Diarrhoea and acute respiratory infections among under-five children in slums

February 5, 2014 · 0 comments

Singh A, Singh MN. (2014) Diarrhoea and acute respiratory infections among under-five children in slums: Evidence from India. PeerJ PrePrints 2:e208v1 http://dx.doi.org/10.7287/peerj.preprints.208v1

Background: In the wake of burgeoning slum population, a substantial reduction in the prevalence of diarrhea and acute respiratory infections (ARI) is necessary for to achieve necessary reduction in child mortality in urban India. To achieve this, we need evidence based public health interventions and programs. However, a review of previous studies indicate that national level studies focused on slum population are very few. Therefore, the present study aims to study differentials and determinants of diarrhea and ARI in urban slums of India.

Methodology: Using data obtained from the third round of National Family Health Survey conducted in 2005-06, we analyzed information on 2687 under-5 children living in urban slums located in eight selected India cities. Apart from bivariate analysis, logistic regression analysis was performed to identify factor associated with diarrhea and ARI among slum children.

Results: The prevalence diarrhea and ARI is about 8% and 8.5%, respectively. Age, birth weight, access to safe water and improved toilet and region emerge as main factors affecting prevalence of diarrhea among slum children. Safe drinking water reduces the likelihood of getting diarrhea by about 19% compared to unsafe water [CI=0.563-1.151]. Children with normal birth are about 51% less likely to suffer from diarrhea compared to those with unknown birth weight [CI=0.368-0.814]. Older children are about 63% less likely to suffer from diarrhea [CI=0.274-0.502]. Children from Southern cities are about half as likely to have diarrhea as children from slums in Northern cities. ARI is associated with age, birth weight, religion, caste, education, family type, safe water, improved toilet, mass-media exposure, region and separate kitchen. Older children and children with normal birth weight are less likely to suffer from ARI. Children from ‘Other’ religions and OBC are 39% [CI=1.000-1.924] and 49% [CI=1.008-2.190], respectively, more likely to suffer from ARI. Parents’ education is strongly associated with prevalence of ARI. Exposure to mass media reduces the likelihood of ARI to 50% compared to the situation when mother of the child did not have any exposure to mass-media [CI=0.324-0.819]. Non-flush toilet and lack of separate kitchen increase the likelihood of ARI. Children from slums located in Southern region are less likely to suffer from ARI.

Conclusion: The findings call for dedicated programs and policies, in line with those already existing ones such as RAY, IHSDP, NUHM, ICDS and JNNURM, for the development of urban slums through provision of affordable housing, improved sanitation, safe water and clean fuel. Adequate nutrition to mothers and their children should be ensured and vulnerable groups identified in the analysis should be the focus of future public health intervention and strategies. The use of mass-media to change health behavior should also be considered.

USAID/Ethiopia Urban Gardens program helps women with HIV

January 29, 2014 · 0 comments

Jan 2014 – USAID supports an Urban Gardens program in Ethiopia to provide vulnerable and HIV-infected women with the tools, land, and knowledge to plant vegetable gardens, feed their families, and sell the produce to increase household income. The program trains women in nutrition, composting, vegetable growing, irrigation, proper hygiene, and HIV/AIDS awareness, and workers with degrees in agriculture assist the women in planting and maintaining their gardens.

Measuring slum severity in Mumbai and Kolkata: A household-based approach

January 22, 2014 · 0 comments

Measuring slum severity in Mumbai and Kolkata: A household-based approach. Habitat International 41 (2014) 300e306.

Authors: Amit Patel, Naoru Koizumi, Andrew Crooks.

E-mail addresses: apatelh@gmu.edu, amitpatel.amit@gmail.com (A. Patel), nkoizumi@gmu.edu (N. Koizumi), acrooks2@gmu.edu (A. Crooks)

Slums pose a significant challenge for urban planning and policy as they provide shelter to a third of urban residents. UN-Habitat reports that, in 2001, approximately 924 million people lived in slums or informal settlements across the world (UN-Habitat, 2003). However, varying definitions of what constitutes a slum result in different slum population estimates. Most definitions treat a slum as a community of several households, rarely recognizing that housing conditions differ for each individual household within the area. Moreover, definitions of slums usually take a dichotomous approach whereby a place is either a slum or not. Little attempt is made to go beyond this slum/non-slum dichotomy.

This paper moves beyond the traditional ways of defining a slum by proposing a new household level enumeration of slums and developing Slum Severity Index (SSI), which measures the level of deprivation on a continuous scale based on the UN-Habitat’s slum definition. We apply this new approach of analyzing slums to a household survey dataset to estimate the total number of slum households in Mumbai and Kolkata, two megacities in India. To contrast our approach, we compare these estimates with the Census of India’s. The comparison highlights stark differences in the two estimates and the slum/non-slum household classifications. The main objective of this study is to demonstrate the usefulness of the household level analysis of slums in drawing implications for designing and implementing slum policies.

State of Women in Cities 2012-2013

January 22, 2014 · 0 comments

State of Women in Cities 2012-2013, 2013. UN HABITAT.

Key Messages

Women need more equitable access to infrastructure, especially sanitation. Although over half (53 per cent) of the survey respondents thought that their cities were ‘committed’ in some form to promoting infrastructural development to fully engage women in urban development and productive work, only 22 per cent stated that they were ‘fully committed’ or ‘committed’, with a high of 39 per cent in Johannesburg. In turn, only 29.5 per cent of respondents felt that infrastructure was adequate, with lows of 15 per cent in Rio de Janeiro and 18.5 per cent in Kingston. The most problematic area was access to sanitation, especially in Bangalore and Rio de Janeiro. 50 per cent stated that sanitation and the burden of disease acted as barriers to the prosperity of women in cities.

Women residing in slums require special attention. Although women in slum and non-slum areas of cities experience a similar range of challenges in relation to gender inequalities, the greater concentration of poverty in slum settlements aggravated by overcrowding, insecurity, lack of access to security of tenure, water and sanitation, as well as lack of access to transport, and sexual and reproductive health services, often creates more difficult conditions for women in trying to achieve prosperity.

More attention to women in the informal economy needed. Only a little over one-third (35 per cent) of city dwellers thought that their cities had programmes that addressed the needs of women working in the informal economy. In cases where programmes existed, almost half (48 per cent) thought that these sought to legalise informal activities, while 44 percent aimed to move informal workers into the formal economy,with a further 42 per cent feeling that these programmes aimed to improve the quality of informal employment.

India – National Urban Health Mission (NUHM) for urban poor launched

January 22, 2014 · 0 comments

National Urban Health Mission (NUHM) for urban poor launched by Health Ministry – Source: The Health Site, Jan 21, 2014

Indian Health Minister Gulam Nabi Azad Monday launched the National Urban Health Mission (NUHM) here to provide health security to the urban poor, amounting to about 200 crore people.

‘The mission envisages setting up health check-up infrastructure and create manpower for the welfare of the poor dwelling in cities and towns on the lines of the National Rural Health Mission (NRHM),’ he said on the occasion.

The central government will bear 80 percent of the cost of implementing the programme in 779 urban areas with over 50,000 population across the country by 2015.

‘Primary health centres, sub-centres, referral units will be strengthened in urban areas and manned by auxiliary nurse midwifes (ANMs). Mobile health check-up vans will visit these centres with two doctors, two nurses and a pharmacist,’ Azad said. (Read: Bangalore’s urban poor to get healthcare facilities)

About 200 million people in urban areas will have access to free healthcare.

Lauding the central government’s initiative to provide healthcare to the needy, Karnataka Chief Minister Siddaramaiah said focus should be on creating awareness towards prevention than cure.

‘Urban rich have access to healthcare facilities but for the urban poor, medical expense is beyond their means, as 17 percent of them live in slums and majority of them are migrant labourers, rag pickers and marginalised sections of society,’ he noted.

State Health Minister U.T. Khader rolled out the ambulance service ‘Nagu Magu’ dedicated to shift pregnant women to the nearest hospital and take them back to home after delivery safely. About 10 ambulances will be operational across Bangalore from Tuesday for the service.

‘We have submitted to the central health ministry a project plan to implement the mission in Bangalore, Bagalkot, Mangalore, Mysore and Ullal in the coastal area at a cost of Rs.132 crore. About 50 health kiosks will be up across Bangalore under the mission,’ Khader said.

Urban health in India: who is responsible?

January 22, 2014 · 0 comments

Urban health in India: who is responsible? The International Journal of Health Planning and Management, Jan 2014.

Indrani Gupta, Swadhin Mondal. Correspondence to: S. Mondal, Quarter # B2, Institute of Economic Growth (IEG), University of Delhi North Campus, Delhi-110007, India. E-mail: kumar.swadhin@gmail.com

Urban health has received relatively less focus compared with rural health in India, especially the health of the urban poor. Rapid urbanization in India has been accompanied by an increase in population in urban slums and shanty towns, which are also very inadequately covered by basic amenities, including health services. The paper presents existing and new evidence that shows that health inequities exist between the poor and the non-poor in urban areas, even in better-off states in India. The lack of evidence-based policies that cut across sectors continues to be a main feature of the urban health scenario. Although the problems of urban health are more complex than those of rural health, the paper argues that it is possible to make a beginning fairly quickly by (i) collecting more evidence of health status and inequities in urban areas and (ii) correcting major inadequacies in infrastructure–both health and non-health–without waiting for major policy overhauls.

Coping Strategies among Urban Poor: Evidence from Nairobi, Kenya

January 15, 2014 · 0 comments

Coping Strategies among Urban Poor: Evidence from Nairobi, Kenya. PLoS One, Jan 2014.

Authors – Djesika D, et al.

Abstract – Aims: In Kenya, it is estimated that 60 to 80% of urban residents live in slum or slum-like conditions. This study investigates expenditures patterns of slum dwellers in Nairobi, their coping strategies and the determinants of those coping strategies.

Method: We use a dataset from the Indicator Development for Surveillance of Urban Emergencies (IDSUE) research study conducted in four Nairobi slums from April 2012 to September 2012. The dataset includes information related to household livelihoods, earned incomes of household members, expenditures, shocks, and coping strategies.

Results: Food spending is the single most important component, accounting for 52% of total households’ income and 42% of total expenditures. Households report a variety of coping strategies over the last four weeks preceding the interview. The most frequently used strategy is related to reduction in food consumption, followed by the use of credit, with 69% and 52% of households reporting using these strategies respectively. A substantial proportion of households also report removing children from school to manage spending shortfalls. Formal employment, owning a business, rent-free housing, belonging to the two top tiers of income brackets, and being a member of social safety net reduced the likelihood of using any coping strategy. Exposure to shocks and larger number of children under 15 years increased the probability of using a coping strategy.

Policy Implications: Policies that contain food price inflation, improve decent-paying job opportunities for the urban poor are likely to reduce the use of negative coping strategies by providing urban slum dwellers with steady and reliable sources of income. In addition, enhancing access to free primary schooling in the slums would help limit the need to use detrimental strategies like “removing” children from school.

Determinants of households’ cleaning intention for shared toilets: Case of 50 slums in Kampala, Uganda

January 10, 2014 · 0 comments

Determinants of households’ cleaning intention for shared toilets: Case of 50 slums in Kampala, Uganda. Habitat International 41 (2014) 108e113.

Innocent K. Tumwebazea, et al.

Cleaning shared toilets is important if users are to receive the significant health, social and economic benefits associated with having access to these facilities. However, achieving and maintaining hygienic toilets shared by several user households in urban slums is usually a challenge. This study assesses determinants of households’ cleaning intention for shared toilets in Kampala, Uganda. Using a structured questionnaire for the household interviews and an observation checklist, data from 1019 users of shared toilets was collected in 50 randomly selected urban slums.

Data analysis showed that most of the shared toilets are unhygienic. Less than a quarter of the shared toilets, for instance, were hygienically clean to users’ satisfaction. The main cleaning intention determinants included: importance of using a clean toilet, the effort involved in cleaning the toilet, the disgust felt from using a dirty toilet, and cleaning habits. Although it is important to have access to sanitation facilities, emphasis should be placed on how to engage users to ensure that the facilities used are appropriately cleaned and maintained.

MCHIP Launches Collaborative Document for Community Health Worker Programs at Scale

January 10, 2014 · 0 comments

MCHIP Launches Collaborative Document for Community Health Worker Programs at Scale, December 2013.

MCHIP is pleased to post for public comment its collaborative document for community health worker (CHW) programs at scale. This document, “Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide for Program Managers and Policy Makers,” is an in-depth review of issues and questions that should be considered when addressing key issues relevant for large-scale CHW program.

Rather than being an instructional manual, the Reference Guide is meant to provide a framework for those in leadership positions in-country as they consider how to develop, expand, and strengthen their CHW program. It is our intention to make this a “living document” that will be revised periodically as the experience and evidence grows in this rapidly expanding activity. The Reference Guide has been developed in parallel with the URC/Project ASSIST CHW Decision-Making Support Tool, which is also in the process of being released.


Nutritional Disparities among Women in Urban India

January 10, 2014 · 0 comments

Nutritional Disparities among Women in Urban India. Jnl Health Pop Nutr, Dec 2013.

Siddharth Agarwal, Vani Sethi

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%).

The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes; (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days.

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