Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.

Intimate partner violence among young women in Ibadan, Nigeria: are there slum and non-slum differences?

This study determined the past-year prevalence of physical, sexual and psychological intimate partner violence (IPV) and associated factors among young women in urban slums and non-slums of Ibadan, Nigeria.A cross-sectional study, using a multistage cluster sampling method was used to select 1050 ever-partnered young women aged between 18 and 24 years from the five Local Government Areas (LGAs) in Ibadan municipal. All localities were classified into slums and non-slums using the UN-Habitat 2003 criterion. Independent variables were respondents' and partners' characteristics. Dependent variables were physical, sexual and psychological IPV. Data were analysed using descriptive statistics and binary logistic regression model (α0.05).Prevalence of physical (31.4%, 13.4%), sexual (37.1%, 18.3%), and psychological IPV (58.6%, 31.5%) were significantly higher in the slum than non-slum communities. Multivariate analysis showed that secondary education (aOR:0.45, 95%CI: 0.21 - 0.92) reduced IPV experience while being unmarried (aOR:2.83, 95%CI: 1.28 - 6.26), partner's alcohol use (aOR:1.97, 95%CI: 1.22 - 3.18), and partner's relationship with other women (aOR:1.79, 95%CI: 1.10 -2.91) increased IPV experience in slum communities. In non-slum communities, having children (aOR:2.99, 95%CI: 1.05-8.51), non-consensual sexual debut (aOR: 1.88, 95%CI: 1.07-3.31) and witness of abuse in childhood (aOR:1.82: 95%CI: 1.01 - 3.28) increased experience of IPV. Acceptance of IPV and partner's witness of abuse in childhood increased experience of IPV in both settings.This study confirms that IPV is common among young women in Ibadan, Nigeria, but higher among women in slum communities. Findings also showed different factors associated with IPV in slum and non-slum communities. Therefore, targeted interventions for each urban stratum are recommended.

Oral health in an urban slum, Nigeria: residents' perceptions, practices and care-seeking experiences.

BACKGROUND/INTRODUCTION: One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. OBJECTIVES: This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria. METHOD: Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis. RESULTS: Six FGD sessions, divided by gender and age, were conducted between September-October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes. CONCLUSION: The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self-care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities.

Prevalence patterns and associated factors of elder abuse in an urban slum of eastern India.

BACKGROUND: The prevalence of elder abuse in various parts of the world has been reported between 2.2 and 90.4%. According to some studies conducted in India, elder abuse prevalence ranges between 9.6 to 61.7%. Yet, elder abuse is an underreported issue. Most available evidence shows the involvement of close family members and caregivers in the abuse of older adults. Several factors associated with various forms of elder abuse need to be studied further. This study has attempted to capture the prevalence, pattern and associated factors of elder abuse in urban slums. METHODS: This study was a cross-sectional community-based study conducted between August 2019 to August 2020 in an urban field practice area of the All India Institute of Medical Sciences, Bhubaneswar. It covers four wards of the Bhubaneswar Municipal Corporation, served by the Urban Primary Health Centre, IRC Village, Nayapalli. A total of 360 participants aged 60 years and above were included in this study. They were interviewed using various semi-structured interview schedules. Validated study tools such as Activities of Daily Living (ADL- Barthel Index), Hindi Mental Scale Examination (HMSE), Geriatric Depression Scale (GDS), and Vulnerability to Abuse Screening Scale (VASS) were also used to assess various factors. RESULTS: Approximately one in five (19.4%) older adults reported some form of abuse. The types of elder abuse reported were physical abuse in 12 (3.3%), verbal abuse in 25 (6.9%), emotional abuse in 40 (11.1%), and financial abuse in 15 (4.2%) older adult participants. The sons and daughters-in-law of the older adult participants were the main perpetrators of abuse reported. Depression and past history of abuse were found significantly associated with any type of abuse. CONCLUSIONS: The prevalence of elder abuse in this study was considerably high, with 70 (19.4%) out of the 360 participants reporting some form of abuse. Emotional abuse was the most reported, and physical abuse was the least reported type. The most common perpetrators were those on whom the older adults depended, like their sons and daughters-in-law.

Prevalence and determinants of hypertension among urban slum dwellers in Bangladesh.

BACKGROUND: In low- and middle- income countries such as Bangladesh, urban slum dwellers are particualry vulnerable to hypertension due to inadequate facilities for screening and management, as well as inadequate health literacy among them. However, there is scarcity of evidence on hypertension among the urban slum dwellers in Bangladesh. The present study aimed to determine the prevalence and factors associated with hypertension among urban slum dwellers in Bangladesh. METHODS: Data were collected as part of a large-scale cross-sectional survey conducted by Building Resources Across Communities (BRAC) between October 2015 and January 2016. The present analysis was performed among 1155 urban slum dwellers aged 35 years or above. A structured questionnaire was adminstered to collect data electronically and blood pressure measurements were taken using standardised procedures. Binary logistic regression with generalized estimating equation modelling was performed to estimate the factors associated with hypertension. RESULTS: The prevalence of hypertension was 28.3% among urban slum dwellers aged 35 years and above. In adjusted analysis, urban slum dwellers aged 45-54 years (AOR: 1.64, 95% CI: 1.17-2.28), 55-64 years (AOR: 2.47, 95% CI: 1.73-3.53) and ≥ 65 years (AOR: 2.34, 95% CI: 1.47-3.72), from wealthier households (AOR: 1.94, 95% CI: 1.18-3.20), sleeping < 7 h per day (AOR: 1.87, 95% CI: 1.39-2.51), who were overweight (AOR: 1.53, 95% CI: 1.09-2.14) or obese (AOR: 2.34, 95% CI: 1.71-3.20), and having self-reported diabetes (AOR: 3.08, 95% CI: 1.88-5.04) had an increased risk of hypertension. Moreover, 51.0% of the participants were taking anti-hypertensive medications and 26.4% of them had their hypertension in control. CONCLUSIONS: The findings highlight a high burden of hypertension and poor management of it among the slum dwellers in Bangladesh requiring a novel approach to improve care. It is integral to effectively implement the available national non-communicable disease (NCD) control guidelines and redesign the current urban primary health care system to have better coordination.

Does the roof type of a house influence the presence of adult Anopheles stephensi, urban malaria vector? - evidence from a few slum settings in Chennai, India.

In an urban setting, it is a difficult task to collect adult Anopheles stephensi, unlike the immature stages, due to various reasons. A longitudinal study was undertaken from January 2016 to April 2017, with CDC light traps to collect adult Anopheles stephensi and other mosquito species in houses located in a few slums of Chennai, India. A total of 203 trap collections were made indoors from human dwellings having different roof types, as well as outdoors. Three to four trap collections were made at night (18:00 to 06:00 h) once a week. Overall, Culex quinquefasciatus (64%) was the predominant mosquito species captured, followed by An. stephensi (24%). In 98 of the 203 trap collections (48.3%), at least one female An. stephensi was trapped. In all, 224 female An. stephensi were trapped, of which the majority were collected during monsoon and winter seasons. Compared to outdoors, 10% more An. stephensi, the majority of them unfed, were collected indoors, with relatively more contribution coming from asbestos-roofed houses (71.4%), followed by thatched-roof houses (47.3%). Overall, 2.2% positivity for Plasmodium vivax was detected in An. stephensi through Circumsporozoite-ELISA. Binary logistic regression model indicated that season (winter and monsoon), asbestos-roofed dwelling, lesser number of rooms in a house, and more members in a family were significant predictor variables for the odds of trapping an An. stephensi. The study brought out significant factors associated with the presence of An. stephensi in urban slums setting in Chennai, where malaria is declining. The findings would help in devising targeted, effective vector control interventions for malaria elimination in urban settings.

Awareness of Leprosy in an urban slum of Western Maharashtra Post 35 Years of the National Leprosy Eradication Program (NLEP).

Background: Even after 35 years of the National Leprosy Eradication Program (NLEP) and 15 years post-elimination, leprosy continues to be a public health challenge in India. This paper discusses the current awareness of leprosy among people living in urban slums of western Maharashtra. Methods: The study was conducted in an urban slum of western Maharashtra with 400 participants. A closed-ended questionnaire regarding the knowledge, attitude, practices, and stigma existing among the people was administered, followed by a small awareness talk and screening for leprosy. Results: Of the total 400 participants, 205 (51.25) were females and 195 (48.75) were males. Only 154/400 (38.5%) people were aware of leprosy. 130/400 (32.5%) people thought that it is treatable; however, 71/130 (54.6) of them thought that it would recur even after completing the treatment. Only 103/400 (25.75) said that they would marry a person with leprosy, denoting prevalent stigma in the society, and 79/400 (19.75) were aware of government services for leprosy and NLEP. Screening of all the participants surveyed did not reveal any new or doubtful cases of leprosy. Conclusion: The present study shows a lack of awareness and knowledge of leprosy among the target population. With only 20% of them being aware of government services and the NLEP, combined with an extremely low knowledge about the disease; it shows the need to further augment the government programs. There is also an increasing need to educate people to accomplish a positive attitude of the community towards leprosy patients.

Impact of an Urban Sanitation Intervention on Enteric Pathogen Detection in Soils.

Environmental fecal contamination is common in many low-income cities, contributing to a high burden of enteric infections and associated negative sequelae. To evaluate the impact of a shared onsite sanitation intervention in Maputo, Mozambique on enteric pathogens in the domestic environment, we collected 179 soil samples at shared latrine entrances from intervention (n = 49) and control (n = 51) compounds during baseline (preintervention) and after 24 months (postintervention) as part of the Maputo Sanitation Trial. We tested soils for the presence of nucleic acids associated with 18 enteric pathogens using a multiplex reverse transcription qPCR platform. We detected at least one pathogen-associated gene target in 91% (163/179) of soils and a median of 3 (IQR = 1, 5) pathogens. Using a difference-in-difference analysis and adjusting for compound population, visibly wet soil, sun exposure, wealth, temperature, animal presence, and visible feces, we estimate the intervention reduced the probability of detecting ≥1 pathogen gene by 15% (adjusted prevalence ratio, aPR = 0.85; 95% CI: 0.70, 1.0) and the total number of pathogens by 35% (aPR = 0.65; 0.44, 0.95) in soil 24 months following the intervention. These results suggest that the intervention reduced the presence of some fecal contamination in the domestic environment, but pathogen detection remained prevalent 24 months following the introduction of new latrines.

Prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria: a cross-sectional study.

BACKGROUND: Little is known about the prevalence of and factors associated with PTSD among adult females in Nigeria, particularly those who live in slums. PTSD is a mental health condition that develops among some individuals who experience or witness a traumatic event. Several other factors could place individuals at heightened risk of PTSD including stress and comorbid mental disorders. Therefore, this study aimed to examine the prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria. METHODS: We conducted a cross sectional survey using multistage sampling of 550 women aged 18 and above from selected slums. Interviewer administered questionnaires were used to elicit information on experience of childhood trauma, recent stressors, intimate partner violence, other mental disorders, sociodemographic characteristics and PTSD. PTSD was measured using the Harvard Trauma Questionnaire (HTQ) which is based on DSM IV. A multivariable linear regression model was built to test associations between PTSD and independent variables. RESULTS: The prevalence for PTSD was found to be 4.18% and the mean PTSD score was 5.80 ± 7.11. Sexual abuse in childhood, past year intimate partner violence and anxiety were significantly associated with higher PTSD scores. PTSD was not significantly associated with a history of recent stressors. Education, employment and marital status were not associated with PTSD however, age and wealth index showed marginal association with PTSD. CONCLUSION: The prevalence of PTSD among women living in Ibadan slums was relatively low. Both child sexual abuse and intimate partner violence can be prevented. We also recommend longitudinal studies to better understand risk and protective factors.

Psychological distress, low-income, and socio-economic vulnerability in the COVID-19 pandemic.

OBJECTIVES: Although literature broadly reports the impact of COVID-19 on global mental health, little is known about the extent of its deleterious impact on the most vulnerable individuals. The present study aimed to evaluate the level of psychological distress of adult's residents of two urban shantytown communities located in São Paulo city, Brazil. STUDY DESIGN: This was a cross-sectional study. METHODS: An online questionnaire was divided into four sections: (1) informed consent, (2) socio-economic data, (3) 12-item general health questionnaire, and (4) Brazilian food insecurity scale was applied. RESULTS: Of the 495 family headship (448 females and 47 males), the mean age was 36.1 years, 85% have an indication of psychological distress, 61.4% had a monthly income less than or equal to $70, and the incidence of households experiencing moderate or severe food insecurity was 40%. Multivariate logistic regression revealed that respondents who experienced moderate or severe food insecurity (odds ratio [OR] = 2.701, confidence interval [CI] 95% = 1.265-5.769; P = 0.010) and lower monthly income (OR = 2.031, CI 95% = 1.056-3.908; P = 0.034) had a higher risk of psychological distress. On the other hand, having an employment is a protective factor against the stressful situations caused by COVID-19 pandemic (P = 0.029). CONCLUSION: The present study identified low-income younger women residents of urban slums who suffer from food insecurity as high-risk groups to have psychological distress. Our findings are of particular importance because they showed the intersection of vulnerabilities during the COVID-19 outbreak.

Asia's largest urban slum-Dharavi: A global model for management of COVID-19.

The Dharavi sector of Mumbai, India is constituted as one of the biggest slums of Asia and the world's most populated areas. The COVID-19 outburst is at its peak in May and curve gets flattened within next two months. This article focuses on factors responsible for transmission, prevention and in controlling the COVID-19 spread in Dharavi. The COVID-19 data was interpreted in terms of Case Recovery Rate (CRR) and Case Fatality Rate (CFR) for total and closed both. The CFR per closed reached 10.12% nearly to per total 9.82% in Dharavi on 31st July 2020. The CRR per total cases in Dharavi and Mumbai is 87.16 & 76.18% and per closed cases is 89.87 & 93.20% respectively in comparison to the CFR. The calculated CFR and CRR for both Dharavi and Mumbai suggest that the COVID-19 recovery rate is more than the fatality rate. The Dharavi people serve as an important role in controlling the pandemic by adopting 4-T model tracing, tracking, testing, and treating strategy. This article is beneficial for government policy makers and private agencies in controlling the COVID-19 pandemic in densely populated areas and also for nations with high fatality rate.

Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study.

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

Perception and attitudinal factors contributing to periodic deworming of preschool children in an urban slum, Nigeria.

BACKGROUND: Over 20 million preschool-age children (PSAC) in Nigeria require periodic chemotherapy (PC) for soil-transmitted helminth (STH) infections. Persistently low coverage for this age group threatens the World Health Organization (WHO) 2030 target for eliminating STH infections. Current strategies for targeting PSAC have been largely ineffective. Hence, PSAC are mostly dewormed by their parents/caregivers. However, little is known of the perception and attitude of parents/caregivers of PSAC to deworming in this setting. METHODS: A mixed methods design, combining a community-based interviewer-administered questionnaire-survey (n = 433) and focus group discussions (FGD) (n = 43) was used to assess the perceptions and attitudes of mothers to periodic deworming of preschool children aged 2-5 years in Abakpa-Nike, Enugu, Nigeria. RESULTS: Coverage of periodic deworming in PSAC is 42% (95% CI: 37.3-46.8%). There is significant difference in the specific knowledge of transmission of STH (AOR = 0.62, 95% CI: 0.48-0.81, p = 0.000), complication of STH infections (AOR = 0.77, 95% CI: 0.61-0.98, p = 0.034), accurate knowledge of deworming frequency (AOR = 0.41, 95% CI: 0.18-0.90, p = 0.026), and knowledge of PC drug, mebendazole (AOR = 0.28, 95% CI: 0.09-0.90, p = 0.031), and pyrantel (AOR = 8.03, 95% CI: 2.22-29.03, p = 0.001) between mothers who periodically deworm their PSAC and those who do not. There is no significant difference in specific knowledge of the symptoms of STH infections (AOR = 0.76, 95% CI: 0.57-1.02, p = 0.069) and PC drug, Albendazole (AOR = 1.00, 95% CI: 0.46-2.11, p = 0.972). FGD revealed misconceptions that are rooted in stark ignorance of the disease. Overall attitude to deworming is positive and favourable. CONCLUSIONS: Poor coverage of periodic deworming for STH infections in PSAC in this setting are primarily driven by poor specific knowledge of the risks and burden of the infection. Focused health education on the burden and transmission of STH infections could complement existing strategies to improve periodic deworming of PSAC in this setting.

Understanding self-construction of health among the slum dwellers of India: a culture-centred approach.

Disembarking from a traditional approach of narrow hazardous environmental and structural conditions in understanding urban slums' health problems and moving towards a new notion of what constitutes health for slum dwellers will open a new avenue to recognise whether and how health is being prioritised in disadvantaged settings. Drawing on in-depth semi-structured interviews with a total of 67 men and 68 women from Kolkata slums and 62 men and 48 women from Bangalore slums, this study explored how knowledge, social realities, material and symbolic drivers of a place interweave in shaping slum-dwellers' patterned way of understanding health, and the ways health and illnesses are managed. The current study adds to the growing evidence that ordinary members of the urban slums can articulate critical linkages between their everyday sociocultural realities and health conditions, which can support the design and delivery of interventions to promote wellbeing. The concept of health is not confined to an abstract idea but manifested in slum-dwellers' sporadic practices of preventive and curative care as well as everyday living arrangements, where a complex arrangement of physical, psychological, financial, sociocultural and environmental dimensions condition their body and wellbeing.

Comprehensive assessment of handwashing and faecal contamination among elementary school children in an urban slum of Indonesia.

OBJECTIVE: Globally, the challenge of handwashing with soap (HWWS) still exists despite the importance of HWWS being shown previously. This study aimed to evaluate faecal contamination on the hands of children and to find factors related to faecal contamination from handwashing techniques, HWWS, knowledge and awareness of water, sanitation, and hygiene (WASH), and a comprehensive WASH index. METHODS: The study was conducted at two elementary schools with 169 children in a densely populated area of Bandung, Indonesia. The survey involved handwashing observation using a checklist, hand bacteria sampling and questionnaires. RESULTS: Most children (98.7%) had faecal contamination. Girls had significantly fewer Escherichia coli than boys (P < 0.05). Ability in handwashing techniques, HWWS, and knowledge and awareness of WASH were poor in the lower grades. Escherichia coli counts were negatively correlated with handwashing technique (r = -0.171, P < 0.05), HWWS (r = -0.225, P < 0.01) and the WASH index (r = -0.205, P < 0.05). CONCLUSIONS: Proper handwashing technique and HWWS at appropriate times can reduce faecal contamination. Moreover, it is important that both grade-based and gender-based handwashing education be considered in elementary school education.

OBJECTIF: A l'échelle mondiale, le défi du lavage des mains au savon (HWWS) existe toujours, en dépit de l'importance révélée de ce procédé. Cette étude visait à évaluer la contamination fécale sur les mains des enfants et à trouver des facteurs liés à la contamination fécale résultant des procédés de lavage des mains, du lavage des mains au savon, de la connaissance et de la sensibilisation à l'eau, aux sanitaires et à l'hygiène (WASH), ainsi qu'un indice WASH détaillé. MÉTHODES: L'étude a été menée dans deux écoles élémentaires avec 169 enfants dans une zone densément peuplée de Bandung, en Indonésie. L'enquête comprenait l'observation du lavage des mains à l'aide d'une liste de contrôle, un échantillonnage bactérien sur les mains et des questionnaires. RÉSULTATS: La plupart des enfants (98,7%) avaient une contamination fécale. Escherichia coli était nettement moins présent chez les filles que chez les garçons (p <0,05). L'aptitude dans les techniques de lavage des mains, le lavage des mains au savon, ainsi que la connaissance et la sensibilisation au WASH étaient faibles dans les classes inférieures. Les comptages d'E. Coli corrélaient négativement avec la technique de lavage des mains (r = -0,171 ; p <0,05), le lavage des mains au savon (r = 0,225 ; p <0,01) et l'indice WASH (r= - 0,205 ; p <0,05). CONCLUSIONS: Une technique de lavage des mains appropriée et un lavage des mains au savon à des moments opportuns peuvent réduire la contamination fécale. De plus, il est important de prendre en compte l'éducation au lavage des mains basée sur le niveau et le sexe dans l'enseignement primaire.

Association between substance use and concurrent sexual relationships among urban slum dwellers in Nairobi, Kenya.

While the overall incidence and prevalence of HIV/AIDS are declining in Africa, substance use-related HIV/AIDS is on the rise. The main objectives of this study were to elicit the types of commonly used substances and to examine the association between substance use and concurrent sexual relationships among slum dwellers in Kenya. Freelisting elicitation techniques were used to identify the most commonly used substances using 53 key informants. This was followed by a self-administered, structured questionnaire using a convenience sample of 506 participants. Findings from our freelisting analysis produced 27 substances that were used in the community. Analysis of the survey data shows that participants who reported using substances in the past three months were more likely to be involved in concurrent sexual relationships than those who did not (86.2% vs. 74.0%; p = .002). In the multivariable model, the odds of ever having concurrent sexual relationships were higher among participants who used any substance in the past three months (aOR 2.46; 95% CI 1.37-4.42, p < .01). The observed association between substance use and concurrent sexual relationships may be influenced by social and economic factors such as poverty and lack of opportunity among urban slum dwellers.

Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health programming. Efforts should be dedicated towards addressing determinants of child health in both urban and rural areas.

Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study.

BACKGROUND: Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. METHODS: Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. RESULT: Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. CONCLUSION: As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

Pathotyping of Escherichia coli isolated from community toilet wastewater and stored drinking water in a slum in Bangladesh.

This study investigated the occurrence of Escherichia coli pathotypes in sanitary wastewater and drinking water in a Bangladeshi urban slum and the potential associations between these sources. We examined 621 E. coli isolates from sanitary wastewater and stored drinking water by multiplex PCR and dual-index sequencing, classifying them into eight pathotypes based on 14 virulence genes and additionally evaluating the possession of the human-specific E. coli genetic biomarker H8. The proportions of pathogenic E. coli were significantly different (P < 0·001) between wastewater (18·6%) and drinking water (1·7%). StIb-positive enterotoxigenic E. coli (ETEC) were predominant in wastewater, indicating that people in the site carried ETEC. In contrast, no ETEC was present in drinking water and the proportion of H8-positive isolates was significantly smaller (7·8%) than that in wastewater (16·3%) (P = 0·001). Our findings indicate that sanitary wastewater from the slum was heavily contaminated with pathogenic E. coli, posing a great health risk. Furthermore, E. coli contamination of drinking water could be derived from not only human but also other sources. SIGNIFICANCE AND IMPACT OF THE STUDY: Sanitary wastewater from an urban slum was heavily contaminated with pathogenic Escherichia coli. It is worth noting a great health risk of accidental exposure to pathogenically contaminated wastewater improperly discharged in and around urban slums. The distinct difference in pathotypes between wastewater and drinking water and the significantly smaller positive proportion of the human-specific E. coli genetic biomarker (H8) in drinking water indicate that drinking water contamination could be derived from not only human but also other sources. This highlights that pathotyping in association with the H8 marker provides an indication of pathogen contamination sources of environmental transmission media.

Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster-randomised controlled trial.

OBJECTIVES: Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness. METHODS: We conducted a cluster-randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six-month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (DID) to assess outcomes and accounted for clustering effects using generalised estimating equations. RESULTS: Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (DID: +4.7%, 95% CI: 0.2, 9.2), access to brush/broom for cleaning (DID: +8.4%, 95% CI: 2, 15) and waste bins (DID: +63%, 95% CI: 59, 66), while less likely to have visible faeces inside the pan (DID: -13%, 95% CI: -19, -5), the smell of faeces (DID: -7.6%, 95% CI: -14, -1.3) and household waste inside the cubicle (DID: -4%, 95% CI: -7, -1). CONCLUSIONS: In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self-finance toilet maintenance, or employ mass media to reduce per-capita costs of behaviour change.