Prevalence of HIV in slums area: a systematic review and meta-analysis.

BACKGROUND: Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations. METHODS: A rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle-Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I2 test. Publication bias was also assessed using Egger's test. Additionally, subgroup analysis was performed to explore potential factors contributing to the observed heterogeneity. RESULTS: A systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI: 7-13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI: 8-19%, 18 studies: I2 = 98%), as opposed to men, where the prevalence was found to be 8% (95% CI: 6-12%, 16 studies: I2 = 95%). A geographical breakdown of the included studies revealed that Africa exhibited the highest prevalence, with a figure of 11% (95% CI: 9-13%, 18 studies: I2 = 98%). Subsequently, studies conducted in the American continent reported a prevalence of 9% (95% CI: 7-11%, 2 studies: I2 = 57%). The Asian continent, on the other hand, displayed the lowest prevalence of 1% (95% CI: 0-3%, 2 studies: I2 = 94%). Notably, studies employing rapid tests indicated a prevalence of 13% (95% CI: 9-17%, 6 studies: I2 = 94%), while those relying on self-reported data reported a lower prevalence of 8% (95% CI: 5-11%, 6 studies: I2 = 99%). Moreover, studies utilizing ELISA reported a prevalence of 9% (95% CI: 6-12%, 10 studies: I2 = 96%). Finally, it was determined that studies conducted in upper-middle-income countries reported a higher prevalence of 20% (95% CI: 16-24%, 5 studies: I2 = 45%), whereas studies conducted in lower- and middle-income countries reported a prevalence of 8% (95% CI: 6-10%, 12 studies: I2 = 98%). CONCLUSION: The current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.

To What Extent Are Informal Healthcare Providers in Slums Linked to the Formal Health System in Providing Services in Sub-Sahara Africa? A 12-Year Scoping Review.

The contributions of informal providers to the urban health system and their linkage to the formal health system require more evidence. This paper highlights the collaborations that exist between informal providers and the formal health system and examines how these collaborations have contributed to strengthening urban health systems in sub-Sahara Africa. The study is based on a scoping review of literature that was published from 2011 to 2023 with a focus on slums in sub-Sahara Africa. Electronic search for articles was performed in Google, Google Scholar, PubMed, African Journal Online (AJOL), Directory of Open Access Journals (DOAJ), ScienceDirect, Web of Science, Hinari, ResearchGate, and yippy.com. Data extraction was done using the WHO health systems building blocks. The review identified 26 publications that referred to collaborations between informal providers and formal health systems in healthcare delivery. The collaboration is manifested through formal health providers registering and standardizing the practice of informal health providers. They also participate in training informal providers and providing free medical commodities for them. Additionally, there were numerous instances of client referrals, either from informal to formal providers or from formal to informal providers. However, the review also indicates that these collaborations are unformalized, unsystematic, and largely undocumented. This undermines the potential contributions of informal providers to the urban health system.

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study.

BACKGROUND: India is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population. METHODS: A community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person. RESULTS: The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02-1.09). Physical inactivity (AOR 1.68, 95% CI 1.027-2.77) and lack of social support (AOR 1.57, 95% CI 1.01-2.45) also increased the likelihood of multimorbidity. CONCLUSION: There is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda.

BACKGROUND: Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with illicit drug and high-risk alcohol consumption. METHODS: We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25 March 2019 to 30 March 2020. Data was collected on social demographics, sexual behavior, and reproductive health using interviewer-administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. RESULTS: We enrolled 490 participants (60.6% female) with a median age of 18 (IQR 17-18) years, 84.9% had less than secondary education, 48.4% had their sexual debut before 15 years, 47.1% reported paid sex in the past 3 months and 22.8% had a sexually transmitted infection (chlamydia, gonorrhea, and active syphilis) baseline characteristics associated with illicit drug use in the past 3 months were male gender (aOR 12.45; 95% CI 7.21-21.50) being married (aOR 2.26; 95%CI 1.03-4.94) 10 or more paying sexual partners (aOR 2.45; 95%CI 1.05-5.69) and high-risk alcohol use (aOR 3.94; 95%CI 2.10-7.40), baseline characteristics associated with high-risk alcohol use were male gender (aOR 0.29; 95% CI 0.13-0.63) emotional violence from sexual partners (aOR 2.35; 95%CI 1.32-418) illicit drug users com (aOR 3.94; 95% CI 2.10-7.40). CONCLUSION: Illicit drug and high-risk alcohol use are prevalent among male adolescents and adolescents involved in high-risk sexual behavior living in the urban slums of Kampala.

Community stigma, victimization, and coping strategies among gay, bisexual, and other cis-gender men who have sex with men in slum communities in Ghana. BSGH-003.

BACKGROUND: Gay, bisexual, and cis-gender men who have sex with men (GBMSM) face severe consequences, especially within stigmatized environments. However, very little is known about the experiences of GBMSM living in slums in SSA and Ghana. This study investigates the experiences of stigma, victimization, and coping strategies and proposes some interventional approaches for combating stigma facing GBMSM in slum communities. METHODS: We engaged GBMSM living in slums in two major Ghanaian cities. We used a time-location sampling and collected data through in-depth individual interviews. Two major themes emerged from the study: (1) insecurities and criminalization of GBMSM activity, and (2) GBMSM coping strategies. RESULTS: Findings show GBMSM experienced negative attitudes from the community due to their sexual behavior/orientation. GBMSM also developed coping strategies to avert negative experiences, such as hiding their identities/behavior, avoiding gender non-conforming men, and having relationships with persons outside their communities. CONCLUSION: We propose interventions such as HIV Education, Empathy, Empowerment, Acceptance, and Commitment Therapy as possible measures to improve the experiences of GBMSM living in Ghanaian slum communities.

Reproductive health service access and utilisation among migrant women in Dhaka's urban slums: a qualitative study.

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18-49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.

Social determinants of chronic diseases reporting among slum dwellers in Egypt.

The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents' health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.

A scoping review on the associations between early childhood caries and sustainable cities and communities using the sustainable development goal 11 framework.

BACKGROUND: Early childhood caries (ECC) is a multifactorial disease in which environmental factors could play a role. The purpose of this scoping review was to map the published literature that assessed the association between the Sustainable Development Goal (SDG) 11, which tried to make cities and human settlements safe, inclusive, resilient and sustainable, and ECC. METHODS: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to housing, urbanization, waste management practices, and ECC. Studies that solely examined ECC prevalence without reference to SDG11 goals were excluded. Of those that met the inclusion criteria, a summary highlighting the countries and regions where the studies were conducted, the study designs employed, and the findings were done. In addition, the studies were also linked to relevant SDG11 targets. RESULTS: Ten studies met the inclusion criteria with none from the African Region. Six studies assessed the association between housing and ECC, with findings suggesting that children whose parents owned a house had lower ECC prevalence and severity. Other house related parameters explored were size, number of rooms, cost and building materials used. The only study on the relationship between the prevalence of ECC and waste management modalities at the household showed no statistically significant association. Five studies identified a relationship between urbanization and ECC (urbanization, size, and remoteness of the residential) with results suggesting that there was no significant link between ECC and urbanization in high-income countries contrary to observations in low and middle-income countries. No study assessed the relationship between living in slums, natural disasters and ECC. We identified links between ECC and SDG11.1 and SDG 11.3. The analysis of the findings suggests a plausible link between ECC and SDG11C (Supporting least developed countries to build resilient buildings). CONCLUSION: There are few studies identifying links between ECC and SDG11, with the findings suggesting the possible differences in the impact of urbanization on ECC by country income-level and home ownership as a protective factor from ECC. Further research is needed to explore measures of sustainable cities and their links with ECC within the context of the SDG11.

Food Vendors and the Obesogenic Food Environment of an Informal Settlement in Nairobi, Kenya: a Descriptive and Spatial Analysis.

Food environments of urban informal settlements are likely drivers of dietary intake among residents of such settlements. Yet, few attempts have been made to describe them. The objective of this study was to characterize the food environment of a densely-populated informal settlement in Nairobi, Kenya according to the obesogenic properties and spatial distribution of its food vendors. In July-August 2019, we identified food vendors in the settlement and classified them into obesogenic risk categories based on the types of food that they sold. We calculated descriptive statistics and assessed clustering according to obesogenic risk using Ripley's K function. Foods most commonly sold among the 456 vendors in the analytic sample were sweets/confectionary (29% of vendors), raw vegetables (28%), fried starches (23%), and fruits (21%). Forty-four percent of vendors were classified as low-risk, protective; 34% as high-risk, non-protective; 16% as low-risk, non-protective; and 6% as high-risk, protective. The mean distance (95% confidence interval) to the nearest vendor of the same obesogenic risk category was 26 m (21, 31) for vendors in the low-risk, protective group; 29 m (25, 33) in the high-risk, non-protective group; 114 m (88, 139) in the high-risk, protective group; and 43 m (30, 56) in the low-risk, non-protective group. Clustering was significant for all obesogenic risk groups except for the high-risk, protective. Our findings indicate a duality of obesogenic and anti-obesogenic foods in this environment. Clustering of obesogenic foods highlights the need for local officials to take action to increase access to health-promoting foods throughout informal settlements.

Food price volatility and socio-economic inequalities in poor food consumption status during coronavirus disease-2019 lockdown among slum and non-slum households in urban Nansana municipality, Uganda.

BACKGROUND: This study assessed staple food price volatility, household food consumption scores (FCS), poor household food consumption status and its association with socio-economic inequalities during enforcing and partial lifting of coronavirus disease-2019 (COVID-19) lockdown restrictions in slum and non-slum households (HHs) of Nansana municipality, Uganda. METHODS: Repeated cross-sectional surveys were conducted during enforcing and partial lifting of COVID-19 lockdown restrictions. A total of 205 slum and 200 non-slum HHs were selected for the study. Telephone based interviews with HH heads were used to collect data on socio-economic factors. Data for FCS was collected using the World Food Programme FCS method. Prices for staple foods were collected by face-to-face interviews with food vendors from the local market. Mean staple food price differences before COVID-19 lockdown, during enforcing, and partial lifting of lockdown was tested by Analysis of variance with repeated measures. Multivariate logistic regression analysis was used to assess the association between socio-economic variables and poor food consumption status. A statistical test was considered significant at p < 0.05. RESULTS: Mean staple food prices were significantly higher during enforcing COVID-19 total lockdown restrictions compared to either 1 week before lockdown or partial lifting of lockdown (p < 0.05). Mean FCS for staple cereals and legumes were significantly higher in slum HHs during COVID-19 lockdown compared to when the lockdown was partially lifted (p < 0.05). In slum HHs, the prevalence of poor food consumption status was significantly higher during partial lifting (55.1%) compared to total lockdown of COVID-19 (15.1%), p < 0.05. Among slum HHs during lockdown restrictions, food aid distribution was negatively associated with poor food consumption status (AOR: 0.4, 95% CI: 0.1-0.6), whilst being a daily wage earner was positively associated with poor food consumption status (AOR: 0.5, 95% CI: 0.1-0.6). During partial lifting of COVID-19 lockdown in slum HHs, poor food consumption status was positively associated with female headed HHs (AOR: 1.2, 95%CI: 1.1-1.6), daily wage earners (AOR: 3.2, 95% CI: 2.6-3.8), unemployment (AOR: 1.9, 95% CI: 1.5-2.1) and tenants (AOR: 2.4, 95% CI: 1.8-3.5). Female headed HHs, daily wage earners and tenants were positively associated with poor food consumption status either during enforcing or partial lifting of COVID-19 lockdown restrictions in non-slum HHs. CONCLUSION: Staple food prices increased during enforcing either the COVID-19 lockdown or partial lifting of the lockdown compared to before the lockdown. During the lockdown, food consumption improved in slum HHs that received food aid compared to those slum HHs that did not receive it. Household heads who were females, daily wage earners, unemployed, and tenants were at risk of poor food consumption status either in slum or non-slum, and therefore needed some form of food assistance either during enforcing or partial lifting of the lockdown.

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers.

BACKGROUND: It is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda. METHODS: A qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software. RESULTS: The main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care. CONCLUSIONS: Despite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Food insecurity and associated factors among households with under-5 children in slum communities in Ibadan, Nigeria.

INTRODUCTION: Food insecurity is a leading cause of childhood morbidity and mortality. This study assessed the prevalence of household food insecurity and its associated factors among under-5 children in Ibadan, Nigeria. METHODS: This was a cross-sectional household survey of 1,027 under-5 children and their caregivers in urban and rural slums in Ibadan. We used an electronic interviewer-administered, semi-structured questionnaire adapted from the Nigeria Demographic Health Survey and Household Food Insecurity Access Scale was used to report sociodemo-economic characteristics, food insecurity, and anthropometric measurement. The household food insecurity scale consisted of nine questions graded from 0 (Never) to 3 (Often) computed to determine the presence of food insecurity. Nutrition indices were computed, and the results were classified according to World Health Organization 2006 cut-off points. Chi-square tests were used to assess associations between food insecurity and the independent variables. Binary logistic regression analyses were conducted to identify the predictors of food insecurity (α = 0.05). RESULTS: The mean ages of the caregivers and under-5 children were 31.7 ± 7.47 years and 34.49 ± 15.8 months respectively. Overall, 530 (51.7%) children were females, and 765 (74.5%) had normal weight for height. In all, 195 (19.0%) households had food insecurity, while 832 (81.0%) households had food security (Chi-square = 103.364, p = < 0.001). Under-5 children living in urban slums were seven times more likely to experience household food insecurity compared to those in rural slums (AOR = 6.859, 95%CI = 4.524-10.509, p = < 0.001). DISCUSSION: Household food insecurity was more prevalent in urban slums. Strengthening of the school health program would help identify children with nutritional deficits, and improve the overall health status of children living in slum communities.

Climate change and health risks in Mukuru informal settlement in Nairobi, Kenya - knowledge, attitudes and practices among residents.

BACKGROUND: Residents of informal settlements in Sub-Sahara Africa (SSA) are vulnerable to the health impacts of climate change. Little is known about the knowledge, attitudes and practices (KAP) of inhabitants of informal settlements in SSA regarding climate change and its health impacts. The aim of this study was to investigate how inhabitants of an informal settlement in SSA experience climate change and its health impacts and assess related knowledge, attitudes and practices. The study was conducted in Mukuru informal settlement in Nairobi City County, Kenya. METHODS: A cross-sectional study was conducted in September 2021 using a structured, semi-closed KAP questionnaire. Inclusion criteria were ≥ 18 years of age and living in one of the three main sections in Mukuru: Kwa Njenga, Kwa Reuben or Viwandani. By spinning a pen at the geographic centre of each section, a random direction was selected. Then, in every second household one individual was interviewed, creating a representative mix of ages and genders of the local community. To assess participant characteristics associated with climate change knowledge multivariable logistic regression was used. Thematic content analysis was performed for qualitative responses. RESULTS: Out of 402 study participants, 76.4% (n = 307) had heard of climate change before the interview, 90.8% (n = 365) reported that climate change was affecting their community, and 92.6% (n = 372) were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with having heard of climate change before (aOR 3.1, 95%CI 1.7 - 5.8 and aOR 2.6, 95%CI 1.1 - 6.1, respectively) and experiencing a climate change related impact on the community (aOR 10.7, 95%CI 4.0 - 28.4 and aOR 7.7; 95%CI 1.7 - 34.0, respectively). Chronic respiratory conditions, vector-borne diseases, including infectious diarrhoea, malnutrition and cardiovascular diseases were identified by respondents as climate related health risks. CONCLUSIONS: Most respondents were knowledgeable about climate change and were experiencing its (health-related) impact on their community. This study provides insights which may prove useful for policy makers, intervention planners and researchers to work on locally adapted mitigation and adaption strategies.

Comparing full immunisation status of children (0-23 months) between slums of Kampala City and the rural setting of Iganga District in Uganda: a cross-sectional study.

BACKGROUND: Immunisation remains the most cost-effective public health intervention in preventing morbidity and mortality due to Vaccine-Preventable Diseases (VPDs). The study aims to compare the differences in immunisation coverage amongst children aged 0 to 23 months living in slums of Kampala city and Iganga as rural districts in Uganda. METHODS: This study utilises data from a cross-sectional survey done in 2019 in the slums of Kampala City and the rural district of Iganga within the Health and Demographic Surveillance Site (HDSS). It included 1016 children aged 0-23 months and their parents. A logistic regression model was used to analyse the relationship between multiple independent variables and the binary dependent variables (fully immunised) using Stata statistical software. The measures of association were odds ratios reported with a corresponding 95% confidence interval. RESULTS: Out of the 1016 participants, 544 participants live in the rural area and 472 participants in the slums. Slums had 48.9% (n = 231) of fully immunised children whilst rural areas had 43.20% (n = 235). The multivariate analysis showed that children living in slums are more likely to be fully immunised as compared to their counterparts in rural areas (Odds ratio:1.456; p = 0.033; CI:1.030-2.058). Immunisation coverage for BCG (98.9%), Polio 0 (88.2%), Penta1 (92.7%), and Pneumo1 (89.8%) were high in both settlements. However, the dropout rate for subsequent vaccines was high 17%, 20% and 41% for Penta, pneumococcal and rota vaccines respectively. There was poor uptake of the new vaccines with slums having 73.4% and 47.9% coverage for pneumococcal and rota vaccines respectively and rural areas had 72.1% and 7.5% for pneumococcal and rota vaccines respectively. CONCLUSION: The low full immunisation status in this study was attributed to the child's residence and the occupation of the parents. Lack of education and poor access to messages on immunisation (inadequate access to mass media) are other contributing factors. Educational messages on the importance of immunisation targeting these underserved populations will improve full immunisation coverage.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities.

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Towards a Link between Quantitative and Qualitative Sciences to Understand Social Systems Using the Example of Informal Settlements.

Urbanization is one of the defining trends of our time and appropriate models are needed to anticipate the changes in cities, which are largely determined by human behavior. In the social sciences, where the task of describing human behavior falls, a distinction is made between quantitative and qualitative approaches, each of which has its own advantages and disadvantages. While the latter often provide descriptions of exemplary processes in order to describe phenomena as holistically as possible, the goal of mathematically motivated modeling is primarily to make a problem tangible. Both approaches are discussed in terms of the temporal evolution of one of the dominant settlement types in the world today: informal settlements. These areas have been modeled in conceptual works as self-organizing entities and in mathematical works as Turing systems. It is shown that the social issues surrounding these areas need to be understood both qualitatively and quantitatively. Inspired by the philosopher C. S. Peirce, a framework is proposed in which the various modeling approaches describing these settlements can be combined to arrive at a more holistic understanding of this phenomenon by using the language of mathematical modeling.

Divided infrastructure: legal exclusion and water inequality in an urban slum in Mumbai, India.

Inadequate water access is central to the experience of urban inequality across low- and middle-income countries and leads to adverse health and social outcomes. Previous literature on water inequality in Mumbai, India's second largest city, offers diverse explanations for water disparities between and within slums.(1) This study provides new insights on water disparities in Mumbai's slums by evaluating the influence of legal status on water access. We analyzed data from 593 households in Mandala, a slum with legally recognized (notified) and unrecognized (non-notified) neighborhoods. Relative to households in a notified neighborhood, households in a non-notified neighborhood suffered disadvantages in water infrastructure, accessibility, reliability, and spending. Non-notified households used significantly fewer liters per capita per day of water, even after controlling for religion and socioeconomic status. Our findings suggest that legal exclusion may be a central driver of water inequality. Extending legal recognition to excluded slum settlements, neighborhoods, and households could be a powerful intervention for reducing urban water inequality.

The connection between slums and COVID-19 cases in Jakarta, Indonesia: A case study of Kapuk Urban Village.

COVID-19 has spread world-wide, and with multiple health, social, and economic ramifications. These present a formidable challenge for those belonging to vulnerable communities, such as those living in slums. There is now a growing literature urging attention to this challenge. However, few studies have examined the actual lived realities within these areas using direct, observational research, notwithstanding commentary elsewhere that such close attention is necessary to ensure effective action. This study took this approach in relation to a particular case-study, Kapuk Urban Village, in Jakarta, Indonesia. Drawing on an existing schema involving three spatial scales of slum areas (environs, settlement, and object), the research confirms how different built and socio-economic features can exacerbate vulnerability, and COVID-19 transmission. We also add to the body of knowledge by contributing a dimension of 'ground-level' research engagement. We conclude by discussing related ideas around ensuring community resilience and effective policy implementation, and recommend an "urban acupuncture" approach to encourage government regulations and actions better tailored to such communities.

Rickettsial Infections Causing Acute Febrile Illness in Urban Slums, Brazil.

We conducted enhanced acute febrile illness surveillance in an urban slum community in Salvador, Brazil. We found that rickettsial infection accounted for 3.5% of urgent care visits for acute fever. Our results suggest that rickettsiae might be an underrecognized, treatable cause of acute febrile illness in impoverished urban populations in Brazil.

Functional principal component analysis for identifying the child growth pattern using longitudinal birth cohort data.

BACKGROUND: Longitudinal studies are important to understand patterns of growth in children and limited in India. It is important to identify an approach for characterising growth trajectories to distinguish between children who have healthy growth and those growth is poor. Many statistical approaches are available to assess the longitudinal growth data and which are difficult to recognize the pattern. In this research study, we employed functional principal component analysis (FPCA) as a statistical method to find the pattern of growth data. The purpose of this study is to describe the longitudinal child growth trajectory pattern under 3 years of age using functional principal component method. METHODS: Children born between March 2002 and August 2003 (n = 290) were followed until their third birthday in three neighbouring slums in Vellore, South India. Field workers visited homes to collect details of morbidity twice a week. Height and weight were measured monthly from 1 month of age in a study-run clinic. Longitudinal child growth trajectory pattern were extracted using Functional Principal Component analysis using B-spline basis functions with smoothing parameters. Functional linear model was used to assess the factors association with the growth functions. RESULTS: We have obtained four FPCs explained by 86.5, 3.9, 3.1 and 2.2% of the variation respectively for the height functions. For height, 38% of the children's had poor growth trajectories. Similarly, three FPCs explained 76.2, 8.8, and 4.7% respectively for the weight functions and 44% of the children's had poor growth in their weight trajectories. Results show that gender, socio-economic status, parent's education, breast feeding, and gravida are associated and, influence the growth pattern in children. CONCLUSIONS: The FPC approach deals with subjects' dynamics of growth and not with specific values at given times. FPC could be a better alternate approach for both dimension reduction and pattern detection. FPC may be used to offer greater insight for classification.