[Risk of dying in the 1st year of life among slum and non-slum residents in the municipality of Porto Alegre, RS (Brazil), in 1980].
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Brazil↗
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Slums, slum dwellers, and health.
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Global Health↗
Impact of Urban Basic Services on immunization coverage in a slum area of northern India.
The Urban Basic Services (UBS) programme was launched in some of the urban slums in the major cities of India in the year 1986. The main objective of the Urban Basic Services (UBS) Program is to improve and upgrade the quality of life of the urban poor, particularly the women and children. The major thrust area under the UBS programme includes child survival and development, learning opportunities for women and children, water and sanitation, and community organization. The present study attempts to find out the impact of the UBS Program in terms of the immunization coverage carried out in slums covered by UBS and comparing it with non-UBS slums using the 30-cluster sampling technique as suggested by WHO. The percentage of fully immunized children was higher (16.2%) in the UBS slums compared to 10.9% in non-UBS slums. The immunization coverage of children was slightly better in the UBS slums for BCG, DPT and Oral Polio Vaccines, while for measles it was 18.6% in UBS slums and 11.9% in non-UBS slums. The dropout rates for I to III doses of DPT was much higher (36.4%) in non-UBS slums as compared to 28% in UBS slums. The availability of immunization cards was found to be higher in both mothers (16.7%) and children (22.4%) in UBS slums compared to the non-UBS ones (5.2% and 8.6% respectively). The slums thus covered under the UBS program have done marginally better in immunization but it appears that to assess the overall impact of UBS, all the components of services and not merely immunization should be assessed.
Child↗
Geohelminth infection of children from rural plantations and urban slums in Malaysia.
This study compares levels of geohelminth infection in children living in rural estates and urban slum areas of Malaysia. The statistical characteristics of geohelminth infection in 1499 children from birth up to 15 years of age, living in rural estates, were analysed according to age, sex and ethnic origin and compared with the same statistics for 1574 slum-dwelling children of similar age groups and ethnic origins. The prevalence and intensity of ascariasis and trichuriasis were significantly higher among children from the urban slums. Slum-dwelling ethnic Indians and Malays had higher levels of infection with Ascaris lumbricoides and Trichuris trichiura than their rural counterparts, but the infection status of the ethnic Chinese in the 2 areas was similar. Hookworm infection was similar in both areas, indicating that hookworm infection is neither necessarily nor solely a rural disease. These results suggest that urban slum children are at greater risk of ascariasis and trichuriasis than their rural counterparts.
Adolescent↗
Sexual risk-taking in the slums of Nairobi, Kenya, 1993-8.
Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in the sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a sub-population uniquely vulnerable to reproductive health problems and to expend more resources in slum settings.
Cross-Sectional Studies↗
Hantaanvirus among urban rats from a slum area in Bangkok.
A total of 106 rodents sera from slum Wat Phai Ton and slum Klong Toey were examined by immunofluorescent antibody assay during May to August 1990. The positive sera were further tested by plaque reduction neutralization test with the prototype hantaanvirus and the rat-associated hantaan like virus. Isolation attempts were also performed from their tissues. Antibody-positive rats were found in both slum areas, 32.7% in slum Wat Phai Ton and 5.6% in slum Klong Toey. Rattus norvegicus was the major species found positive. Positive plaque reduction neutralization results indicated that the infecting virus was antigenically similar to the strain of rat-associated hantaanvirus. The presence of low titer antibodies (IFA titer 32 to 128) may be an obstacle to isolation of associated virus using tissue culture.
Animals↗
Under fives mortality in the urban slums of Lucknow.
The main objective of this study was to elicit proportional cause specific mortality in the underfives in the urban slums of Lucknow in North India. The families with under five mortality in the 28 randomly selected slums in 1993 were located from the records of the slum health workers and verbal autopsy was conducted to assign a cause of death. There were 71 deaths among 2796 children. The annual under five mortality was 25.4 and the under five mortality rate was 126.7. After the neonatal period, "high fever" that could not be classified into any other disease incorporated in the verbal autopsy instrument, was the most common symptom associated with death, seen in 21.1% cases (95% C.I.: 15.5-34.4%) followed by these diseases: pneumonia in 19.7%, diarrhea in 18.3% and measles in 11.4%. "High fever" as the leading symptom associated with death is being reported for the first time from the urban slums of India. There is an urgent need to identify the underlying etiologies of death due to "high fever" and the policy implications are that children with fever must receive immediate and continued medical attention till the symptom persists.
Cause of Death↗
Asymptomatic environmental enteropathy among slum-dwelling infants.
OBJECTIVE: We documented asymptomatic environmental enteropathy, which may occur in low socioeconomic populations, and which is manifested by bacterial proliferation in the upper portions of the small bowel and by alterations in the digestive-absorptive capacity. DESIGN: Forty asymptomatic infants (< 1 year) of the Cidade Leonor slum in São Paulo, Brazil, were investigated for digestive-absorptive function, bacterial proliferation in the small bowel lumen, and jejunal morphology. They were compared with a control group of 8 well-nourished children from economically sound families. RESULTS: Mean value of the D-xylose absorption test in the slum infants 21.0 +/- 10.0 mg%) was significantly lower than in controls (46.0 +/- 13.8 mg%) (p < 0.001). Colonic bacterial proliferation in the small bowel was identified in 25 (62.5%) of slum-dwelling infants. Grade II villous atrophy with inflammatory infiltration in the lamina propria was the most frequent alteration found. CONCLUSION: These data show that alterations in the microecology, function and morphology of the small intestine can occur even in the absence of diarrhea. Therefore, the absence of symptoms does not necessarily imply a healthy well-being among children living in a slum.
Bacteria↗
Difficulties in conducting participatory action research to prevent diarrhoea in a slum area of Bangkok.
Childhood diarrhoea is a major cause of childhood morbidity and mortality in Thailand. During April 1988-April 1990, a study was conducted to evaluate participatory action research as a method of intervening on unhygienic practices in two communities in the Klong Toey slum of Bangkok (intervention group) and compared these practices in two other communities of the same slum where there was no intervention (control group). The following variables were compared in two groups: hygiene behaviour and factors associated with participation of community leaders and mothers with children aged less than five years. Two hundred and twenty-one mothers of the original 606 (36%) were still available at the end of the study. It was found that the mothers in the intervention groups were more likely to wash their hands before feeding and use cupboards and covered containers for keeping food. Several factors negatively affected community participation: matters concerning the slum culture and organization, community leadership, family problems, occupational problems, and physical environment of the community. The conclusions of the study are limited because of the considerable proportion of the subjects that was lost to follow-up. The study points at some of the methodological issues when conducting research in challenging and difficult to reach communities that have important health problems.
Adult↗
Policy directions in urban health in developing countries--the slum improvement approach.
The urban development, or housing, sector has a longer experience of addressing the problems of the urban poor in developing countries than the health sector. In recent years the policy of 'slum improvement', which involves both sectors, has attracted the support of international donors. This article documents the development of the slum improvement approach and addresses key issues of the approach which have implications for health planning: covering the poorest dwellers; relocation; land tenure; gentrification; debt burdens and the impact on women. Questions about the approach which still need answering are defined and a summary of the constraints in slum improvement and potential solutions is presented.
Developing Countries↗
Determinants of mortality among children in the urban slums of Dhaka city, Bangladesh.
The growing slum population in the developing world is an increasing challenge for local health authorities. Little is known of the patterns of disease occurrence including treatment types offered in this population. The paper describes reported child mortality and its determinants, including the main diseases affecting children and treatments, in the slum population of Dhaka city, Bangladesh. 1500 households in three slum communities were included in a cross-sectional survey. Reported death rates in the households per 1000 children (0-107 months) within the last year from the interview were 20.5 for boys and 27.0 for girls. More girls than boys died in infancy (age < 12 months). The most frequent reported causes of deaths were tetanus in infancy and diarrhoea among children aged < or = 12 months. Vaccination coverage (DPT, polio, measles and BCG) was 73% for children < 3 years of age. The results showed that gender difference in mortality may have been influenced by the patterns of treatment received during sickness and the choice of treatment was determined by the financial ability of the households. Household income, children's vaccinations, TT immunization of mothers and personal cleanliness appeared to be significantly associated with child mortality. Despite the relatively high vaccination coverage for this population, child mortality remained alarmingly high, indicating that socioeconomic and environmental conditions must be improved to substantially reduce morbidity and mortality in this population.
Accidents↗
Livelihoods, nutrition and health in Dhaka slums.
OBJECTIVES: To identify groups within Dhaka slums that report similar patterns of livelihood, and to explore nutritional and health status. DESIGN: A random sample of households participated in a longitudinal study in 1995-1997. Socio-economic and morbidity data were collected monthly by questionnaire and nutritional status was assessed. Cluster analysis was used to aggregate households into livelihood groups. SETTING: Dhaka slums, Bangladesh. SUBJECTS: Five-hundred and fifty-nine households. MAIN OUTCOME MEASURES: Socio-economic and demographic variables, nutritional status, morbidity. RESULTS: Four livelihood groups were identified. Cluster 1 was the richest cluster with land, animals, business assets and savings. Loans as well as income were higher, which shows that this group was credit-worthy. The group was mainly self-employed and worked more days per month than the other clusters. The cluster had the second highest body mass index (BMI) score, and the highest children's nutrition status. Cluster 2 was a poor cluster and was mainly dependent self-employed. Savings and loans were lower. Cluster 3 was the most vulnerable cluster. Members of this group were mainly casual unskilled, and 40% were female-headed households. Total income and expenditure were lowest amongst the clusters. BMI and children's nutritional status were lowest in the slum. Cluster 4 was the second richest cluster. This group comprised skilled workers. BMI was the highest in this cluster and children's nutritional status was second highest. CONCLUSIONS: Cluster analysis has identified four groups that differed in terms of socio-economic, demographic and nutritional status and morbidity. The technique could be a practically useful tool of relevance to the development, monitoring and targeting of vulnerable households by public policy in Bangladesh.
Adult↗
A nutritional profile of non-pregnant women from the slums of Dinajpur, Bangladesh.
The health and nutritional status of many urban slum dwellers in the developing world is said to be deteriorating. The nutritional profile of 328 adult, non-pregnant women from the slums of Dinajpur, Bangladesh, confirms this. Results of a cross-sectional survey showed that approximately half the women were acutely malnourished and all but six were anaemic. This, despite the fact that the slums of Dinajpur are considered relatively 'better-off' than many in the developing world; most families having permanent land tenureship, and access to basic education and health services.
Adolescent↗
Changes in nutritional status and morbidity over time among pre-school children from slums in Pune, India.
OBJECTIVE: To investigate changes in nutritional status and morbidity over time among pre-school slum children. DESIGN: Longitudinal. METHODS: Children in the age group of 0-5 years from three slums in Pune (n = 845) were studied for a period of two years. Measurement of weight (up to 20 g) and height (up to 0.1 cm), morbidity (in last 7 days) and clinical assessment was undertaken once every four months. RESULTS: Peak prevalence of malnutrition was observed around 18 months and shorter period (3.5 months) of exclusive breastfeeding was probably responsible. Morbidity was generally higher in rainy season and was associated with wasting but not stunting. Gastrointestinal illness and fever contributed 50% of total morbidity days. Higher morbidity affected significantly growth velocities in weight throughout pre-school age. Height velocities were significantly low upto three years of age but there appeared no scope for catch-up growth as velocities remained similar thereafter. Higher morbidity in younger children (less than 2 years) led to deterioration of nutritional status over time in 30% to 50% children. CONCLUSION: Shorter period of exclusive breastfeeding results in undernutrition at an early age among slum children. Morbidity further deteriorates the nutritional status
Anthropometry↗
Risk factors for acute respiratory infections among the slum infants of Dhaka city.
A cross-sectional study was conducted in five slums of Dhaka city. The study population was all adult women of reproductive age having an infant aged less than one year with a view to assessing the prevalence of Acute Respiratory Infections (ARIs) among the slum infants and also to identify the factors responsible for it. A total of 1,008 mothers were interviewed. Among them, 927 had children aged 0-12 months. Mothers with live infants (927) were asked if their children had any disease during the two weeks prior to the interview. Respiratory infection was the highest among the prevalent diseases (ARI 72%, diarrhoeal diseases 28%, measles 4% and others 4%). So, an emphasis was given in this regard. Out of 228 ARI cases, percentage of mild (78%) and severe ARI (11%) were present in children aged less than 6 months, whereas moderate ARI (23%) was higher in 6 months and above age groups. The variation was statistically significant between the two age groups (p<0.05). But there was no significant difference in ARI by sex (p>0.05). In logistic analysis, maternal age below 20 years, working mothers, low housing and socio-economic index, no household possession, no access to piped water and infant's age above 6 months appeared to be significant predictors of ARIs. The risk of acquiring ARI was 3.33 times higher in low socio-economic index, 3 times in no access to piped water, 2.39 times in low housing index, 1.9 times in mother's age below 20 years, 1.85 times in infant's age above 6 months, 1.69 times in working mothers. On the other hand, household possessions had protective effects on ARIs. The study provides important information for policy makers regarding the prevention of ARI among the children of the slum dwellers.
Acute Disease↗
Epidemiological investigation of cholera outbreak in a periurban slum colony in Chandigarh.
An investigation was carried out in a periurban slum colony in Chandigarh in September 1999 following a report of two microscopically confirmed cases of cholera admitted in Govt. Medical College Hospital, Chandigarh. Rapid survey in the colony covering a population of 1404 found that there were 14 cases of diarrhoea in the colony with attack rate of 9.97/1000 population. Majority (70%) of cases were females and 62% cases were under five years of age. Health education, ORS packets and medications were distributed to cases. Water sampling was also done and it was found that water from one of the hand pump was positive for V. cholerae 01 biotype El Tor serotype Ogawa. Closing of that hand pump and chlorination of drinking water in other parts of slum was recommended to higher health authorities, which was done immediately. Surveillance for diarrhoeal diseases was found to be poor. Provision of safe drinking water, improving sanitation and strengthening of disease surveillance is necessary for control of cholera and other diarrhoeal diseases in slum areas.
Child↗
Status of lymphatic filariasis in some select slum clusters of Delhi.
Filaria surveys conducted in some select slum clusters namely Hari Nagar, Yamuna pusht near Vijaya Ghat along the Ring Road and Timarpur in Delhi during 1989, 1991 and 1992 respectively, covering a population of approximately 5000 slum dwellers revealed the presence of bancroftian microfilaria (mf) carriers and disease cases. The mf and disease rates (per cent) in these three slum areas were in the order of 6.3, 2.2, 3.7 and 1.4, 0.5 and 0.1 respectively. The mf density varied from 3.1 to 12.3 per 20 cumm. blood. High ten man hour densities of Culex quinquefasciatus (581) in Yamuna pusht followed by (355) in Timarpur were recorded during entomological investigations. Hari Nagar accounted for least ten man hour density of Cx. quinquefasciatus (160), because collection was made during winter months (November-December). The dissection of Cx. quinquefasciatus did not reveal any human filarial infection except in Yamuna pusht where out of 139 only one Cx. quinquefasciatus was found infective.
Animals↗