Living environment and health of under-five children in urban slums of a coastal region in South India

Objective: The primary objective of the study was to determine the association between the living environment and morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums in southern India. Methods: This study included 224 mothers of under-five children living in urban slums of Udupi Taluk, Karnataka. A total of 17 urban slums were selected randomly using random cluster sampling. Results: Undernutrition was high among children of illiterate mothers (63.8%), and the children of working mothers were affected by more morbidity (96.6%) as compared with housewives. Morbidity was also found to be high among children belonging to families with low incomes (66.1%) and low socio-economic backgrounds (93.1%). Safe drinking water, water supply, sanitation, hygiene, age of the child, mother’s and father’s education, mother’s occupation and age, number of children in the family, use of mosquito nets, type of household, and family income were significantly associated with child morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums. Conclusion: Overall, in our study, family characteristics including parental education, occupation and income were significantly associated with outcomes among under-five children. The availability of safe drinking water and sanitation, and the use of mosquito nets to prevent vector-borne diseases are basic needs that need to be urgently met to improve child health

Overview of migration, poverty and health dynamics in Nairobi City's slum settlements

The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents

A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India.

BackgroundLow-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work.MethodsThrough a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators.ResultsEven in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work.ConclusionThis qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated with negative mental health amongst specific population groups in order to ensure greater impact

Improving the health and welfare of people who live in slums

Summary In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health

Domestic unintentional injury of 1 to 5-year-old children in a rural area of West Bengal, India: a community-based study

Background: Childhood unintentional injury, a major public health problem in India, is largely preventable. The aim of this study was to determine the burden and determinants of unintentional injury of 12 to 59 months old child at household level.Method: A community based cross-sectional study was conducted at Singur block, Hooghly district, West Bengal, India among randomly chosen children using a predesigned and pretested interviewer administered questionnaire and a checklist for assessing household level injury hazard during the period of November 2015 to February 2016. Parental supervisory behaviour was assessed using PSAPQ questionnaire. Multivariable logistic regression was performed using SPSS 19.0 software.Result: A total of 163 were involved in the study. Over one-third (37.4%) of the children underwent any type of injury during last 3-month time period, predominant body part being upper limb. Parental supervisory behaviour [AOR-2.6, (95% CI-1.2-4.9)] and household level injury hazard (AOR-1.55, 95% CI- 1.3-1.7)] were found to be significant predictors of unintentional injury.Conclusion: Unintentional injury among children is prevalent in West Bengal in India. Dissemination of injury prevention information with special focus on household modification and increased parental supervision are effective strategies to prevent unintentional injury

Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009

Background Substantial progress has been made in reducing childhood mortality worldwide from 1990–2015 (Millennium Development Goal, target 4). Achieving target goals on this however remains a challenge in Sub-Saharan Africa. Kenya’s infant mortality rates are higher than the global average and are more pronounced in urban areas as compared to rural areas. Only limited knowledge exists about the differences in individual level risk factors for infant death among rural, non-slum urban, and slum areas in Kenya. Therefore, this paper aims at 1) assess individual and socio-ecological risk factors for infant death in Kenya, and at 2) identify whether living in rural, non-slum urban, or slum areas moderated individual or socio-ecological risk factors for infant death in Kenya. Methodology We used a cross-sectional study design based on the most recent Kenya Population and Housing Census of 2009 and extracted the records of all females who had their last child born in 12 months preceding the survey (N = 1,120,960). Multivariable regression analyses were used to identify risk factors that accounted for the risk of dying before the age of one at the individual level in Kenya. Place of residence (rural, non-slum urban, slum) was used as an interaction term to account for moderating effects in individual and socio-ecological risk factors. Results Individual characteristics of mothers and children (older age, less previously born children that died, better education, girl infants) and household contexts (better structural quality of housing, improved water and sanitation, married household head) were associated with lower risk for infant death in Kenya. Living in non-slum urban areas was associated with significantly lower infant death as compared to living in rural or slum areas, when all predictors were held at their reference levels. Moreover, place of residence was significantly moderating individual level predictors: As compared to rural areas, living in urban areas was a protective factor for mothers who had previous born children who died, and who were better educated. However, living in urban areas also reduced the health promoting effects of better structural quality of housing (i.e. poor or good versus non-durable). Furthermore, durable housing quality in urban areas turned out to be a risk factor for infant death as compared to rural areas. Living in slum areas was also a protective factor for mothers with previous child death, however it also reduced the promoting effects of older ages in mothers. Conclusions While urbanization and slum development continues in Kenya, public health interventions should invest in healthy environments that ideally would include improvements to access to safe water and sanitation, better structural quality of housing, and to access to education, health care, and family planning services, especially in urban slums and rural areas. In non-slum urban areas however, health education programs that target healthy diets and promote physical exercise may be an important adjunct to these structural interventions

Infant and Childhood Mortality Research in the Philippines: Review and Agenda

This article advocates for more focused research designs and the use of more complex causal models. Investigations of morbidity and mortality differentials indicate a higher death rate in urban than in rural areas. Further inquiry can be made to the dearth of studies conducted regarding mortality on infant and children.mortality rate, morbidity rate

Infant and Childhood Mortality Research in the Philippines: Review and Agenda

This article advocates for more focused research designs and the use of more complex causal models. Investigations of morbidity and mortality differentials indicate a higher death rate in urban than in rural areas. Further inquiry can be made to the dearth of studies conducted regarding mortality on infant and children.mortality rate, morbidity rate

Health consequences of violence within marriage: Need for strengthening the health sector response

This policy brief provides a synthesis of available evidence of the magnitude of marital violence experienced by women, including married young women, in India, and the ways in which the experience of physical and sexual violence within marriage compromises health, with a focus on sexual, reproductive, and child health, as well as mental health. It argues for strengthening the health sector response to address the needs of women who have experienced marital violence. Findings underscore the urgent need to strengthen efforts to prevent the incidence of marital violence. Recommendations include: sscreening and referring women who experience marital violence, screening activities provided in a wide range of services, and addressing provider-level barriers