Search

African cities are experiencing increasing living standard disparities with limited evidence of intra-urban health disparities. Using data from the 2006–2016 Uganda Demographic and Health Surveys, we employed the UN-Habitat definition to examine slum-like household conditions in the Greater Kampala Metropolitan Area (GKMA). Subsequently, we developed a slum-like severity index and assessed its association with under-5 common morbidities and healthcare access. We also assessed the characteristics of people in slum-like household conditions. We identified five slum-like conditions: substandard housing conditions, limited water access, overcrowding, unclean cooking fuel, and limited toilet access. By 2016, 67% of GKMA households were classified as slum-like conditions, including 31% in severe conditions. Limited toilet access, overcrowding, and limited water access were the main forms of deprivation. Living in slum-like household conditions correlated with lower education levels, youth status, unprofessional jobs, and marriage. Compared to neighboring Kampala city urban outskirts, Kampala city households had lower slum-like prevalence. Children in GKMA living in slum-like household conditions were more likely to experience diarrhea (moderate: OR = 1.21[95% CI: 1.05–1.39], severe: OR = 1.47 [95% CI: 1.27–1.7]); fever (moderate: OR = 2.67 [95% CI: 1.23–5.8], severe: OR = 3.09 [95% CI: 1.63–5.85]); anemia (moderate: OR = 1.18 [95% CI: 0.88–1.58], severe: OR = 1.44 [95% CI: 1.11–1.86]); and stunting (moderate: OR = 1.23 [95% CI: 1.23–1.25], severe: OR = 1.40 [95% CI: 1.41–1.47]) compared to those living in less slum-like conditions. However, seeking treatment for fever was less likely in slum-like household conditions, and the association of slum-like household conditions with diarrhea was insignificant. These findings underscore the precarious urban living conditions and the need for targeted health interventions addressing the social determinants of health in urban settings. [ABSTRACT FROM AUTHOR]

Rapid urban population growth, the urbanization of poverty, and the proliferation of slums are being driven to a great extent by this dynamic form of globalization. Consequently, the multifaceted effects of globalization on the poor and low-income populations in the cities need to be better understood in this context, both at the individual level and within the community. Therefore, the present study was conducted to highlight the various determinants affecting the lives and enhancing the vulnerability of the dwellers of four slum settlements present in various areas of Jammu City, India. Emphasis was made to integrate biological, physical, social, and spatial facets of vulnerability to understand the complex dynamics of urban areas in developing countries. A descriptive survey design was used for questions concerning the social and environmental aspects. Social aspects including age, sex, education, religion, caste, profession, and family income that correspond to social stratification acted as baseline information, while both indoor and outdoor environments such as housing conditions, sanitation, personal habits, solid waste disposal, disaster proneness, and air and water pollution problems were taken into consideration to assess the environmental aspect. Results indicated that the slum settlement has a migratory population with permanent or temporary settlements. The status of education and skill level is poor which results in poor economic development and social well-being of the dwellers in slums. The study also identified vulnerability of the population on social and environmental front which could result into severe health issues. The study concluded and recommended policy planning specified for slums for uplifting such unprivileged populations. [ABSTRACT FROM AUTHOR]

Slums are closely associated with riverbanks. The same situation can be found in one of the urban regions in Indonesia, that is, Palembang City. This research was intended to spatially analyze slum areas along the edge of the river traversing the city using the Anselin Local Moran's I statistic. In the quantitative method used, samples of slum houses were taken by area-proportional random sampling, and data on their locations were collected with a GPS and then spatially analyzed using the Anselin Local Moran's I. Results showed families living on flood-prone riverbanks in two districts, non-flood-prone banks in 15 districts, and flood-prone areas outside the banks in one district. Most slum areas are located in one district, Kertapati. Slums with the highest number of houses, i.e., more than 1000, are spread across Jakabaring, Kertapati, Seberang Ulu II, Plaju, and Gandus, and the most occupied slums with more than 1000 families are found in seven districts: Seberang Ulu I, Ilir Timur I, Kertapati, Ilir Timur III, Seberang Ulu II, Plaju, and Gandus. The Anselin Local Moran's I analysis found high-low (HL) outliers in six districts and low-low (LL) clusters of slums in five districts. The Local Moran's I index values were positive for neighboring population densities and negative for farther-spaced population densities. In addition, this analysis produced z-scores and p-values that suggested the riverbank slums in Palembang formed a clustered and random pattern. [ABSTRACT FROM AUTHOR]

Deprived settlements, usually referred to as slums, are often located in hazardous areas. However, there have been very few studies to examine this notion. In this study, we leverage the advancements in open geospatial data, earth observation (EO), and machine learning to create a multi-hazard susceptibility index and a transferrable disaster risk approach to be adapted in low- and middle-income country (LMIC) cities, with low-cost methods. Specifically, we identify multi-hazards in Nairobi's selected case study area and construct a susceptibility index. Then, we test the predictability of deprived settlements using the multi-hazard susceptibility index in comparison with EO texture-based methods. Lastly, we survey 100 households in two deprived settlements (typical and atypical slums) in Nairobi and use the survey outcomes to validate the multi-hazard susceptibility index. To test the assumption that deprived areas are dominantly located in areas with higher susceptibility to multiple hazards, we contrast morphologically identified deprived settlements with non-deprived settlements. We find that deprived settlements are generally more exposed to hazards. However, there are variations between central and peripheral settlements. In testing the predictability of deprivation using multi-hazards, the multi-hazard-based model performs better for deprived settlements than for other classes. In contrast, the texture-based model is better at classifying all types of morphological settlements. Lastly, by contrasting the survey outcomes to the household interviews, we conclude that proxies used for the multi-hazard susceptibility index adequately capture the hazards. However, more localized proxies can be used to improve the index performance. [ABSTRACT FROM AUTHOR]

In India, around 17% of the total urban population is residing in slums. In Pune city, the percentage of the slum population is high, whereas approximately 44% of the urban population resides in slums. It led to a rapid increase in housing demand under the slum redevelopment scheme. Thus, an in situ slum redevelopment scheme is exercised when the slum is located on tenable land. But, there are hardly any proper open spaces and access to the slums. In high-density areas, this may encompass the redevelopment of the whole site to provide more living space and improved environmental conditions. It requires apt spatial planning. Therefore, the present research paper explores land suitability analysis for in situ slum redevelopment of Pune city using the AHP model on Geographical Information System and remote sensing platform. There are seven criteria considered for the identification of in situ slum redevelopment sites. These include land ownership, land value, slum dwelling unit density, slum population density, slope, transport network and land use/land cover. The land suitability map for in situ slum redevelopment is grouped into four classes, i.e., unsuitable, less, moderate and highly suitable. Land suitability for in situ slum redevelopment map reveals that 18% of the area is highly suitable, 60% is moderately suitable, 5% is less suitable, and 17% is unsuitable. The highly and moderately potential sites are low land price, open land, easy to access, located on plain surfaces and far away from hilly areas. It has been taken care of as environmentally sensitive zones are considered either less suitable or unsuitable to protect it. The study has relevance to the sustainable urban planning of the city. [ABSTRACT FROM AUTHOR]

In 2018, the UN estimated that 23.5% of the world's urban population was living in informal settlements by United Nations (The Sustainable Development Goals Report 2019, 2021). This number is projected to increase as urbanization rates continue to rise in locations where governments cannot keep pace with infrastructure and housing developments. The populations living in these informal settlements face unique health challenges; slum health is an understudied subject when compared against rural health, urban health, and poverty and health. The current literature lacks a focused analysis of research on the health of women living in informal settlements. This population is of particular concern due women's unique need for reproductive health care, the health impacts of work done by women, and the disadvantages women face due to gender discrimination and violence. This study reviewed and summarized publications from the past 10 years focused on the health of women living in informal settlements in Sub-Saharan Africa. This review also included analysis of study location, spatial scale, health focus, and characteristics of the study population. Results from this review provide insight into topics and locations where future research is needed to address health disparities of women living in slums. [ABSTRACT FROM AUTHOR]

In the context of the coronavirus disease 2019 (COVID-19) pandemic, compliance with government regulations is a tremendous challenge in the effort to curb the viral transmission. The fact that specific communities and people across the world continue to ignore government regulations of COVID-19 is a crucial issue to address. Researchers sought to examine the political psychological and sociocultural determinants of adherence to COVID-19-related law and policy measures among waste pickers in a sub-urban slum community in Iran. A cross-sectional survey of 362 waste pickers from two municipalities in the countryside of Tehran, Iran, was conducted between January and May 2022. Multiple regression analysis was used to predict the significant difference between the direct or indirect effects of political psychological and sociocultural variables on compliance with COVID-19 emergency measures. Confidence intervals were estimated using the bootstrap method. The findings supported the proposed model. The results indicated that political ideology (β = − 0.13, 95% CI − 0.29 to 0.02), individualism worldview (β = − 0.14, 95% CI − 0.32 to 0.07), fatalism (β = − 0.18, 95% CI − 0.40 to 0.04), health literacy (β = 0.16, 95%CI − 0.05 to 0.37) and prosociality (β = 0.09, 95%CI 0.03–0.13) exert an indirect effect on compliance with the COVID-19 emergency measures through both trust in government and trust in science and scientific community. This study has implications for authorities in ensuring adherence to governmental orders for COVID-19 outbreak. A democracy-based and human rights-based approach and a flexible framework for proceeding more equitable COVID-19 legal and government regulations is critical to an effective and acceptable health response to COVID-19. Instituting slum emergency planning committees, incorporating the informal providers into all pandemic response plans in every urban informal settlement and providing an immediate guarantee of payments to waste packers will be indispensable. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an under-researched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18–29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or "brain"), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word "tension" was the central idiom of distress. "Tension" existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected "tension" to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes. [ABSTRACT FROM AUTHOR]

India is the home of more than 253 million adolescents, which account for almost 21% of the country's population. In the recent past, there has been a rise in the prevalence of mental illness and maladaptive behaviours among adolescents living in slum populations, which are increasing at an alarming rate in many developing countries, mainly due to rural–urban migration, are characterized by poverty, poor housing, overcrowding, poor environment, and high prevalence of communicable diseases. This neglected population has become a major reservoir for a broad spectrum of adverse health conditions. Studies on the mental health status among adolescents in India are relatively scarce. The main objective of the study was to estimate the prevalence of mental health disorder and its determinants among adolescents in slum settings in Lucknow, India; by using GHQ-12. The study used cross-sectional primary data which was collected in 2015–2016 from the adolescents living in various slums of Lucknow city. About 590 adolescents whose parents gave consent to participate were included in the study. Descriptive statistics, Chi square test and ordered logistic regression analysis (OLR) technique were used to assess the mental health. Reliability of GHQ-12 was assessed before performing the analysis which was found to be 0.79. Approximately, 33% of adolescents were found to suffer from severe level of mental disorder. The results of this study depicts that adolescents of age 12–15 years had more severe mental health problems compares to 16–19 years of adolescents. Females were more likely to suffer from severe mental health problems compared to moderate/normal mental health problems (OR 1.72; p < 0.001). Odds of severe mental health problems was significantly higher among Muslims (OR 1.66; p < 0.001) than Hindus. Thus, it was found that age, gender, education, caste, household economic status, media exposure and religion to be significantly associated with mental health problem. Government should provide a wide range of adolescent friendly health services (clinical, mental, nutritional, including counselling) in these slums for a better adolescent health outcome. [ABSTRACT FROM AUTHOR]

The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings. [ABSTRACT FROM AUTHOR]

Bangladesh is undergoing a rapid urbanization process. About one-third of the population of major cities in the country live in slums, which are areas that exhibit pronounced concentrations of factors that negatively affect health and nutrition. People living in slums face greater challenge to improve their health than other parts of the country, which fuels the growing intra-urban health inequities. Two rounds of the Bangladesh Urban Health Survey (UHS), conducted in 2013 and 2006, were designed to examine the reproductive health status and service utilization between slum and non-slum residents. We applied an adaptation of the difference-in-differences (DID) model to pooled data from the 2006 and 2013 UHS rounds to examine changes over time in intra-urban differences between slums and non-slums in key health outcomes and service utilization and to identify the factors associated with the reduction in intra-urban gaps. In terms of change in intra-urban differentials during 2006-2013, DID regression analysis estimated that the gap between slums and non-slums for skilled birth attendant (SBA) during delivery significantly decreased. DID regression analysis also estimated that the gap between slums and non-slums for use of modern contraceptives among currently married women also narrowed significantly, and the gap reversed in favor of slums. However, the DID estimates indicate a small but not statistically significant reduction in the gap between slums and non-slums for child nutritional status. Results from extended DID regression model indicate that availability of community health workers in urban areas appears to have played a significant role in reducing the gap in SBA. The urban population in Bangladesh is expected to grow rapidly in the coming decades. Wide disparities between urban slums and non-slums can potentially push country performance off track during the post-2015 era, unless the specific health needs of the expanding slum communities are addressed. To our knowledge, this is the first systematic explanation and quantification of the role of various factors for improving intra-urban health equity in Bangladesh using nationally representative data. The findings provide a strong rationale for continuing and expanding community-based reproductive health services in urban areas by the NGOs with a focus on slum populations. [ABSTRACT FROM AUTHOR]

The developing world is rapidly urbanizing, but an understanding of how child health differs across urban and rural areas is lacking. We examine the association between area of residence and child health in India, focusing on composition and selection effects. Simple height-for-age averages show that rural Indian children have the poorest health and urban children have the best, with slum children in between. With wealth or observed health environment held constant, the urban height-for-age advantage disappears, and slum children fare significantly worse than their rural counterparts. Hence, differences in composition across areas mask a substantial negative association between living in slums and height-for-age. This association is more negative for girls than boys. Furthermore, a large number of girls are "missing" in slums; we argue that this implies that the negative association between living in slums and health is even stronger than our estimate. The missing girls also help explain why slum girls appear to have a substantially lower mortality than rural girls, whereas slum boys have a higher mortality risk than rural boys. We estimate that slum conditions (such as overcrowding and open sewers), which the survey does not adequately capture, are associated with 20 % to 37 % of slum children's stunting risk. [ABSTRACT FROM AUTHOR]

Informal settlements are an important source of affordable housing and economic activity in developing cities. Research shows that informal settlements are at high risk from natural hazards and the effects of global climate change. Conditions within such settlements are diverse, however, and it is important that we understand the variation in risk across households. In this paper, we study the uneven terrain of risk to localized hazards in informal settlements in Kolkata, India. Our research question is, which factors predict household exposure to monsoon rain hazards? We surveyed 414 households living in low-lying informal settlements on the city's periphery. Using a variety of predictors, we estimate binary logistic models for two outcome variables tied to monsoon rain: home flooding and home leaking. We find that household exposure varies significantly across our study population and follows predictable patterns based on socio-economic and infrastructure variables. The home flooding model results show that households with higher incomes are less likely to flood, but in situ births increase exposure. Households living in structures made of more permanent materials are less likely to flood, as are households living near infrastructure. The home leaking model shows that households with relative financial stability are less likely to leak, as are those that have been living in the settlement for longer periods of time and whose houses are made of better quality materials. These findings indicate that extensive risk in informal settlements is unevenly experienced and that policies intended to reduce disaster and climate risk should focus on the lowest-income households, the provision of infrastructure, and security of tenure. [ABSTRACT FROM AUTHOR]

This paper illustrates an innovative approach to characterize the metabolic pattern of informal urban settlements or slums with the aim to better understand the factors that affect the material standard of living of slum residents, the dynamics of slum development and the interaction of the slum with its wider socioeconomic context. The proposed system of accounting, multi-scale integrated analysis of societal and ecosystem metabolism (MuSIASEM), integrates socioeconomic and spatial data and studies energy and monetary flows in relation to the pattern of human activities and land uses. The theoretical basis of the approach is illustrated with data from Vidigal favela in Rio de Janeiro, Brazil. In particular, we show how to construct taxonomies of accounting categories to characterize: (1) the set of activities carried out by the slum dwellers, to which to link assessments of flow rates per hour; (2) the set of land uses or spatial elements making up the slum, to which to link assessments of flow densities per hectare. The analysis of the interaction of Vidigal with its wider socioeconomic context focuses on monetary flows and transport (job commuting). [ABSTRACT FROM AUTHOR]

Women living in Nairobi's informal settlements face a higher risk of maternal death than those living elsewhere in the country, and have limited knowledge of actions they can take to improve their chances of survival during pregnancy and childbirth. As one strategy to reach this high risk group, Jhpiego has implemented young mothers' clubs (YMCs). These clubs comprise mothers aged 18-30 who come together on a weekly basis to share experiences and solutions to their challenges while receiving health education from health facility staff and community health workers (CHWs). The aim of this study was to assess whether the YMC strategy could be used to improve participants' knowledge of postpartum hemorrhage (PPH), positive behavior around childbirth, and family planning. Participants in nine YMCs (n = 193) across four informal settlements were interviewed to assess their knowledge of safe motherhood topics before and after a series of eight health education sessions. Data were analyzed with the McNemar test to determine significance of change in knowledge pre- and post-intervention. The largest improvements were observed in knowledge about what to include in a birth plan, with correct responses increasing from 32 to 73 % ( p < 0.001), 58-93 % ( p < 0.001), 36-66 % ( p < 0.001), 58-85 % ( p < 0.001), and 64-88 % ( p < 0.001) for identifying a birth companion, budget, skilled birth attendant, emergency supplies, and place of birth, respectively. Less substantial improvements were observed in knowledge of danger signs of PPH (up 10 % from 77 %, p = 0.003). Although knowledge of actions to take in the event of bleeding after delivery did significantly improve, final knowledge scores remained low-knowledge to urinate increased from 14 to 28 % ( p < 0.001) and to breastfeed from 12 to 24 % ( p = 0.005). Even though the vast majority of respondents (84 %) knew before the intervention that a woman should space pregnancy by at least 2 years after delivery, there was an increase to 94 % after the sessions ( p = 0.008). Overall, participants demonstrated significant improvements in knowledge of safe motherhood and family planning topics, suggesting that the materials and methods used were generally effective for improving knowledge among this high risk group. [ABSTRACT FROM AUTHOR]

Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou's informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services. [ABSTRACT FROM AUTHOR]

Urban informal settlements are often under-recognized in national and regional surveys. A lack of quality intra-urban data frequently contributes to a one-size-fits-all public health intervention and clinical strategies that rarely address the variegated socioeconomic disparities across and within different informal settlements in a city. The 2010 Brazilian census gathered detailed population and place-based data across the country's informal settlements. Here, we examined key socio-demographic and infrastructure characteristics that are associated with health outcomes in Rio de Janeiro with the census tract as the unit of analysis. Many of the city's residents (1.39 million people, 22 % of the population) live in informal settlements. Residents of census tracts in Rio de Janeiro's urban informal areas are younger, (median age of 26 versus 35 years in formal settlements), and have less access to adequate water (96 versus 99 % of informal households), sanitation (86 versus 96 %), and electricity (67 versus 92 %). Average per household income in informal settlement census tracts is less than one third that of non-informal tracts (US\$708 versus US\$2362). Even among informal settlements in different planning areas in the same city, there is marked variation in these characteristics. Public health interventions, clinical management, and urban planning policies aiming to improve the living conditions of the people residing in informal settlements, including government strategies currently underway, must consider the differences that exist between and within informal settlements that shape place-based physical and social determinants of health. [ABSTRACT FROM AUTHOR]

This paper explores the role of citizen journalism in the improvement of slums through the Voice of Kibera (VoK) case study. To meet the research objectives, both qualitative and quantitative methods are applied. The study used content analysis, a survey and interview techniques. It concluded that citizen journalism in the VoK uses a participatory, bottom-up approach, with the residents taking a lead role in the production and consumption of news, and that it plays its part in improving the lives of people in Kibera, contributing to governance and processes of democracy. The core development values of participation and empowerment are central to this study, which examines how these values are being impacted on by information technology interventions in the communications area. The research also concludes that citizen journalism may be sustainable if it is financed, promoted, resourced with professional journalists, equipped with new technologies and citizens continue to participate. Lack of cooperation from the audience, finance both for the running of the project, salary and technical problems were cited as the major challenges of citizen journalism. [ABSTRACT FROM AUTHOR]

The term 'slum' is difficult to define, but if we see one, we know it. Definitions for slums are qualitative such as 'areas of people lacking, for example, durable housing or easy access to safe water'. This study aims at identifying characteristic physical features of the built environment that allows defining slum areas based on quantitative and measurable parameters. In general, spatial data on slums are generalized, outdated, or even nonexistent. The bird's eye view of remotely sensed data is capable to provide an independent, area-wide spatial overview, to capture the complex morphological pattern and at the same time capture the large-scale individual objects typical for slums. Using high-resolution optical satellite data, parameters such as building density, building heights, and sizes are used to differentiate between slums and formal settlements. From it, the physical features are used to analyze structural homogeneity and heterogeneities within and across slums and to suggest characteristic physical features for spatial slum delineation at three study sites in Mumbai, India. [ABSTRACT FROM AUTHOR]

Urban slum dwellers are not only prone to develop communicable diseases but also to non-communicable disease (NCDs). The extent and magnitude of NCDs among slum dwellers is largely unknown in Nigeria. A total of 964 adults aged 20–81 years (male 330 and female 634) residing in the urban slum of Ajegunle in Lagos State, Nigeria were studied to determine the prevalence of hypertension and associated factors. The overall prevalence of hypertension was 38.2 %. Of the 368 respondents identified as having hypertension, only 50 (5.2 %) respondents were previously aware of their diagnosis. Of the 50 known hypertensive patients, 48(96 %) had poor control of their high blood pressure. The socio-demographic factors significantly associated with hypertension status were age, sex, education, religion, BMI, and marital status. The study concludes a high prevalence of hypertension among urban slums dwellers in Lagos. The need for government to develop policies for the control of hypertension, improve access to early diagnosis and provide an enabling socioeconomic environment while promoting healthy living. [ABSTRACT FROM AUTHOR]

A number of young people from the north of Ghana migrate to live in the slums of the city of Accra, the administrative capital. These slums, characterized by poor quality housing, and inadequate sanitary facilities, make the young migrants vulnerable to the effects of economic, social, political and environmental insecurities and stressors. One of such slums is Old Fadama, which is located in the heart of the city. The main objective of this paper is to explain how resilient a sample of young migrants are to the stressors encountered at the slum through a self-rated level of resilience. Drawing on resilience thinking, the Youth Resilience Framework and Social Resilience perspectives are discussed and variables for analysis are considered from their synthesis. A survey questionnaire instrument is used to collect data from 104 young migrant residents in the slum. The methods of analysis include: analyses of variance, Chi-square test, and ordinal regression. From the multivariate analyses (that is, the ordinal regression analyses), it is suggested that significant predictors of resilience among the sampled young migrants in Old Fadama include type of employment, social capital, number of stressors experienced, and ability to afford medicine. Specific social capital constructs such as having a boy or girlfriend and strong leadership are predictors of resilience among these young migrants in the slum. [ABSTRACT FROM AUTHOR]

Almost 40 years of war in Angola forced millions of people fleeing rural areas to seek a safe haven in the capital and to settle in informal slum settlements ( musseques) on the periphery of Luanda. The new urban migrants created homes and settlements on land that they purchased in good faith but for which they could get no legal title. Now, they face eviction threats due to commercial interests and government infrastructure expansion. With a population today approaching of over six million, Luanda is Africa's fastest growing and fifth largest city. A decade of post-war rapid economic growth, fuelled by rising commodity prices, has seen GDP per capita grow eightfold, but poverty reduction has not kept apace. The poor, representing over 50 % of the population, have benefited little from the 'peace dividend'. The Angolan Government has promised to build one million homes country-wide before the 2012 elections and aims to eliminate much of the musseque in the process. However, the government's urban plans remain hindered by a weak administration and little national implementation capacity. Despite the government's assertion as the unique owner and manager of all land, there exists a thriving real-estate market for both formal (titled) and informally occupied land. Most urban residents with weak or non-existent tenure rights benefit little from increasing land values and are susceptible to being forcibly removed and increasingly obliged to occupy environmentally risky flood-prone areas. This paper presents the results of work on property markets in Luanda that permit a better understanding of the nature and economic value of land and identify the problems and potentials the market has to offer. The paper argues for a major reform in public land policy, recognising the legitimacy of common practices in land acquisition and long-term occupation in good faith. Inclusive land management, adapting to both formal and existing informal markets, can contribute to the improvement of urban settlement conditions and economic wellbeing of the poor in post-war Luanda. [ABSTRACT FROM AUTHOR]

This research illustrates and analyses the effects of land tenure security on two groups of low-income slum dwellers of Accra (the Ghanaian capital) who have been resettled in 1975 and 1993. The problem of squatting in Accra has been attributed to deficits in housing supply and the high rents of decent accommodation which have left some of the poor with little or no choice but to squat illegally on private or public property. Due to the failure of previous policies to solve the housing problems of the squatters in the capital, this study was conceived to verify the effects of land tenure security and assess the merits of tenure security as an alternative approach to enable low-income residents of the city to improve their housing. Even though tenure security may not be the only condition needed to improve the housing situation of the low-income people of Accra, it can nevertheless be argued that observable improvements and transformations in living conditions have occurred among low-income urbanites that have some sort of tenure security. This research was therefore driven by the central question: to what extent is there a relationship between tenure security and access to housing, and improved living and environmental conditions? A mixed method research design was adopted to draw on relevant information for the research. The study revealed that adequate resettlement of slum dwellers and granting them land tenure security indeed enhanced their access to housing, and improved their living and environmental conditions. [ABSTRACT FROM AUTHOR]

Family planning has widespread positive impacts for population health and well-being; contraceptive use not only decreases unintended pregnancies and reduces infant and maternal mortality and morbidity, but it is critical to the achievement of Millennium Development Goals. This study uses baseline, representative data from six cities in Uttar Pradesh, India to examine family planning use among the urban poor. Data were collected from about 3,000 currently married women in each city (Allahabad, Agra, Varanasi, Aligarh, Gorakhpur, and Moradabad) for a total sample size of 17,643 women. Participating women were asked about their fertility desires, family planning use, and reproductive health. The survey over-sampled slum residents; this permits in-depth analyses of the urban poor and their family planning use behaviors. Bivariate and multivariate analyses are used to examine the role of wealth and education on family planning use and unmet need for family planning. Across all of the cities, about 50% of women report modern method use. Women in slum areas generally report less family planning use and among those women who use, slum women are more likely to be sterilized than to use other methods, including condoms and hormonal methods. Across all cities, there is a higher unmet need for family planning to limit childbearing than for spacing births. Poorer women are more likely to have an unmet need than richer women in both the slum and non-slum samples; this effect is attenuated when education is included in the analysis. Programs seeking to target the urban poor in Uttar Pradesh and elsewhere in India may be better served to identify the less educated women and target these women with appropriate family planning messages and methods that meet their current and future fertility desire needs. [ABSTRACT FROM AUTHOR]

Much of the excitement generated in Britain since 2007 by the York Archaeological Trust's excavations of the city's Hungate neighborhood, which Benjamin Seebohm Rowntree characterized as a 'slum' in his pioneering poverty survey of 1901, derives from the unexpected volume and variety of material evidence uncovered about life in a poor community within a modern industrial city. Such material evidence and its often uncertain relationships to other historical data can enhance analysis by complicating understanding of the past, rather than echoing conventional wisdom. Findings from Hungate can thus contribute to nuanced understandings of urban social disadvantage not only at the neighborhood level in this one particular British city, but at the larger scales of analysis that encompass the growth of cities and interacting urban regions in Britain and around the world during the nineteenth and twentieth centuries. These understandings have contemporary relevance for a world in which over half of humanity now lives in urban areas, as misconceptions about 'slums' continue to undermine efforts to reduce urban inequality. [ABSTRACT FROM AUTHOR]

This reflective piece draws together the themes and issues presented within the volume, exploring historic and contemporary definitions and attitudes towards poverty and their implications of the archaeological study of 'slum' neighborhoods. It compares and contrasts the individual case studies from York and Manchester with investigations in America and Australia, drawing attention to the differences between them. Suggestions are made for future investigations, particularly in the potential for further comparative work at an international level. [ABSTRACT FROM AUTHOR]

The communities who live in urban informal settlements are diverse, as are their environmental conditions. Characteristics include inadequate access to safe water and sanitation, poor quality of housing, overcrowding, and insecure residential status. Interventions to improve health should be equity-driven and target those at higher risk, but it is not clear how to prioritise informal settlements for health action. In implementing a maternal and child health programme in Mumbai, India, we had conducted a detailed vulnerability assessment which, though important, was time-consuming and may have included collection of redundant information. Subsequent data collection allowed us to examine three issues: whether community environmental characteristics were associated with maternal and newborn healthcare and outcomes; whether it was possible to develop a triage scorecard to rank the health vulnerability of informal settlements based on a few rapidly observable characteristics; and whether the scorecard might be useful for future prioritisation. The City Initiative for Newborn Health documented births in 48 urban slum areas over 2 years. Information was collected on maternal and newborn care and mortality, and also on household and community environment. We selected three outcomes-less than three antenatal care visits, home delivery, and neonatal mortality-and used logistic regression and classification and regression tree analysis to test their association with rapidly observable environmental characteristics. We developed a simple triage scorecard and tested its utility as a means of assessing maternal and newborn health risk. In analyses on a sample of 10,754 births, we found associations of health vulnerability with inadequate access to water, toilets, and electricity; non-durable housing; hazardous location; and rental tenancy. A simple scorecard based on these had limited sensitivity and positive predictive value, but relatively high specificity and negative predictive value. The scorecard needs further testing in a range of urban contexts, but we intend to use it to identify informal settlements in particular need of family health interventions in a subsequent program. [ABSTRACT FROM AUTHOR]

lthough linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious that a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory models to infer a reliable and valid measure of hunger and food insecurity relevant to low-income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System. The reliability and accuracy of the items are tested using both the Mokken scale analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households' economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food-secure, and nearly half of all households are categorized as 'food-insecure with both adult and child hunger.' Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children. [ABSTRACT FROM AUTHOR]

The aim of this study was to ascertain the prevalence of physical inactivity and examine the role of potential predictors in a very low-income adult population in a slum located in Recife city, northeast of Brazil. A cross-sectional study was conducted with 1,176 subjects aged 20-60 years residing in a slum. Using the short version of the International Physical Activity Questionnaire, 307 (26.1%) study participants-97 (23.8%) men and 210 (27.3%) women-have a low physical activity score (MET-minutes per week). Increased age was associated with physical inactivity only in people without overweight/obesity. Low physical activity was less common (i.e., respondents were more active) than in other Brazilian population-based studies. These results suggest that the relationship between physical activity and socioeconomic level is more complex and depends on the internal characteristics of the community. [ABSTRACT FROM AUTHOR]

The paper seeks to contribute to the recent slum tourism-debate. On the basis of an empirical field study conducted in Mumbai in 2009, this article investigates how Indian slums are observed by different actors within the communication context of this (emerging) form of tourism. Taking into consideration that slums are defined in public discourse nearly exclusively by poverty and sordidness, it is interesting to examine how the tour agency's objective of correcting the negative connotations of poverty is achieved. Accordingly, the study aims, by means of a second order observation, to observe how the tourists and the tour agency simultaneously perceive and charge poverty. Following the epistemological premise that reality is an observer-dependent construction, it seeks to outline which different images or realities of the investigated slum, Dharavi, are created by the different observations. The findings will then facilitate a discussion of the extent to which poverty can be defined as the dominant mode of observation of the slum tourism context as a whole. [ABSTRACT FROM AUTHOR]

During the mid-1990s, a new form of tourism was established in metropolises of several developing countries or emerging nations. This type of tourism consists in visits to the most disadvantaged parts of the respective city. Poverty tours or slum tours are offered on a relatively large scale in the South African cities of Johannesburg and Cape Town, Rio de Janeiro in Brazil, as well as in Indian metropolises, to name some important examples. The target group of these tours consists primarily of international tourists. It is estimated that 40,000 such tourists visit favelas in Rio de Janeiro each year, around 300,000 the townships in Cape Town. This contribution refers to and comments on these developments and insights regarding poverty tourism or slumming, based on empirical research and experiences in South Africa, Brazil, and India. It will be shed light on the phenomenon from an observational-theoretical perspective. It is aimed to open a discussion on the ways poverty tours or slumming observes and simultaneously programmatically charges poverty. And, it will be considered in which way poverty tourism is observed. [ABSTRACT FROM AUTHOR]

The urban population in India is one of the largest in the world. Its unprecedented growth has resulted in a large section of the population living in abject poverty in overcrowded slums. There have been limited efforts to capture the health of people in urban slums. In the present study, we have used data collected during the National Family Health Survey-3 to provide a national representation of women’s reproductive health in the slum population in India. We examined a sample of 4,827 women in the age group of 15–49 years to assess the association of the variable slum with selected reproductive health services. We have also tried to identify the sociodemographic factors that influence the utilization of these services among women in the slum communities. All analyses were stratified by slum/non-slum residence, and multivariate logistic regression was used to analyze the strength of association between key reproductive health services and relevant sociodemographic factors. We found that less than half of the women from the slum areas were currently using any contraceptive methods, and discontinuation rate was higher among these women. Sterilization was the most common method of contraception (25%). Use of contraceptives depended on the age, level of education, parity, and the knowledge of contraceptive methods ( p < 0.05). There were significant differences in the two populations based on the timing and frequency of antenatal visits. The probability of ANC visits depended significantly on the level of education and economic status ( p < 0.05). We found that among slum women, the proportion of deliveries conducted by skilled attendants was low, and the percentage of home deliveries was high. The use of skilled delivery care was found to be significantly associated with age, level of education, economic status, parity, and prior antenatal visits ( p < 0.05). We found that women from slum areas depended on the government facilities for reproductive health services. Our findings suggest that significant differences in reproductive health outcomes exist among women from slum and non-slum communities in India. Efforts to progress towards the health MDGs and other national or international health targets may not be achieved without a focus on the urban slum population. [ABSTRACT FROM AUTHOR]

Community-based slum enumeration was carried out in Kisumu from 2005 to 2008 as part of a city-wide slum-upgrading initiative. This paper analyses this enumeration exercise particularly in relation to land management and tenure security. The paper draws on a peer evaluation that included interviews with slum-upgrading stakeholders as well as community-based focus group discussions, mainly with enumerators. The paper finds that, for a grassroots enumeration exercise to be successful, grassroots trust must be sustained for ongoing verification and updating of the enumeration data and the enumeration must link up effectively with the planning authorities. Broader preconditions are the coordination of the slum-upgrading initiative, and beyond this, of wider and often competing city initiatives. Key findings towards securing tenure include the importance of various forms of mobilisation that accompany enumeration and of the informal and formal knowledge generation that results from the enumeration process. [ABSTRACT FROM AUTHOR]

The objectives of this study were to develop a Bangla version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), and assess its reliability and validity on an adolescent population in Bangladesh. In total, 187 boys (mean age 14.6 years +/- SD 2.1) and 137 girls (15.2 +/- SD 2.0) from residential areas, and 157 boys (13.8 +/- SD 2.1) and 121 girls (13.4 +/- SD 2.1) from slums in Dhaka were interviewed using a questionnaire, which included a Bangla translation of the WHOQOL-BREF. Thirty-eight randomly selected adolescents from the original interviewed group were re-administered the same questionnaire 1 week later. On the whole, the Bangla version of WHOQOL-BREF showed good internal consistency and test-retest reliability. In comparisons between residential and slum areas, discriminant validities were observed in the total and environmental domain of both genders and in the social relationship domain of males. Furthermore, discriminant validities of physical and psychological domains were observed in gender comparisons. These results suggest that the Bangla version of WHOQOL-BREF is valid and reliable in assessing the quality of life of adolescents in Bangladesh. [ABSTRACT FROM AUTHOR]

On December 26, 2004, a tsunami struck coastal areas in the Bay of Bengal. Among the communities affected were Pallavan Nagar and Anju Kudasai slums in Chennai India. These communities have been collaborating, with some success, on a project to manage the urban environment for human health that employs an adaptive ecosystem approach framework, and is heavily influenced by participatory action research methodology. The tsunami resulted in loss of life, shelter, property and livelihoods in these communities. This profile presents an overview of the project, the two settlements, and the impact of the tsunami on the communities. This article also discusses the impact of the disaster on the direction and nature of the ecohealth project. [ABSTRACT FROM AUTHOR]

The prevalence of poisoning and bites was 0.76% (48/6308) and 1.24% (78/6308), respectively in a community-based survey in Ujjain district, Madhya Pradesh. Household cleansing agents and medicines, and-dog bite and bee-sting were the most common poisons and bites, respectively. Most parents (59%) reported lack of appropriate first-aid knowledge. Educational interventions and implementing the medicine take-back program are suggested. [ABSTRACT FROM AUTHOR]

Of this pilot study was to assess the iron status and dietary intake of 1–3 year-old apparently healthy toddlers of the lower socio-economic class, and the effect of eight weeks intervention with liquid oral iron in an urban slum in Pune, India. 50 toddlers (M= 25, F= 25) with mean age of 2.4 years (SD 0.82) were evaluated. Anthropometry, Food Frequency Questionnaire, a hemogram and ferritin were measured. Twenty mg of elemental iron was given to all toddlers. After 8 weeks clinical examination, anthropometry, hemoglobin (HGB) and Ferritin were measured. Prevalence of anemia was 66% (HGB <11gm %) and ferritin (iron stores) were low (< 12 μgm/L) in 45 (90%). After therapy prevalence of anemia was 30%. There was a significant difference in the HGB and ferritin levels of children after eight weeks of therapy (p<0.001). The prevalence of anemia decreased from 66 to 30% after treatment with liquid iron. We propose that all concerned in the care of toddlers should join the fight against anemia and prescribe iron to all toddlers when they are seen for minor ailments. [ABSTRACT FROM AUTHOR]

Background: More than half of the disease burden in Uganda can be prevented through improving water, sanitation, and hygiene (WASH). In slum communities, water supply is insufficient but also highly contaminated; therefore, ensuring that the safe water chain is maintained by households is paramount to preventing water-related diseases. This study aimed at assessing knowledge and practices of households on safe water chain maintenance in slum communities in Kampala City, Uganda. Methods: This was a community-based cross-sectional study carried out among 395 households in slum communities in Kampala, Uganda. Data were collected using a semi-structured questionnaire. Prevalence ratios (PRs) and their 95% confidence intervals were used as a measure of association between safe water chain management and associated knowledge and practice factors. The PRs were obtained using a multivariable modified Poisson regression with logarithm as the link function, with robust standard errors. Results: Majority (76.7%, 303/395) of the households collected their water from a piped water system and paid for the water (72.9%, 288/395). Almost all (97.2%, 384/395) of the participants said that they knew the dangers associated with drinking unsafe water, boiled their drinking water (95.4%, 377/395), and used storage containers that minimize contamination (97.0%, 383/395). However, only (32.4%, 128/395) of the households satisfactorily maintained the safe water chain. Female- (adjusted PR = 1.82, 95% CI (1.19–2.78)) and student-led households (adjusted PR = 1.58, 95% CI (1.03–2.41)) and those whose heads had attained post-primary education (adjusted PR = 1.48, 95% CI (1.02–2.17)) were more likely to satisfactorily maintain the safe water chain. This was similar among members who thought most contamination occurs during storage (adjusted PR = 1.47, 95% CI (1.10–1.97)). Conclusion: Only a third of the households maintained the safe water chain satisfactory. Female-led, student-led, and post-primary educated-led household and household that thought most contamination occurs during storage were more likely to maintain the safe water chain. There is a need to improve the level of awareness about the importance of the safe water chain among slum dwellers. [ABSTRACT FROM AUTHOR]