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1.
Medicina (B Aires) ; 81(2): 135-142, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33906129

RESUMEN

Most countries in Latin America have already reported thousands of confirmed cases and vulnerable populations are the most affected by the coronavirus disease 2019 (COVID-19) pandemic. Preventive measures such as hygiene, social distancing, and isolation, essential to stop the spread of coronavirus, are difficult to accomplish for vulnerable populations due to their living conditions. Seroepidemiological surveys are assets to measure the transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until July 1st, the incidence rate of SARS-CoV-2 infection in Barrio Padre Mugica, one of the largest slums in Buenos Aires City, was 5.9%. This study aimed to establish the prevalence of SARS-CoV-2 antibodies immunoglobulin G (IgG) immediately after the outbreak, and to identify neighbourhood, household and individual factors associated with seroconversion. The prevalence based on IgG was 53.4% (95% CI 52.8% to 54.1%). For each polymerase chain reaction (RT-qPCR) confirmed case, nine people tested IgG positive, indicating a high rate of undetected (probably asymptomatic) infections. Hence, the high rate of undiagnosed people suggests that clinical criteria and epidemiological nexus should be considered. The high seroprevalence observed in the context of an intense epidemic in a vulnerable area might serve as a reference to other countries. This study contributes to future decision making by understanding population immunity against SARS-CoV2 and its relation to living conditions and foccus that comprehensive biosocial, household-level interventions are needed.


Asunto(s)
Áreas de Pobreza , Anticuerpos Antivirales , Humanos , ARN Viral , Estudios Seroepidemiológicos
2.
Artículo en Inglés | MEDLINE | ID: mdl-33807919

RESUMEN

BACKGROUND: Climate change influences patterns of human mobility and health outcomes. While much of the climate change and migration discourse is invested in quantitative predictions and debates about whether migration is adaptive or maladaptive, less attention has been paid to the voices of the people moving in the context of climate change with a focus on their health and wellbeing. This qualitative research aims to amplify the voices of migrants themselves to add nuance to dominant migration narratives and to shed light on the real-life challenges migrants face in meeting their health needs in the context of climate change. METHODS: We conducted 58 semi-structured in-depth interviews with migrants purposefully selected for having moved from rural Bhola, southern Bangladesh to an urban slum in Dhaka, Bangladesh. Transcripts were analysed using thematic analysis under the philosophical underpinnings of phenomenology. Coding was conducted using NVivo Pro 12. FINDINGS: We identified two overarching themes in the thematic analysis: Firstly, we identified the theme "A risk exchange: Exchanging climate change and health risks at origin and destination". Rather than describing a "net positive" or "net negative" outcome in terms of migration in the context of climate change, migrants described an exchange of hazards, exposures, and vulnerabilities at origin with those at destination, which challenged their capacity to adapt. This theme included several sub-themes-income and employment factors, changing food environment, shelter and water sanitation and hygiene (WaSH) conditions, and social capital. The second overarching theme was "A changing health and healthcare environment". This theme also included several sub-themes-changing physical and mental health status and a changing healthcare environment encompassing quality of care and barriers to accessing healthcare. Migrants described physical and mental health concerns and connected these experiences with their new environment. These two overarching themes were prevalent across the dataset, although each participant experienced and expressed them uniquely. CONCLUSION: Migrants who move in the context of climate change face a range of diverse health risks at the origin, en route, and at the destination. Migrating individuals, households, and communities undertake a risk exchange when they decide to move, which has diverse positive and negative consequences for their health and wellbeing. Along with changing health determinants is a changing healthcare environment where migrants face different choices, barriers, and quality of care. A more migrant-centric perspective as described in this paper could strengthen migration, climate, and health governance. Policymakers, urban planners, city corporations, and health practitioners should integrate the risk exchange into practice and policies.


Asunto(s)
Emigración e Inmigración , Migrantes , Bangladesh , Humanos , Renta , Áreas de Pobreza , Investigación Cualitativa
3.
BMJ Glob Health ; 6(4)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33926892

RESUMEN

INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities. RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45). CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.


Asunto(s)
/etnología , Grupos Étnicos/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Neumonía Viral , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estudios Seroepidemiológicos , Factores Socioeconómicos
4.
Ciênc. Saúde Colet ; 26(3): 1023-1033, mar. 2021. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1153816

RESUMEN

Resumo A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (β=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (β=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (β=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.


Abstract Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (β=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (β=1.40), and maximum per capita household income of the poorest fifth (β=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Infecciones por Coronavirus/epidemiología , Poblaciones Vulnerables , Análisis Espacio-Temporal , Factores Socioeconómicos , Brasil/epidemiología , Áreas de Pobreza , Comorbilidad , Incidencia , Teorema de Bayes , Factores de Edad , Densidad de Población , Ciudades/epidemiología , Salud Suburbana/estadística & datos numéricos , Escolaridad , Empleo/estadística & datos numéricos , Vivienda/normas , Renta , Persona de Mediana Edad
5.
J Racial Ethn Health Disparities ; 8(2): 280-282, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33742351

RESUMEN

With Black and Hispanic communities across the USA experiencing more detrimental negative effects from the COVID-19 pandemic as compared with other demographic groups, the virus has exposed the racial and ethnic disparities in treatment and care that public health experts have been grappling with for years. This paper explains how the systematic collection of racial and ethnic data gleaned from COVID-19 testing in underserved communities can be used to better understand this pandemic and inform measures within our control to prevent the spread of disease in the future.


Asunto(s)
Afroamericanos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Hispanoamericanos , /diagnóstico , Control de Enfermedades Transmisibles , Servicios de Salud Comunitaria , Redes Comunitarias , Accesibilidad a los Servicios de Salud , Humanos , Pobreza , Áreas de Pobreza , Estados Unidos
6.
PLoS One ; 16(3): e0248420, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33705480

RESUMEN

BACKGROUND: Coronavirus disease (COVID-19) is a highly transmittable virus that continues to disrupt livelihoods, particularly those of low-income segments of society, around the world. In Ethiopia, more specifically in the capital city of Addis Ababa, a sudden increase in the number of confirmed positive cases in high-risk groups of the community has been observed over the last few weeks of the first case. Therefore, this study aims to assess knowledge, practice and associated factors that can contribute to the prevention of COVID-19 among high-risk groups in Addis Ababa. METHODS: A cross-sectional in person survey (n = 6007) was conducted from 14-30 April, 2020 following a prioritization within high-risk groups in Addis Ababa. The study area targeted bus stations, public transport drivers, air transport infrastructure, health facilities, public and private pharmacies, hotels, government-owned and private banks, telecom centers, trade centers, orphanages, elderly centers, prison, prisons and selected slum areas where the people live in a crowded areas. A questionnaire comprised of four sections (demographics, knowledge, practice and reported symptoms) was used for data collection. The outcomes (knowledge on the transmission and prevention of COVID-19 and practice) were measured using four items. A multi variable logistic regression was applied with adjustment for potential confounding. RESULTS: About half (48%, 95% CI: 46-49) of the study participants had poor knowledge on the transmission mode of COVID-19 whereas six out of ten (60%, 95% CI: 58-61) had good knowledge on prevention methods for COVID-19. The practice of preventive measures towards COVID-19 was found to be low (49%, 95% CI: 48-50). Factors that influence knowledge on COVID-19 transmission mechanisms were female gender, older age, occupation (health care and grocery worker), lower income and the use of the 8335 free call centre. Older age, occupation (being a health worker), middle income, experience of respiratory illness and religion were significantly associated with being knowledgeable about the prevention methods for COVID-19. The study found that occupation, religion, income, knowledge on the transmission and prevention of COVID-19 were associated with the practice of precautionary measures towards COVID-19. CONCLUSION: The study highlighted that there was moderate knowledge about transmission modes and prevention mechanisms. Similarly, there was moderate practice of measures that contribute towards the prevention of COVID-19 among these priority and high-risk communities of Addis Ababa. There is an urgent need to fill the knowledge gap in terms of transmission mode and prevention methods of COVID-19 to improve prevention practices and control the spread of COVID-19. Use of female public figures and religious leaders could support the effort towards the increase in awareness.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Instituciones de Salud , Humanos , Masculino , Persona de Mediana Edad , Áreas de Pobreza , Prisiones , Instalaciones Públicas , Factores de Riesgo , Transportes , Adulto Joven
7.
BMC Public Health ; 21(1): 502, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33722207

RESUMEN

BACKGROUND: There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities. METHODS: In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities. RESULTS: The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m2 per person up to 67.7 m2 per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities. CONCLUSION: The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.


Asunto(s)
/transmisión , Aglomeración , Composición Familiar/etnología , Áreas de Pobreza , Bangladesh/epidemiología , Estudios Transversales , Humanos , Higiene/normas , Factores de Riesgo , Saneamiento/normas , Cuartos de Baño/normas , Población Urbana
8.
JAMA Netw Open ; 4(3): e210684, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33704475

RESUMEN

Importance: Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment. Objective: To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19. Design, Setting, and Participants: The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020. Main Outcomes and Measures: Themes and subthemes that reflected patient experiences. Results: Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates). Conclusions and Relevance: In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19-related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.


Asunto(s)
/etnología , Emigración e Inmigración , Empleo , Miedo , Conducta de Búsqueda de Ayuda , Hispanoamericanos , Hospitalización , Salud Pública , Adulto , California , Colorado , Comunicación , Estatus Económico , Femenino , Gastos en Salud , Humanos , Masculino , Persona de Mediana Edad , Áreas de Pobreza , Investigación Cualitativa , Ausencia por Enfermedad , Clase Social , Normas Sociales , Inmigrantes Indocumentados
9.
Cien Saude Colet ; 26(3): 1023-1033, 2021 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33729356

RESUMEN

Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (ß=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (ß=1.40), and maximum per capita household income of the poorest fifth (ß=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.


Asunto(s)
/epidemiología , Análisis Espacio-Temporal , Poblaciones Vulnerables , Adulto , Factores de Edad , Teorema de Bayes , Brasil/epidemiología , Ciudades/epidemiología , Comorbilidad , Escolaridad , Empleo/estadística & datos numéricos , Femenino , Vivienda/normas , Humanos , Incidencia , Renta , Masculino , Persona de Mediana Edad , Densidad de Población , Áreas de Pobreza , Factores Socioeconómicos , Salud Suburbana/estadística & datos numéricos
10.
BMC Infect Dis ; 21(1): 201, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33622284

RESUMEN

BACKGROUND: In Mozambique, infection by intestinal parasites is reported all over the country. However, infection in children with diarrhoea is mostly focused in the southern region of Mozambique. This work aims to determine the frequency and potential risk factors for infection by Cryptosporidium spp., Giardia lamblia, and Entamoeba histolytica in children under-five years hospitalized with diarrhoea in Hospital Central de Nampula, northern Mozambique. METHODS: A cross-sectional hospital-based surveillance was conducted between March 2015 and January 2018 in children admitted with diarrhoea in Hospital Central de Nampula. Sociodemographic information was obtained through semi-structured interviews applied to the children's caregivers. A single stool sample was collected from each child to detect antigens from Cryptosporidium spp., G. lamblia, and E. histolytica using an immune-enzymatic technique. Crude and adjusted odds ratios (with 95% Confidence Intervals) were obtained by logistic regression models to identify factors associated with infection by Cryptosporidium spp. and G. lamblia. RESULTS: The median age and interquartile intervals of our sample population was 12 months (8-20). Intestinal protozoa were detected in 21.4% (59/276). Cryptosporidium spp. was the most common protozoa (13.9% - 38/274), followed by G. lamblia (9.1% - 25/274) and E. histolytica (0.4% - 1/275). Children with illiterate caregiver's (p-value = 0.042) and undernourished (p-value = 0.011) were more likely to be infected by Cryptosporidium spp. G. lamblia was more common in children living in households with more than four members (p-value = 0.039). E. histolytica was detected in an eleven month's child, co-infected with Cryptosporidium spp. and undernourished. CONCLUSION: Cryptosporidium spp. and Giardia lamblia were the most common pathogenic intestinal protozoa detected in children with diarrhoea hospitalized in the Hospital Central de Nampula. Our findings obtained highlight the importance of exploring the caregiver's education level, children's nutritional status for infections with Cryptosporidium spp., and living conditions, namely crowded households for infections with G. lamblia in children younger than five years.


Asunto(s)
Diarrea/epidemiología , Diarrea/parasitología , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Áreas de Pobreza , Preescolar , Coinfección/epidemiología , Coinfección/parasitología , Estudios Transversales , Heces/parasitología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Mozambique/epidemiología , Factores de Riesgo
11.
Epidemiol Infect ; 149: e39, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33536108

RESUMEN

People living in urban slums or informal settlements are among the most vulnerable communities, highly susceptible to coronavirus disease 2019 (COVID-19) infection and vulnerable to the consequences of the measures taken to control the spread of the virus. Fear and stigma related to infection, mistrust between officials and the population, the often-asymptomatic nature of the disease is likely to lead to under-reporting. We conducted a cross-sectional study to determine the seroprevalence of COVID-19 infection in a large slum in South India 3 months after the index case and recruited 499 adults (age >18 years). The majority (74.3%) were females and about one-third of the population reported comorbidities. The overall seroprevalence of IgG antibody for COVID-19 was 57.9% (95% CI 53.4-62.3). Age, education, occupation and the presence of reported comorbidities were not associated with seroprevalence (P-value >0.05). Case-to-undetected-infections ratio was 1:195 and infection fatality rate was calculated as 2.94 per 10 000 infections. We estimated seroprevalence of COVID-19 was very high in our study population. The focus in this slum should shift from infection prevention to managing the indirect consequences of the pandemic. We recommend seroprevalence studies in such settings before vaccination to identify the vulnerability of COVID-19 infection to optimise the use of insufficient resources. It is a wake-up call to societies and nations, to dedicate paramount attention to slums into recovery and beyond - to build, restore and maintain health equity for the 'Health and wellbeing of all'.


Asunto(s)
/epidemiología , Áreas de Pobreza , Adulto , Factores de Edad , Comorbilidad , Estudios Transversales , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estudios Seroepidemiológicos , Encuestas y Cuestionarios , Poblaciones Vulnerables/estadística & datos numéricos , Adulto Joven
12.
J Urban Health ; 98(2): 211-221, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33533010

RESUMEN

Nairobi's urban slums are ill equipped to prevent spread of the novel coronavirus disease (COVID-19) due to high population density, multigenerational families in poorly ventilated informal housing, and poor sanitation. Physical distancing policies, curfews, and a citywide lockdown were implemented in March and April 2020 resulting in sharp decreases in movement across the city. However, most people cannot afford to stay home completely (e.g., leaving daily to fetch water). If still employed, they may need to travel longer distances for work, potentially exposing them COVID-19 or contributing to its spread. We conducted a household survey across five urban slums to describe factors associated with mobility in the previous 24 h. A total of 1695 adults were interviewed, 63% female. Of these, most reported neighborhood mobility within their informal settlement (54%), 19% stayed home completely, and 27% reported long-distance mobility outside their informal settlement, mainly for work. In adjusted multinomial regression models, women were 58% more likely than men to stay home (relative risk ratio (RRR): 1.58, 95% confidence interval (CI): 1.16, 2.14) and women were 60% less likely than men to report citywide mobility (RRR: 0.40; 95% CI 0.31, 0.52). Individuals in the wealthiest quintile, particularly younger women, were most likely to not leave home at all. Those who reported citywide travel were less likely to have lost employment (RRR: 0.49; 95% CI 0.38, 0.65) and were less likely to avoid public transportation (RRR: 0.30; 95% CI 0.23, 0.39). Employment and job hunting were the main reasons for traveling outside of the slum; less than 20% report other reasons. Our findings suggest that slum residents who retain their employment are traveling larger distances across Nairobi, using public transportation, and are more likely to be male; this travel may put them at higher risk of COVID-19 infection but is necessary to maintain income. Steps to protect workers from COVID-19 both in the workplace and while in transit (including masks, hand sanitizer stations, and reduced capacity on public transportation) are critical as economic insecurity in the city increases due to COVID-19 mitigation measures. Workers must be able to commute and maintain employment to not be driven further into poverty. Additionally, to protect the majority of individuals who are only travelling locally within their settlement, mitigation measures such as making masks and handwashing stations accessible within informal settlements must also be implemented, with special attention to the burden placed on women.


Asunto(s)
Control de Enfermedades Transmisibles , Adulto , Femenino , Humanos , Kenia , Masculino , Áreas de Pobreza
13.
Santiago; PAHO; 2021-02-11.
en Portugués | PAHO-IRIS | ID: phr-53264

RESUMEN

Durante 2019, 7,4% da população da América Latina e do Caribe conviveu com a fome, o que equivale a 47,7 milhões de pessoas. A situação vem se deteriorando nos últimos 5 anos, com um aumento de 13,2 milhões de pessoas subalimentadas. Se essa tendência continuar, a possibilidade de cumprimento da meta Fome Zero da Meta 2 (ODS2) dos Objetivos de Desenvolvimento Sustentável (ODS) está se afastando. Estima-se que, em 2030, a fome afetará 67 milhões de pessoas na região, número que não inclui as repercussões da pandemia de COVID-19. A população afetada pela insegurança alimentar continuou a aumentar na América Latina durante os últimos 5 anos. Em 2019, quase um terço da população, ou seja, 191 milhões de pessoas, foram afetadas pela insegurança alimentar moderada ou grave. O atraso do crescimento infantil está diminuindo na região e o sobrepeso entre as crianças com menos de 5 anos de idade está aumentando. Informações recentes sobre a desnutrição nos países da região, mostram que cerca de um em cada cinco territórios está muito atrasado, seja devido à baixa estatura ou ao sobrepeso em crianças menores de 5 anos. Os níveis mais altos de atraso no crescimento encontram-se nas áreas rurais que têm alto índice de pobreza, baixa renda, baixa escolaridade, maior grau de informalidade no emprego, menor acesso a serviços e maior proporção de população indígena e afrodescendente. O sobrepeso parece estar distribuído geograficamente de forma mais homogênea. Contudo, os territórios mais atrasados tendem a se concentrar nas áreas urbanas, com maiores rendas, menor pobreza, maior acesso a serviços e maior formalidade de trabalho. Embora a real dimensão do impacto da pandemia de coronavírus ainda seja desconhecida, ela ameaça ampliar essas diferenças e as lacunas entre territórios atrasados e não atrasados. A pandemia atinge especialmente as populações e territórios mais vulneráveis, onde existe um maior número de empregos informais, os rendimentos são mais baixos e os alimentos saudáveis são escassos. Enfrentar o problema da segurança alimentar e nutricional em territórios atrasados requer intervenções multidimensionais que abordem as várias causas da má nutrição de forma integrada e que ofereçam uma resposta coordenada em várias dimensões do desenvolvimento. O Panorama descreve algumas das principais intervenções políticas que são desenvolvidas na região em torno de três grupos de medidas com foco em: 1) melhorar e promover o acesso econômico a alimentação adequada, 2) melhorar o acesso físico aos alimentos e produzir alimentos que promovam uma nutrição adequada e 3) melhorar o uso e a qualidade dos alimentos.


Asunto(s)
Nutrición, Alimentación y Dieta , Alimentos , Hambre , Nutrición de los Grupos de Riesgo , Desarrollo Sostenible , Indicadores de Desarrollo Sostenible , Infecciones por Coronavirus , Coronavirus , Infecciones por Coronavirus , Betacoronavirus , Pobreza , Áreas de Pobreza
14.
Santiago; PAHO; 2021-02-11.
en Inglés | PAHO-IRIS | ID: phr-53263

RESUMEN

During 2019, 7.4 percent of the population in Latin America and the Caribbean (LAC) lived in hunger, which is equivalent to 47.7 million people. The situation has been deteriorating over the past 5 years, with an increase of 13.2 million undernourished people. If this trend continues, the possibility of meeting the Zero Hunger target of Goal 2 (SDG2) of the Sustainable Development Goals (SDG) will be even further away. It is estimated that, in 2030, hunger will affect 67 million people in the region, a figure that does not take into account repercussions of the COVID-19 pandemic. The population affected by food insecurity in Latin America has continued to increase over the past 5 years. In 2019, almost a third of the population, or 191 million people, were affected by moderate or severe food insecurity. In the region, child stunting is decreasing and overweight in children under 5 is increasing. Recent information on malnutrition in the region’s countries shows that nearly one in every 5 territories is lagging in relation to either stunting or overweight in children under 5. The highest lags in relation to stunting are found in rural areas. These territories have high levels of poverty, low income, low schooling rate, a higher presence of informal employment, less access to services and a higher proportion of indigenous and Afro-descendant population. Overweight in children under 5 seems to be geographically distributed in a more homogeneous way. However, highly lagging territories tend to be concentrated in urban areas, with higher incomes, lower poverty, greater access to services and more formal labor. Although the real dimension of the impact of the coronavirus pandemic is still unknown, it threatens to widen these differences and the gaps between lagging and non-lagging territories. The pandemic hits the most vulnerable populations and territories particularly hard, where there are a greater number of informal jobs, incomes are lower and healthy food is scarce. Addressing the problem of food security and nutrition in lagging territories requires multidimensional interventions that address the various causes of malnutrition in an integrated manner, and that offer a coordinated response across various dimensions of development. This Regional Overview describes some of the main policy interventions that are being carried out in the region within three groups of measures focused on: 1) improving and promoting economic access to adequate food, 2) improving physical access to food and the production of food that promotes adequate nutrition, and 3) improving food use and quality.


Asunto(s)
Nutrición, Alimentación y Dieta , Alimentos , Hambre , Nutrición de los Grupos de Riesgo , Desarrollo Sostenible , Indicadores de Desarrollo Sostenible , Infecciones por Coronavirus , Infecciones por Coronavirus , Coronavirus , Betacoronavirus , Pobreza , Áreas de Pobreza
15.
J Prim Care Community Health ; 12: 2150132720987432, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33448254

RESUMEN

A "superspreader" refers to an unusually contagious organism infected with a disease. With respect to a human borne illnesses, a superspreader is someone who is more likely to infect other humans when compared to a typically infected person. The existence of human superspreaders is deeply entrenched in history; the most famous case being that of Typhoid Mary. Through contact tracing, epidemiologists have identified human superspreaders in measles, tuberculosis, rubella, monkeypox, smallpox, Ebola hemorrhagic fever, and SARS. The recent outbreak of Coronavirus disease (COVID-19) has shifted the focus back on the superspreaders. We herein present a case report of a COVID-19 superspreader with a hitherto unusually high number of infected contacts. The index case was a 33 year old male who resided in a low income settlement comprising of rehabilitated slum dwellers and worked as a healthcare worker (HCW) in a tertiary care hospital and had tested positive for COVID-19.On contact tracing, he had a total of 125 contacts, of which 49 COVID-19 infections had direct or indirect contact with the index case, qualifying him as a "superspreader." This propagated infection led to an outbreak in the community. Contact tracing, testing and isolation of such superspreaders from the other members of the community is essential to stop the spread of this disease and contain the COVID-19 pandemic.


Asunto(s)
Número Básico de Reproducción , Trazado de Contacto , Personal de Salud , Adulto , Tos/fisiopatología , Brotes de Enfermedades , Fiebre/fisiopatología , Humanos , India , Masculino , Faringitis/fisiopatología , Áreas de Pobreza , Centros de Atención Terciaria , Lugar de Trabajo
16.
Mymensingh Med J ; 30(1): 196-201, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397874

RESUMEN

Malnutrition is a serious public health problem that has been linked to increase risk of morbidity and mortality in slums of Dhaka city and where the prevalence of malnutrition is very high. This study was conducted to evaluate the risk factors of malnutrition among under-5 children of selective slum area in Dhaka City. This cross sectional study was conducted from January 2016 to December 2019, among 500 under-5 children selected by random sampling technique from Agargaon and Beribadh slums of Dhaka city. Anthropometric measurements were taken using standard methods those were weight, height, MUAC and age. A questionnaire was ready for data collection containing episode of diseases, breast feeding status, complementary feeding, family size, family income, maternal education status, housing, source of drinking water etc in under-5 children. Data were analyzed by using SPSS version 21.0. Among 500 children from slums area, malnutrition was present in 220(44%) cases. Out of them 115(23%) children were wasted, 205(41%) children were stunted and 175(35%) children were underweight. Malnutrition was found significantly high among non-breast feed babies, who breast feed only for 6 months, in whom colostrum was not given and also when complimentary feeding was not given properly (p<0.05). Malnourished children were found significantly higher among illiterate mothers and those who used Kancha house (p<0.05). Wasting, stunting and underweight were more with increasing family size. There were a decreased number of malnutrition cases when family income rises. Diarrhoea and ARI was significantly associated with malnutrition (p<0.05). Large number of children in slum areas of Dhaka city was suffering from malnutrition. Malnutrition was significantly higher among children who did not get colostrum; non-breast fed and got improper complimentary feeding. Maternal illiteracy, living in Kancha house, large family size, family income and associated disease condition were also contributed to malnutrition.


Asunto(s)
Desnutrición , Áreas de Pobreza , Bangladesh/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Lactante , Desnutrición/epidemiología , Prevalencia , Factores de Riesgo
17.
BMC Public Health ; 21(1): 176, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478445

RESUMEN

The response to the coronavirus outbreak and how the disease and its societal consequences pose risks to already vulnerable groups such those who are socioeconomically disadvantaged and ethnic minority groups. Researchers and community groups analysed how the COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity, and discussed future strategies on how best to engage and involve local groups in research to improve outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity. Discussions centred around: access, engagement and quality of care; racism, discrimination and trust; the need for engagement with community stakeholders; and the impact of wider social and economic inequalities. Addressing biomedical factors alone is not sufficient, and integrative and holistic long-term public health strategies that address societal and structural racism and overall disadvantage in society are urgently needed to improve health disparities and can only be implemented in partnership with local communities.


Asunto(s)
Disparidades en el Estado de Salud , Salud Materna , Características de la Residencia/estadística & datos numéricos , /epidemiología , Diversidad Cultural , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Salud Materna/etnología , Áreas de Pobreza , Embarazo , Reino Unido/epidemiología
18.
J Nerv Ment Dis ; 209(2): 92-99, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33502140

RESUMEN

ABSTRACT: Mental health clients with serious mental illness in urban settings experience multiple chronic stresses related to poverty, unemployment, discrimination, homelessness, incarceration, hospitalization, posttraumatic stress disorder, pain syndromes, traumatic brain injury, and other problems. Substance use disorder exacerbates these difficulties. This study examined the efficacy of algorithm-driven substance use disorder treatments for 305 inner-city mental health clients with multiple challenges. Researchers assessed substance use quarterly using a combination of standardized self-reports and case manager ratings. Of the 305 multiply impaired clients who began treatment, 200 (66%) completed 2 years of treatment. One fourth (n = 53) of the completers were responders who developed abstinence and improved community function; one half (n = 97) were partial responders, who reduced substance use but did not become abstinent; and one fourth (n = 50) were nonresponders. Evidence-based interventions for substance use disorder can be effective for multiply impaired, inner-city clients, but numerous complications may hinder recovery.


Asunto(s)
Trastornos Mentales/complicaciones , Trastornos Relacionados con Sustancias/terapia , Adulto , Anciano , Algoritmos , Femenino , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Áreas de Pobreza , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Resultado del Tratamiento , Adulto Joven
19.
J R Soc Interface ; 18(174): 20200599, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33468021

RESUMEN

We study the spread of COVID-19 across neighbourhoods of cities in the developing world and find that small numbers of neighbourhoods account for a majority of cases (k-index approx. 0.7). We also find that the countrywide distribution of cases across states/provinces in these nations also displays similar inequality, indicating self-similarity across scales. Neighbourhoods with slums are found to contain the highest density of cases across all cities under consideration, revealing that slums constitute the most at-risk urban locations in this epidemic. We present a stochastic network model to study the spread of a respiratory epidemic through physically proximate and accidental daily human contacts in a city, and simulate outcomes for a city with two kinds of neighbourhoods-slum and non-slum. The model reproduces observed empirical outcomes for a broad set of parameter values-reflecting the potential validity of these findings for epidemic spread in general, especially across cities of the developing world. We also find that distribution of cases becomes less unequal as the epidemic runs its course, and that both peak and cumulative caseloads are worse for slum neighbourhoods than non-slums at the end of an epidemic. Large slums in the developing world, therefore, contain the most vulnerable populations in an outbreak, and the continuing growth of metropolises in Asia and Africa presents significant challenges for future respiratory outbreaks from perspectives of public health and socioeconomic equity.


Asunto(s)
/epidemiología , Países en Desarrollo , Áreas de Pobreza , Población Urbana , /economía , Ciudades/epidemiología , Humanos
20.
BMJ Open ; 11(1): e044592, 2021 01 20.
Artículo en Inglés | MEDLINE | ID: mdl-33472790

RESUMEN

OBJECTIVE: To summarise the unfolding of the COVID-19 epidemic among slum dwellers and different social strata in the city of Buenos Aires during the first 20 weeks after the first reported case. DESIGN: Observational study using a time-series analysis. Natural experiment in a big city. SETTING: Population of the city of Buenos Aires and the integrated health reporting system records of positive RT-PCR for COVID-19 tests. PARTICIPANTS: Records from the Argentine Integrated Health Reporting System for all persons with suspected and RT-PCR-confirmed diagnosis of COVID-19 between 31 January and 14 July 2020. OUTCOMES: To estimate the effects of living in a slum on the standardised incidence rate of COVID-19, corrected Poisson regression models were used. Additionally, the impact of socioeconomic status was performed using an ecological analysis at the community level. RESULTS: A total of 114 052 people were tested for symptoms related with COVID-19. Of these, 39 039 (34.2%) were RT-PCR positive. The incidence rates for COVID-19 towards the end of the 20th week were 160 (155 to 165) per 100 000 people among the inhabitants who did not reside in the slums (n=2 841 997) and 708 (674 to 642) among slums dwellers (n=233 749). Compared with the better-off socioeconomic quintile (1.00), there was a linear gradient on incidence rates: 1.36 (1.25 to 1.46), 1.61 (1.49 to 1.74), 1.86 (1.72 to 2.01), 2.94 (2.74 to 3.16) from Q2 to Q5, respectively. Slum dwellers were associated with an incidence rate of 14.3 (13.4 to 15.4). CONCLUSIONS: The distribution of the epidemic is socially conditioned. Slum dwellers are at a much higher risk than the rest of the community. Slum dwellers should not be considered just another risk category but an entirely different reality that requires policies tailored to their needs.


Asunto(s)
/estadística & datos numéricos , Disparidades en el Estado de Salud , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Niño , Preescolar , Femenino , Política de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Adulto Joven
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