1.  Peer Reviewed Title: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Author: Fotso J; Ezeh A; Madise N; Ziraba A; Ogollah R Source: Maternal and Child Health Journal. 2009 Jan;13(1):130-7. Abstract: Objectives: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and "appropriate" health facilities. Methods: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either "inappropriate" or "appropriate". Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy "wantedness", and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | SLUMS | URBAN POPULATION | WOMEN IN DEVELOPMENT | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | CHILDBIRTH | EDUCATIONAL STATUS | PROMOTION | ANTENATAL CARE | MULTIPARITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Economic Development | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Health Services Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Marketing | Parity | Fertility Measurements | Fertility | Population Dynamics Document Number: 308031 |
| 2. Peer Reviewed Title: Vulnerability to HIV/AIDS among women of reproductive age in the slums of Delhi and Hyderabad, India. Author: Ghosh J; Wadhwa V; Kalipeni E Source: Social Science and Medicine. 2009 Feb;68(4):638-42. Abstract: This report explores how vulnerability to HIV/AIDS applies to women in the reproductive age range living in the slum areas of Delhi and Hyderabad. The paper is based on a qualitative study of AIDS awareness levels conducted during the summer of 2006. It offers insightful narratives from a sample of 32 women, providing an in depth view of their vulnerability to HIV/AIDS due to their precarious socioeconomic conditions and low AIDS awareness. The women cited lack of education, low empowerment in expressing and accessing information related to sexual matters, and poverty as key factors to vulnerability. Language: English Keywords: INDIA | RESEARCH REPORT | QUALITATIVE RESEARCH | WOMEN | SLUMS | CONTRACEPTIVE METHODS | AWARENESS | REPRODUCTIVE AGE | RISK FACTORS | POVERTY | INFORMATION | PROGRAM ACCESSIBILITY | Asia, Southern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Contraception | Family Planning | Knowledge | Sociocultural Factors | Reproduction | Health | Socioeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration Document Number: 341554 |
| 3. Peer Reviewed Title: HIV-related risk behaviours and the correlates among rickshaw pullers of Kamrangirchar, Dhaka, Bangladesh: a cross-sectional study using probability sampling. Author: Hoque HE; Ono-Kihara M; Zamani S; Ravari SM; Kihara M Source: BMC Public Health. 2009;9:80. Abstract: BACKGROUND: National HIV serological and behavioural surveillance of Bangladesh repeatedly demonstrated a very high proportion of rickshaw pullers in Dhaka city, having sex with female sex workers (FSWs) and using illicit substances. However, no study has been conducted to identify the correlates of having sex with FSWs among this population. This study aimed to describe behavioural profile of rickshaw pullers in Dhaka city using probability samples and to identify the correlates for having sex with FSWs in order to focus HIV prevention intervention. METHODS: Six hundred rickshaw pullers were randomly selected from rickshaw garages in the Kamrangirchar area, the single largest slum cluster of Dhaka, Bangladesh, during March-April 2008 using the Proportion Probability to Size method. Participants were interviewed, with a response rate of 99.2% (n = 595), using a structured questionnaire and asked about illicit substance use, sexual behaviour and risk perception for HIV and sexually transmitted diseases. Independent predictors of having sex with FSWs were analysed by multivariate analysis. A qualitative study was subsequently conducted with 30 rickshaw pullers to supplement the findings of the initial survey. RESULTS: The proportion of survey respondents who had sex with FSWs and those who used illicit substances in the previous 12 months period were 7.9% and 24.9%, respectively, much lower than the results achieved in the 2003-04 behavioural surveillance (72.8% and 89.9%, respectively). Multivariate analysis revealed the characteristics of younger age, being never married, living alone with family remaining in other districts and using illicit substances in the previous 12 months were significantly associated with having sex with FSWs. CONCLUSION: HIV-related risk behaviour of our study population of the rickshaw pullers was lower than what has been suggested by the results of behavioural surveillance. While this discrepancy should be addressed in further studies, our study emphasizes the importance of focused HIV prevention programs for rickshaw pullers as high-risk behaviour is displayed at an unacceptable level and concentrated in identifiable sub-populations. Language: English Keywords: BANGLADESH | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | LABOR FORCE | SLUMS | SEX BEHAVIOR | SAMPLING ERRORS | Developing Countries | Asia, Southern | Asia | Research Methodology | Human Resources | Economic Factors | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Behavior | Error Sources | Measurement Document Number: 341351 |
| 4. Peer Reviewed Title: Relationship between intestinal parasitic infection in children and soil contamination in an urban slum. Author: Korkes F; Kumagai FU; Belfort RN; Szejnfeld D; Abud TG; Kleinman A; Florez GM; Szejnfeld T; Chieffi PP Source: Journal of Tropical Pediatrics. 2009 Feb;55(1):42-5. Abstract: PURPOSE: Urban slums are well known for their high infant mortality and morbidity rates, and parasitic infections seem to be a common problem among these children. The aim of the present study was to determine protozoa and nematodes prevalence among children of a selected community located in Sao Paulo, Brazil, and access the relation between soil and children infection. METHODS: Soil contamination samples from 15 strategic locations in the slum area as well as stool samples (examined for protozoa and nematodes through five different methods) from 120 children aged 2-14 years (49% M: 51% F, mean +/- SD = 7.9 +/- 3.8 years) were assessed in a cross-sectional study. Children's domicile locations were determined, and a comparative analysis was undertaken to correlate children and soil infection. RESULTS: Overall infection rate was 30.8% (n = 37), without difference between genders. The most frequent intestinal protozoa were Endolimax nana (20.8%), Entamoeba coli (15.8%) and Giardia lamblia (16.7%). Frequencies of Ascaris lumbricoides and Enterobius vermicularis in stool samples were 2.5 and 1.7%, respectively. No cases of hookworms, Schistosoma mansoni or Tricuris trichiura were identified. Polyparasitism occurred in 10.8% of the children, while 69.2% were free of parasitic infections. Out of the 15 soil samples analyzed, Ascaris sp. eggs were found in 20% and hookworm eggs in 6.7%. CONCLUSION: Helminth infection is not as prevalent as previously reported in urban slums in Sao Paulo, neither as clinical disease nor in soil samples. Protozoa intestinal infection, however, is still frequent in some marginalized populations in Sao Paulo. Improvement in living standards, mostly sanitation might decrease the prevalence of these diseases. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | CHILDREN | SLUMS | PREVALENCE | SOIL QUALITY | ENVIRONMENTAL POLLUTION | PARASITIC DISEASES | GASTROINTESTINAL EFFECTS | SCHISTOSOMIASIS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Measurement | Environment | Environmental Degradation | Diseases | Physiology | Biology Document Number: 330412 |
| 5. Peer Reviewed Title: HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. Author: Kyobutungi C; Ezeh AC; Zulu E; Falkingham J Source: BMC Public Health. 2009 May 27;9(1):153. Abstract: ABSTRACT: BACKGROUND: The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums. METHODS: Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance area, who on 1st October 2006, were 50 years and older. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures - self-rated health and a composite health score - were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: "How have you been personally affected by HIV/AIDS?" was asked. Ordinal logistic regression was used in models with self-rated health and linear regression in models with the health score. RESULTS: About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9). Females reported worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t=3.21), and an adjusted odds ratio of reporting "poor health" of 1.42 (95%CI: 1.12-1.80). CONCLUSION: Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles. Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STATISTICAL REGRESSION | KAP SURVEYS | HEALTH SURVEYS | OLDER ADULTS | SLUMS | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | SEX FACTORS | SELF-PERCEPTION | AIDS | HIV INFECTIONS | HEALTH POLICY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Surveys | Sampling Studies | Studies | Health | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Viral Diseases | Diseases | Perception | Psychological Factors | Behavior | Policy | Political Factors | Sociocultural Factors Document Number: 341484 |
| 6. Peer Reviewed Title: Attribution of malnutrition to cause-specific diarrheal illness: evidence from a prospective study of preschool children in Mirpur, Dhaka, Bangladesh. Author: Mondal D; Haque R; Sack RB; Kirkpatrick BD; Petri WA Jr Source: American Journal of Tropical Medicine and Hygiene. 2009 May;80(5):824-6. Abstract: We examined whether malnutrition (underweight [WAZ] < -2) increased the risk of diarrhea equally for all enteropathogens. The study was conducted prospectively between January 1999 and July 2002 in Mirpur, an urban slum in Dhaka. Two hundred eighty-nine Bangladeshi children (147 male and 142 female) 2-5 years of age were included in the study. Malnutrition was present in 39% of the children at the time of enrollment. The parents and children were visited and interviewed every other day by health care workers for details about any diarrheal episodes. Stool samples were successfully collected from 62% of episodes of diarrhea. Of the identified enteropathogens, only enterotoxigenic Escherichia coli (ETEC), Cryptosporidium sp., and Entamoeba histolytica were significantly more prevalent in malnourished children. We concluded that the malnutrition attributed risk is not equal for enteric pathogens associated with diarrheal illness. Language: English Keywords: BANGLADESH | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | SLUMS | CHILDREN | DIARRHEA | MALNUTRITION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Youth | Age Factors | Diseases | Nutrition Disorders Document Number: 341333 |
| 7. Peer Reviewed Title: Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya's urban slums. Author: Odek WO; Busza J; Morris CN; Cleland J; Ngugi EN; Ferguson AG Source: AIDS and Behavior. 2009 Jun;13(3):449-61. Abstract: This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research. Language: English Keywords: KENYA | SLUMS | RESEARCH REPORT | SEX WORKERS | HIV PREVENTION | MICROENTERPRISE DEVELOPMENT | TRAINING PROGRAMS | PROGRAM EVALUATION | RISK REDUCTION BEHAVIOR | SEX BEHAVIOR | CONDOM USE | AGE FACTORS | WOMEN'S EMPOWERMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Behavior | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Education | Population Characteristics | Demographic Factors | Women's Status | Socioeconomic Factors | Economic Factors Document Number: 342112 |
| 8. Title: A rights-based approach to accessing health determinants. Author: Perkins F Source: Global Health Promotion. 2009 Mar;16(1):61-4. Abstract: This commentary summarizes the experience and learnings from a site visit in May 2008 to a drop-in centre for vulnerable women in downtown Cairo run by El-Shehab Institution for Comprehensive Development, which provides street outreach for the prevention of Sexually Transmitted Infection (STI). The Centre successfully provides services and support for women, many of who are displaced or refugees and are from the most marginalized areas in Cairo. Through a rights-based approach to the work, the Centre helps people living in the slums fight and win the right to access clean water, sewerage and electrical power in their communities. An individual-based approach to human rights is also used. In the last year El-Shehab have helped 67 women go to court and win their marriage rights from husbands who have abandoned them. Their approach is an example of a successful way to achieve access to basic health determinants. Language: English Keywords: EGYPT | SLUMS | CRITIQUE | NONGOVERNMENTAL ORGANIZATIONS | SEX WORKERS | HIV PREVENTION | AIDS PREVENTION | HUMAN RIGHTS | HEALTH | ADVOCACY | WATER SUPPLY | SANITATION | ELECTRICITY | COURT DECISION | Developing Countries | Africa, North | Africa | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Organizations | Political Factors | Sociocultural Factors | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | AIDS | Communication | Natural Resources | Environment | Public Health | Energy Supply | Litigation Document Number: 342373 |
| 9. Title: Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia. Author: Semba RD; de Pee S; Kraemer K; Sun K; Thorne-Lyman A; Moench-Pfanner R; Sari M; Akhter N; Bloem MW Source: International Journal of Hygiene and Environmental Health. 2009 Jul;212(4):387-97. Abstract: In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums. Language: English Keywords: INDONESIA | SLUMS | RESEARCH REPORT | SAMPLING STUDIES | CHILDREN | HOUSEHOLDS | WATER SUPPLY | EXPENDITURES | CHILD MORTALITY | INFANT MORTALITY | DIARRHEA | MALNUTRITION | PREVALENCE | Developing Countries | Asia, Southeastern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Family and Household | Sociocultural Factors | Natural Resources | Environment | Financial Activities | Economic Factors | Mortality | Population Dynamics | Diseases | Nutrition Disorders | Measurement Document Number: 342114 |
| 11. Title: Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria. Author: Adedimeji AA; Heard NJ; Odutolu O; Omololu FO Source: East African Journal of Public Health. 2008 Dec;5(3):215-22. Abstract: This study explored condom use behavior, specifically the extent to which beliefs, self efficacy, risk perception, and perceived social support act as predictors of use or non-use of condoms among sexually active young people aged 15–24 years. Data were obtained from 448 and 338 sexually active boys and girls, respectively, who were selected through multistage sampling techniques. Generally, there was widespread knowledge and low levels of condoms use, despite high levels of risky sexual behavior. Although half of boys and one third of girls reported ever using condoms, a considerably lower proportion of male and female adolescents regularly used condoms. Logistic regression models showed that among girls, those who perceived social support from peers and non-parental figures were more likely to use condoms while among boys, earning an income, high risk perception, and self efficacy were associated with higher odds of condom use. Language: English Keywords: NIGERIA | RESEARCH REPORT | DATA ANALYSIS | URBAN POPULATION | SLUMS | YOUTH | CONDOMS | CARE AND SUPPORT | COMMUNITY-BASED DISTRIBUTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Age Factors | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Health Services | Delivery of Health Care | Health | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration Document Number: 331150 |
| 12. Peer Reviewed Title: Strengthening functional community-provider linkages: lessons from the Indore urban health programme. Author: Agarwal S; Satyavada A; Patra P; Kumar R Source: Global Public Health. 2008 Jul;3(3):308-325. Abstract: Weak linkages between health providers and slum communities hinder the improvement of health services for India's urban poor. To address this issue, an urban health programme is implementing two approaches in Indore city, Madhya Pradesh, the demand-supply linkage approach and ward coordination approach. The former is based on the premise that building social capital, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services for the urban poor. The latter focuses on encouraging local stakeholders to function in a coordinated manner to ensure better health service coverage in underserved slum areas. Findings suggest that the programme has enhanced utilization of services among Indore's slum communities and helped improve immunization coverage and other maternal and child health indicators. (author's) Language: English Keywords: INDIA | EVALUATION REPORT | OPERATIONS RESEARCH | SLUMS | HEALTH PERSONNEL | INTERPERSONAL COMMUNICATION | PHYSICIAN-PATIENT RELATIONS | COMMUNICATION STRATEGY | COORDINATION | HUMAN CAPITAL | SOCIAL MOBILIZATION | COMMUNITY PARTICIPATION | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Evaluation | Program Evaluation | Programs | Organization and Administration | Research Methodology | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Delivery of Health Care | Health | Communication | Interpersonal Relations | Behavior | Human Resources | Economic Factors | Social Change | Sociocultural Factors | Health Services Document Number: 327758 |
| 13. Title: Effects of deworming on malnourished preschool children in India: An open-labelled, cluster-randomized trial. Author: Awasthi S; Peto R; Pande VK; Flectcher RH; Read S Source: PLoS Neglected Tropical Diseases. 2008 Apr;2(4):e223. Abstract: More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children. We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area. The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6-1.4 kg, p = 10211). In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize. (author's) Language: English Keywords: INDIA | SLUMS | RESEARCH REPORT | CLINICAL TRIALS | CHILDREN | MALNUTRITION | PARASITE CONTROL | GASTROINTESTINAL EFFECTS | DRUGS | BODY WEIGHT | Developing Countries | Asia, Southern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Nutrition Disorders | Diseases | Public Health | Health | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 326362 |
| 14. Peer Reviewed Title: Malnutrition and morbidity among children not reached by the national vitamin A capsule programme in urban slum areas of Indonesia. Author: Berger SG; de Pee S; Bloem MW; Halati S; Semba RD Source: Public Health. 2008 Apr;122(4):371-378. Abstract: The objective was to determine whether vitamin A capsule programmes fail to reach children who are at higher risk of malnutrition and morbidity. Although it has been suggested that there are health disparities between children who are reached or not reached by these programmes, little quantitative work has been undertaken to characterize this relationship. As part of a national surveillance system, nutritional status and other factors were compared in 138,956 children, aged 12-59 months, who had and had not received vitamin A supplementation in urban slum areas in Indonesia. In total, 63.1% of children had received a vitamin A capsule within the previous 6 months. Among children who had and had not received vitamin A supplementation, respectively, the proportion with weight-for-age and height-forage Z scores less than -3 were 7.8% vs 8.6% (P less than 0.0001) and 9.4% vs 10.7% (P less than 0.0001), and with a history of diarrhoea in the previous week was 8.1% vs 10.7% (P less than 0.0001). In families where a child had or had not received vitamin A supplementation, the proportion with a history of infant death less than 12 months was 5.2% vs 7.2% (P less than 0.0001) and child death less than 5 years was 6.7% vs 9.2%, respectively (P less than 0.0001). Children who had not received vitamin A supplementation were also significantly more likely to be anaemic and have diarrhoea or fever on the survey day compared with children who had received supplementation. In the urban slums of Indonesia, children who do not receive vitamin A supplementation tend to be slightly more malnourished and ill, and are more likely to come from families with higher child mortality than children who receive vitamin A. Higher rates of child mortality in non-participating households suggest that reaching preschoolers could yield a disproportionate survival benefit. Importantly, children who are not reached by the vitamin A programme are also unlikely to be reached by vaccination and other services, emphasizing the need to identify and extend efforts to reach non-participants. (author's) Language: English Keywords: INDONESIA | SLUMS | RESEARCH REPORT | NUTRITION SURVEYS | CHILDREN | MALNUTRITION | MORBIDITY | VITAMIN A | ANEMIA | DIARRHEA | IMMUNIZATION | FOOD SUPPLEMENTATION | Developing Countries | Asia, Southeastern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Nutrition | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Nutrition Disorders | Diseases | Vitamins and Minerals | Physiology | Biology | Primary Health Care | Health Services | Delivery of Health Care | Nutrition Programs Document Number: 325094 |
| 15. Title: New forms of citizenship and socio-political inclusion: accessing antiretroviral therapy in a Rio de Janeiro favela. Author: Cataldo F Source: Sociology of Health and Illness. 2008 Sep;30(6):900-12. Abstract: Brazil has received praise internationally for its national health policy against HIV. Whilst the ethical stance of the Brazilian programme has been widely applauded, there is a lack of empirical data on how the commitment to equitable and universal HIV prevention and treatment works in practice among the poorest population groups. The aim of this paper is to explore the broad ethics of the Brazilian AIDS programme by investigating how universal access to HIV treatment is being implemented within a favela (shanty town). Data collected through anthropological research show that in settings such as the favelas, the universal character of this public health programme is challenged by a number of issues such as local definitions of illness, problems related to the understanding of and adherence to treatment, structural violence, political alienation, and lack of perspectives about the future. It is also argued that such health intervention has contributed to the promotion of novel attitudes towards individual notions of socio-political participation. These are explored with reference to the notion of therapeutic citizenship, which in the context of a favela neighbourhood translates into a new set of concerns around free access to and availability of treatment, the right to health care and the sustainability of public health policies. Language: English Keywords: BRAZIL | CRITIQUE | EVALUATION | LOW INCOME POPULATION | SLUMS | INEQUALITIES | HIV PREVENTION | AIDS PREVENTION | POVERTY | ETHICS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | PUBLIC HEALTH | VIOLENCE | POLITICAL FACTORS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | HIV Infections | Viral Diseases | Diseases | AIDS | Sociocultural Factors | Program Evaluation | Programs | Organization and Administration | Health | Behavior Document Number: 329206 |
| 16. Title: Tuberculosis risk among staff of a large public hospital in Kenya. Author: Galgalo T; Dalal S; Cain KP; Oeltmann J; Tetteh C; Kamau JG; Njenga MK; Breiman RF; Chakaya JM; Irimu HM; Miller B; De Cock KM; Bock NN; Ijaz K Source: International Journal of Tuberculosis and Lung Disease. 2008 Aug;12(8):949-54. Abstract: SETTING: In sub-Saharan Africa, high rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection pose a serious threat for occupationally acquired TB among health care workers. OBJECTIVE: To identify factors associated with TB disease among staff of an 1800-bed hospital in Kenya. DESIGN: We calculated TB incidence among staff and conducted a case-control study where cases (n = 65) were staff diagnosed with TB and controls (n = 316) were randomly selected staff without recent TB. RESULTS: The annual incidence of TB from 2001 to 2005 ranged from 645 to 1115 per 100000 population. Factors associated with TB disease were additional daily hours spent in rooms with patients (adjusted odds ratio [aOR] 1.3, 95%CI 1.2-1.5), working in areas where TB patients received care (aOR 2.1, 95%CI 1.1-4.2), HIV infection (aOR 29.1, 95%CI 5.1-167) and living in a slum (aOR 4.7, 95%CI 1.8-12.5) or hospital-provided low-income housing (aOR 2.6, 95%CI 1.2-5.6). CONCLUSION: Hospital exposures were associated with TB disease among staff at this hospital regardless of their job designation, even after controlling for living conditions, suggesting transmission from patients. Health care facilities should improve infection control practices, provide quality occupational health services and encourage staff testing for HIV infection to address the TB burden in hospital staff. Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | HEALTH PERSONNEL | SLUMS | PREVALENCE | HOSPITALS | TUBERCULOSIS | RISK ASSESSMENT | OCCUPATIONAL HEALTH | WORKPLACE | TIME FACTORS | LIVING ARRANGEMENTS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Delivery of Health Care | Health | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Measurement | Health Facilities | Infections | Diseases | Evaluation | Employment | Macroeconomic Factors | Economic Factors | Population Dynamics | Demographic Factors | Residence Characteristics Document Number: 329457 |
| 17. Title: Water disinfection and hygiene behaviour in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs. Author: Graf J; Meierhofer R; Wegelin M; Mosler HJ Source: International Journal of Environmental Health Research. 2008 Oct;18(5):335-55. Abstract: In this research project, we studied factors that presumably affect the incidence of diarrhoea among young children in urban slums in developing countries: consumption of safe drinks, hygiene behaviour, cleanliness of household surroundings and the quality of raw water. Beliefs concerning the causes of diarrhoea were also related to health-improving behaviour, namely the application of the water-treatment method SODIS (solar water disinfection) and hygiene behaviour. We conducted a survey in a shanty town in Nairobi, Kenya. Field workers interviewed 500 households. Analysis with regression models revealed that two out of the four postulated factors were significant: children have a lower risk of contracting diarrhoea when they consume high percentages of safe drinks and live in households with good hygiene. As regards beliefs, we found that biomedical knowledge of children's diarrhoea as well as the perceived social norm for treating water was associated with the use of SODIS and good hygiene. Language: English Keywords: KENYA | RESEARCH REPORT | URBAN AREAS | URBAN POPULATION | SLUMS | HYGIENE | SANITATION | BEHAVIOR | WATER QUALITY | DIARRHEA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Population Characteristics | Demographic Factors | Urbanization | Urban Population Distribution | Population Distribution | Public Health | Health | Water | Natural Resources | Environment | Diseases Document Number: 329315 |
| 18. Peer Reviewed Title: Geographic prevalence and multilevel determination of community-level factors associated with herpes simplex virus type 2 infection in Chennai, India. Author: Jennings JM; Louis TA; Ellen JM; Srikrishnan AK; Sivaram S Source: American Journal of Epidemiology. 2008;167(12):1495–1503. Abstract: Herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections, and it increases the risk of transmission of human immunodeficiency virus type 1 at least twofold. Individual-level factors are insufficient to explain geographic and population variation in HSV-2, suggesting the need to identify ecologic factors. The authors sought to determine the geographic prevalence and community-level factors associated with HSV-2 after controlling for individual-level factors among slums in Chennai, India. From March to June 2001, participants aged 18-40 years voluntarily completed a survey and were tested for HSV-2. Community characteristics were assessed through interviews with key informants and other secondary data sources. Multilevel nonlinear analysis was conducted. Eighty-five percent of eligible persons completed the survey; of these, 98% underwent HSV-2 testing, producing a final sample of 1,275. Participants were of Tamil ethnicity, were predominantly female and married, and were on average 30 years old. Fifteen percent were infected with HSV-2, and there was significant variation in HSV-2 prevalence among communities. After controlling for individual-level factors, the authors identified community-level factors, including socioeconomic status and the presence of injection drug users, that were independently associated with HSV-2 and explained 11% of the variance in prevalence. Future studies are needed to test mechanisms through which these community-level factors may be operating. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | SURVEYS | CLINICAL RESEARCH | URBAN POPULATION | SLUMS | HERPES GENITALIS | EPIDEMIOLOGY | PREVALENCE | GEOGRAPHIC FACTORS | SOCIOECONOMIC STATUS | RESIDENCE CHARACTERISTICS | IV DRUG USERS | Developing Countries | Asia, Southern | Asia | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Public Health | Health | Measurement | Socioeconomic Factors | Economic Factors | Drug Use and Abuse | Behavior Document Number: 327018 |
| 19. Peer Reviewed Title: Socio-economic factors explain differences in public health-related variables among women in Bangladesh: A cross-sectional study. Author: Khan MM; Kraemer A Source: BMC Public Health. 2008 Jul 23;8(254):[24] p. Abstract: Worldwide one billion people are living in slum communities and experts projected that this number would double by 2030. Slum populations, which are increasing at an alarming rate in Bangladesh mainly due to rural-urban migration, are often neglected and characterized by poverty, poor housing, overcrowding, poor environment, and high prevalence of communicable diseases. Unfortunately, comparisons between women living in slums and those not living in slums are very limited in Bangladesh. The objectives of the study were to examine the association of living in slums (dichotomized as slum versus nonslum) with selected public health-related variables among women, first without adjusting for the influence of other factors and then in the presence of socio-economic variables. Secondary data was used in this study. 120 women living in slums (as cases) and 480 age-matched women living in other areas (as controls) were extracted from the Bangladesh Demographic and Health Survey 2004. Many socio-economic and demographic variables were analysed. SPSS was used to perform simple as well as multiple analyses. Pvalues based on t-test and Wald test were also reported to show the significance level. Unadjusted results indicated that a significantly higher percent of women living in slums came from country side, had a poorer status by household characteristics, had less access to mass media, and had less education than women not living in slums. Mean BMI, knowledge of AIDS indicated by ever heard about AIDS, knowledge of avoiding AIDS by condom use, receiving adequate antenatal visits (4 or more) during the last pregnancy, and safe delivery practices assisted by skilled sources were significantly lower among women living in slums than those women living in other areas. However, all the unadjusted significant associations with the variable slum were greatly attenuated and became insignificant (expect safe delivery practices) when some socio-economic variables namely childhood place of residence, a composite variable of household characteristics, a composite variable of mass media access, and education were inserted into the multiple regression models. Taken together, childhood place of residence, the composite variable of mass media access, and education were the strongest predictors for the health related outcomes. Reporting unadjusted findings of public health variables in women from slums versus non-slums can be misleading due to confounding factors. Our findings suggest that an association of childhood place of residence, mass media access and public health education should be considered before making any inference based on slum versus non-slum comparisons. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CROSS SECTIONAL ANALYSIS | WOMEN | URBAN POPULATION | SLUMS | WOMEN'S HEALTH | PUBLIC HEALTH | SANITATION | SOCIOECONOMIC FACTORS | MASS MEDIA | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Population Characteristics | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Health | Economic Factors | Communication Document Number: 327815 |
20.  Title: The burden of disease profile of residents of Nairobi's slums: Results from a Demographic Surveillance System. Author: Kyobutungi C; Ziraba AK; Ezeh A; Ye Y Source: Population Health Metrics. 2008 Mar 10;6(1):[26] p. Abstract: With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data generated from a Demographic Surveillance System. Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age. The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and tuberculosis accounted for about 50% of the mortality burden. Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | LONGITUDINAL STUDIES | URBAN AREAS | SLUMS | POVERTY | MORTALITY | CHILD MORTALITY | MORTALITY DETERMINANTS | CAUSES OF DEATH | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Geographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Socioeconomic Factors | Economic Factors | Population Dynamics | Demographic Factors Document Number: 325037 |
| 21. Peer Reviewed Title: Nutrition and public hygiene among children under five years of age in Mukuru slums of Makadara Division, Nairobi. Author: Muoki MA; Tumuti DS; Rombo GO Source: East African Medical Journal. 2008 Aug;85(8):386-97. Abstract: OBJECTIVE: To determine the relationship between sanitation and malnutrition among children below five years. DESIGN: A random sampling followed by an experimental design on microbiological analysis of food and water samples. SETTING: Mukuru slums of Makadara division in Nairobi City. SUBJECTS: Eighty food and thirty water samples from households within the study area were used. RESULTS: Poor food and personal hygiene were observed within the households in the study area. Most of the respondents did not practice hygienic methods during food handling such as washing hands and vegetables before preparation. Food especially the leftovers was served at ambient temperatures. Sneezing and coughing over food during preparation were also a common practice which exposed consumers to contamination, Garbage disposal and proper drainage were also poor deepening on the sanitation problem. Microbiological analysis of water and food revealed that food and water quality were poor due to the high coliform counts and confirmed presence of Escherichia coli (E-coli) and Salmonella spp. pathogens which are known causes of diarrhoea in children under five years of age. CONCLUSION: Poor hygienic and unsanitary practices are major causes of diarrhoea, hence malnutrition in crowded Mukuru slums of Nairobi City. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | CHILDREN | SLUMS | HOUSEHOLDS | SANITATION | CHILD NUTRITION | MALNUTRITION | WATER SUPPLY | FOOD SUPPLY | HYGIENE | WASTE MANAGEMENT | BACTERIAL AND FUNGAL DISEASES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Family and Household | Sociocultural Factors | Public Health | Health | Nutrition | Nutrition Disorders | Diseases | Natural Resources | Environment | Infections Document Number: 330590 |
| 22. Title: Child morbidity and care-seeking in Nairobi slum settlements: the role of environmental and socio-economic factors. Author: Ndugwa RP; Zulu EM Source: Journal of Child Health Care. 2008 Dec;12(4):314-28. Abstract: The aim of this study was to investigate factors that influence morbidity patterns and health-seeking decisions in an urban slum community. Data were collected between May and August 2003 as part of the ongoing Nairobi urban demographic surveillance system and were analysed to identify factors that influence morbidity patterns and health-seeking decisions. The results show that the factors that influenced morbidity were the child's age, ethnicity and type of toilet facility. Predictors for seeking health care were the child's age, type and severity of illness, survival of father and mother, mother's education, mother's work status and wealth class. The conclusions drawn show that economic resources fall short in preventing child illnesses where children live in poor environmental conditions. However, by enhancing access to health care services, socio-economic status is critical for mitigating disease burden among children in slum settlements. Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | DEMOGRAPHIC SURVEYS | ORPHANS AND VULNERABLE CHILDREN | SLUMS | ETHNIC GROUPS | CHILD HEALTH | UTILIZATION OF HEALTH CARE | ENVIRONMENT | RISK FACTORS | AGE FACTORS | EMPLOYMENT STATUS | SANITATION | EDUCATIONAL STATUS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Dynamics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Cultural Background | Population Characteristics | Health | Health Services | Delivery of Health Care | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Public Health Document Number: 331063 |
| 23. Title: Social determinants, suboptimal health behavior, and morbidity in urban slum population: an Indian perspective. Author: Pawar AB; Mohan PV; Bansal RK Source: Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2008 Jul;85(4):607-618. Abstract: Improving the health of urban residents, particularly those living in slum areas, requires an integrated approach. Appropriate interventions must be based on a well-grounded understanding of health determinants. Social factors are as important as physical factors in determining health status and suggest alternative interventions. Employment, stress, social exclusion, social support, substance use, nutrition, transport, and conditions during childhood are among the most important social determinants of health status identified by the International Center for Health and Society. This paper uses social determinants of health approach to understand morbidity outcomes for people residing in the slums of Surat City, India. To quantify suboptimal health behavior and identify the determinants of health status for this population survey data on household characteristics, health-seeking behavior, socioeconomic status, food and personal habits, social life, and physical activity has been used. After controlling for socioeconomic and demographic factors, logistic regression analysis reveals that social exclusion, stress, and lack of social support are significantly associated with morbidity. Thus, understanding of social determinants of health by policy makers is important as the health sector has a crucial role in addressing disparities in social determinants. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | SURVEYS | INTERVENTIONS | SLUMS | URBAN POPULATION | SOCIOECONOMIC FACTORS | MORBIDITY | BEHAVIOR | HEALTH STATUS INDEXES | EMPLOYMENT | STRESS | SOCIAL NETWORKS | NUTRITION | SUBSTANCE ADDICTION | SOCIOECONOMIC STATUS | Developing Countries | Asia, Southern | Asia | Sampling Studies | Studies | Research Methodology | Programs | Organization and Administration | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Economic Factors | Diseases | Health | Macroeconomic Factors | Psychological Factors | Friends and Relatives | Family and Household | Sociocultural Factors | Social Problems Document Number: 327886 |
| 24. Peer Reviewed Title: Family structure and adolescent sexual behavior in a poor area of Sao Paulo, Brazil. Author: Peres CA; Rutherford G; Borges G; Galano E; Hudes ES Source: Journal of Adolescent Health. 2008 Feb;42(2):177-183. Abstract: In Brazil, as elsewhere, behavior during adolescence can place young people at risk for serious medical and social problems, including sexually transmitted infections, unintended pregnancy, drugs, crime, and violence. Few studies internationally have examined the influence of family structure on risk behavior among low-income youths. This cross-sectional study included 296 young people in one of the poorest areas of Sao Paulo who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. We examined associations between family structure and various risk behaviors. Ages ranged from 13-24 years (82%, 15-18); 67% were of Afro-Brazilian ancestry, and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. The presence of both parents is an important protective factor for Brazilian youth vulnerable to multiple risks. Prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | QUESTIONNAIRE DESIGN | ADOLESCENTS | URBAN POPULATION | POVERTY | SLUMS | SEX BEHAVIOR | RISK BEHAVIOR | FAMILY AND HOUSEHOLD | FAMILY CHARACTERISTICS | PARENTAL INVOLVEMENT | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Survey Methodology | Surveys | Sampling Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Behavior | Sociocultural Factors | Child Rearing Document Number: 323967 |
| 25. Title: Effectiveness of combined strategies to improve low coverage of child immunization in urban slums of Bangladesh. Author: Uddin MJ; Larson CP; Oliveras E; Khan AI; Quaiyum MA; Saha NC; Khan IA; Shamsuzzaman Source: Dhaka, Bangladesh, International Centre for Diarrhoeal Disease Research, Bangladesh [ICDDR,B], 2008 Oct. 38 p. (ICDDR,B Working Paper No. 169) Abstract: Rapid urbanization, high density of population, and low coverage of immunization in urban slums call for the increased emphasis on immunization coverage for vulnerable urban poor children where spread of infection is faster. The study assessed the impact of an EPI intervention package to improve the coverage of child immunization in urban slums. This was an intervention trial with pre- and post-test design. The intervention package was tested for 12 months during September 2006-August 2007 in two purposively-selected urban slums of Dhaka city. The interventions package included: (a) a modified EPI service schedule, (b) training for service providers on valid doses, (c) a screening tool to identify immunization needs among clinic attendants, and (d) an EPI support groups for social mobilization. Data were drawn from the following three main sources: the random sample surveys to assess the immunization coverage (interview with mothers of children aged 12-23 months), service statistics, and qualitative data. Analysis of quantitative data was based on a before and after assessment of the selected immunization-coverage indicators by Pearson's chi-square test/proportions test and to compare means by t-test for continuous variables. Qualitative data collected through in-depth interviews and observations were analyzed using content analysis. The findings of the study revealed that 99% of 526 children were fully immunized after the implementation of the interventions while it was only 43% before their implementation, and the difference was highly significant. Antigen-wise coverage after the implementation of the interventions was also higher compared to before their implementation, and the difference was also highly significant. Only 1% drop-out was found after the implementation of the interventions while it was 33% before their implementation, and the difference was also highly significant. Not a single invalid dose was found after the implementation of the interventions while 22% of the children had invalid doses before their implementation. Although it was not possible to assess the individual contribution of each component intervention with great accuracy because of overlapping effects, the findings suggest that each intervention contributed to improving the coverage. Therefore, the policy-makers and programme manages should implement the package of successful interventions in all the slums of Bangladesh for improving the coverage of child immunization among this marginalized group of people. Manuals and guidelines need to be developed and distributed among service providers, and training for them is essential before scaling up of the interventions. Moreover, a team consisting of the partners of the study should provide technical assistance in scaling up the interventions. (author's) Language: English Keywords: BANGLADESH | SUMMARY REPORT | PRE-POST TESTS | URBAN AREAS | SLUMS | CHILDREN | IMMUNIZATION | IMMUNIZATION SCHEDULE | SCREENING | INTERVENTIONS | PROGRAM ACTIVITIES | IMPLEMENTATION | PROGRAM EVALUATION | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Geographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Youth | Age Factors | Population Characteristics | Demographic Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 328020 |
| 26. Peer Reviewed Title: HIV treatment in times of civil strife: serious threats to antiretroviral drug access in the Kibera slum following the Kenyan elections [letter] Author: Unge C; Sodergard B; Thorson A; Ragnarsson A; Carter J; Ilako F; Waweru M; Ekstrom AM Source: AIDS. 2008 Aug 20;22(13):1693-4. Abstract: Language: English Keywords: KENYA | RESEARCH REPORT | SLUMS | PERSONS LIVING WITH HIV/AIDS | VIOLENCE | HEALTH FACILITIES | ANTIRETROVIRAL THERAPY | TREATMENT | OBSTACLES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Behavior | Delivery of Health Care | Health | HIV | Medical Procedures | Medicine | Health Services | Organization and Administration Document Number: 328543 |
| 27. Peer Reviewed Title: Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. Author: Unge C; Johansson A; Zachariah R; Some D; Van Engelgem I Source: AIDS Care. 2008 Feb;20(2):146-149. Abstract: The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Medecins Sans Frontiers (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative semi-structured interviews were conducted with 26 patients, 9 men and 17 women. Six main reasons emerged for not accepting ART: a) fear of taking medication on an empty stomach due to lack of food; b) fear that side-effects associated with ART would make one more ill; c) fear of disclosure and its possible negative repercussions; d) concern for continuity of treatment and care; e) conflicting information from religious leaders and community, and seeking alternative care (e.g. traditional medicine); f) illiteracy making patients unable to understand the information given by health workers. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | SLUMS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | FEAR | SIDE EFFECTS | SOCIAL DISCRIMINATION | RELIGIOUS ASPECTS | TRADITIONAL HEALTH PRACTICES | ILLITERACY | BELIEFS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | HIV | Behavior | Emotions | Psychological Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Social Problems | Sociocultural Factors | Religion | Culture | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 324765 |
| 28. Peer Reviewed Title: HIV risk perception and constraints to protective behaviour among young slum dwellers in Ibadan, Nigeria. Author: Adedimeji AA; Omololu FO; Odutolu O Source: Journal of Health, Population and Nutrition. 2007 Jun;25(2):146-157. Abstract: This study examined the relationship between HIV/AIDS risk perception and protective behaviour among sexually-active urban young slum dwellers in Ibadan, Nigeria. The multistage sampling techniques were used for selecting 1,600 respondents aged 15-24 years. Of these, 1,042 (65%) respondents who reported unprotected sex in the last three months were selected for analysis. Although the sexually-active respondents demonstrated basic knowledge of HIV/AIDS and high risk perception, risky behaviour was common and protective behaviour was poor. About 48% of 505 males and 12% of 537 females had multiple partners. Similarly, 29% of males and 38% of females were engaged in transactional sex. Only 14% of males and 5% of females used any form of protection, resulting in the high rates of sexually transmitted infections reported by 27% of males and 10% of females. Structural and environmental constraints were identified as barriers to adopting protective behaviour. Therefore, programme and policy interventionsshould be designed to address the peculiar circumstances of urban young slum dwellers to curtail the HIV epidemic. (author's) Language: English Keywords: NIGERIA | SLUMS | RESEARCH REPORT | KAP SURVEYS | YOUTH | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | PERCEPTION | RISK REDUCTION BEHAVIOR | HIV PREVENTION | MULTIPLE PARTNERS | TRANSACTIONAL SEX | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Surveys | |