and weight for height) were birth spacing, parity, maternal education level and mothers marital status. Child spacing and parity emerged as the most important predictors of stunting among study children. Maternal nutritional status was also shown to be positively associated with child nutritional status. Maternal ill health had a negative effect on child nutritional status. CONCLUSION: Maternal factors are an underlying cause of childhood malnutrition.

Adult↗
PubMed1991

ALERT-India 1981-89: nine years' experience of leprosy control in the slums of Bombay.

Bombay has a population of about 8 million people, one-half of whom live in slums. In 1981, ALERT-India started its first leprosy control project in N, S and T Wards of Greater Bombay Municipal Corporation covering an area of 122 sq km in the north-eastern suburbs of Vidhyavihar, Ghatkopar, Vikhroli, Kanjurmarg, Bhandup and Mulund, with a total population of 1,100,000 according to the 1981 census. In the 9 years of operation, over 12,000 patients have been registered and treated and of these 7425 have been released from treatment, having satisfactorily completed courses of chemotherapy. However, over 1000 cases are still identified every year by house-to-house or school surveys, or by self-reporting, including a considerable percentage in children. The origin, development, staff structure, operational procedure, administration and recording system of ALERT-India are described in detail, with emphasis on what has been accomplished with purely outpatient facilities, using paramedical workers, all of whom have received inservice training from Government recognized training centres for their specific tasks. The account includes a brief description of an expansion of the organization's work into townships in New Bombay, where preliminary surveys in 1988 confirmed the presence of leprosy cases and the need for treatment facilities. The discussion addresses: 1, the better use of the large volume of statistical information which has been collected by ALERT-India during the past 9 years, with emphasis on its value in assessing the impact on the control programme and modifying future policy; 2, the need to radically examine the present policy of survey, versus an 'education campaign approach' with regard to increasing early case-detection and self-reporting; 3, the establishment of a central coordinating body for leprosy control in Bombay to exchange information, coordinate efforts and formulate a future plan of action, the latter in association with the National Leprosy Eradication Programme; and 4, the development of a health education resource centre in association with the Bombay Municipal Corporation.

Health Services↗
PubMedDate not supplied

Practice of self medication among slum-dwellers.

A cross sectional study including 110 households covering 630 individuals was carried out in an urban slum community to study the prevalence of practice of self medication by house to house survey. Self medication was practiced by 34.55% respondents and prevalent among all the age groups. Allopathic drugs were commonly used (78.95%). Economic inability in utilizing established medical facilities was the commonest reason for self medication (60.53%). The practice was more prevalent amongst literate but lower soci-economic class.

Adult↗
PubMed1999

Micronutrient deficiency disorders amongst pregnant women in three urban slum communities of Delhi.

OBJECTIVE: To assess the prevalence of three micronutrient deficiency disorders (MDDs), i.e., iron deficiency, iodine deficiency and vitamin-A deficiency individually and in combination amongst pregnant women. METHODS: A hospital based study was conducted amongst 829 pregnant women of II and III trimester attending antenatal clinic, Rural Health Training Center (RHTC), Najafgarh, New Delhi. Anemia was assessed by the presence of clinical signs and by hemoglobin levels. Iodine deficiency disorders (IDD) were assessed by clinical examination of thyroid gland and by urinary iodine excretion levels. Iodine content of the salt consumed by the pregnant women was also assessed by iodometric titration method. Vitamin A deficiency (VAD) was assessed by the presence of clinical symptoms of nightblindness. Current dietary intake, morbidity conditions on the day of survey and anthropometric measurements of pregnant women were also documented. RESULTS: Prevalence of anemia, IDD and VAD amongst pregnant women was 78.8%, 22.9% and 4.8%, respectively. One per cent of the pregnant women had concomitant presence of all the three MDDs. Pregnant women having combined prevalence of IDD and anemia, IDD and VAD, and VAD and anemia was 15.1%, 0.18% and 2.69%, respecively. Eighty nine per cent of the pregnant women were consuming salt with iodine content of more than 15 ppm which was recommended at household level. Results on dietary intake showed that 18%, 34%, 85% and 57% of the pregnant women were consuming less than 50% of calories, proteins, iron and b-carotene, respectively as compared to their RDA. Forty per cent of the pregnant women were suffering from various morbidity conditions on the day of survey. CONCLUSIONS: The prevalence of micronutrient deficiencies amongst pregnant women of urban slum communities is high.

Adolescent↗
PubMed2000

Effectiveness and cost-effectiveness of albendazole in improving nutritional status of pre-school children in urban slums.

OBJECTIVE: To study the clinical efficacy and the incremental cost-effectiveness of albendazole in improving the nutritional status of pre-school children. DESIGN: Single blind, placebo-controlled trial with child as the unit of randomization. SETTING: In the Anganwadi centers of the Integrated Child Development Services situated in the urban slums of Lucknow, North India. METHODS: Thirty-two Anganwadi centers were randomly selected for the trial. Included were registered resident children between 1.5 to 3.5 years of age with informed and written parental consent. The intervention group received 600 mg of albendazole powder every six months while the placebo group received same quantity of calcium powder. Enrolled children were contacted once in six months from January 1995 to 1997 and given treatment. The outcome measure were change in the proportion of underweight (weight for age <-2.00z), stunted (height for age <-2.00z) children and the cost per child prevented from becoming stunted. RESULTS: There were 610 and 451 children in the albendazole and placebo groups, respectively. Mean age at recruitment was 31.8 months (SD: 9.7). Follow-up and compliance in both the groups was >95%. During the 2 year follow-up, the proportion of stunted children increased by 11.44% and 2.06% in the placebo and albendazole groups, respectively, and the difference was 9.38% (95% CI 6.01% to 12.75%; p value <0.0001). Direct fecal smear was positive for the ova of ascaris in 41.2% and 55.3% children in the albendazole and placebo groups, respectively at the end of the study (p value <0.001). The annual family expenditure on illness in the recruited child was Rs. 743 (SD: 662) and Rs. 625 (SD: 609) in the albendazole and the placebo groups, respectively. The incremental cost-effectiveness ratio was Rs 543.00 for each case of stunting prevented with albendazole. There was no difference in the various morbidity or cognitive performance, as judged by the revised Denver prescreening questionnaire, in both the groups at enrollment as well as at the end of the study. CONCLUSIONS: Six monthly albendazole reduces the risk of stunting with a small increase in the expenditure on health care from the payer's perspective. Larger trials are needed to study the effect of albendazole on prevention of stunting, cognitive functions and all-cause childhood mortality.

Albendazole↗
PubMed1999

Quantitative assessment of Ascaris lumbricoides infection in school children from a slum in Visakhapatnam, south India.

An epidemiological study was conducted on 217 school children aged between 7-13 years, from Relliveedhi a slum in Visakhapatnam, Andhra Pradesh, south India, during August 1993 to August 1994. The children belonged to a socioeconomically backward community-parental occupation being fishing or waged labor. Intensity and prevalence estimations for Ascaris lumbricoides were done indirectly by formalin-ethyl-acetate sedimentation technic and directly by worm expulsions following albendazole administration at a single oral dose of 400 mg/child. Prevalence rate was 73% while the intensity of infection ranged between low to moderate. Boys had severe infection than girls due to their outdoor activities and behavioral habits. Nine year old children had the highest prevalence rates. Mean Ascaris worm intensity was 2.2 (+/-1.91) with an over-dispersed distribution of the parasite in the host population. Reinfection study over a period of nine month showed that the prevalence rates exceeded the pre-intervention level but the intensity of infection was very low. Dual species intensity correlation between Ascaris and Trichuris was consistently strong.

Adolescent↗
PubMed1999

Awareness of urban slum mothers regarding home management of diarrhoea and symptoms of pneumonia.

A total of 635 mothers of under five children from urban slum area of Nanded city were assessed to know their awareness about home management of diarrhoea and symptoms of pneumonia. 48.5% of the mothers were unaware of any method of rehydrating the child with diarrhoea at home level followed by 36.2% mothers who were knowing home available fluids for rehydrating the child. 50.4% of the mothers were not knowing a single symptom of pneumonia followed by 35.1% mothers who were aware rapid abdominal movements (Pet Udna) as a symptom of pneumonia.

Awareness↗