Intra-urban Differentials Research Articles

Intra-urban differentials in the exclusive use of hygienic methods during menstruation among young women in India.

Menstrual hygiene among women is a critical public health issue in urban India, but it remains understudied and under-researched. However, to our knowledge, no national level study in India has yet examined the differentials in the exclusive use of hygienic methods among young women (aged 15-24) in urban India. This study attempts to fill this gap by analysing biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods among these women. We analysed data on 54561 urban women aged 15-24 from National Family Health Survey-5, 2019-21. We used binary logistic regression to examine differentials in the exclusive use of hygienic methods. To examine spatial variation, we mapped exclusive use of hygienic methods across Indian states and districts. The study found that two-thirds of young women in urban India reported exclusive use of hygienic methods. However, there was significant geographic heterogeneity observed at both state and district levels. In states such as Mizoram and Tamil Nadu, the use of hygienic methods was over 90%, while in Uttar Pradesh, Bihar, Chhattisgarh, and Manipur, it was less than 50%. The district-level variation in exclusive use of hygienic methods was even more striking. In many states, districts with extremely low exclusive use (less than 30%) were located in close proximity to districts with high exclusive use. Being poor, uneducated, Muslim, having no mass media exposure, living in the north and central regions, not having a mobile phone, getting married before 18, and having an early experience of menarche were associated with lower exclusive use of hygienic methods. In conclusion, substantial biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods suggest the need for context-specific behavioural interventions. Mass media campaigns and targeted distribution of subsidized hygienic methods could help reduce the existing inequities in the exclusive use of hygienic methods.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in S\xe3o Paulo Municipality, Brazil

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

Intra-urban differentials of congenital and acquired syphilis and syphilis in pregnant women in an urban area in northeastern Brazil.

BackgroundCurrently syphilis is considered an epidemic disease worldwide. The objective of this study was to identify intra-urban differentials in the occurrence of congenital and acquired syphilis and syphilis in pregnant women in the city of Natal, in northeast Brazil.MethodsCases of syphilis recorded by the municipal surveillance system from 1 January 2011 to 30 December 2018 were analysed. Spatial statistical analyses were performed using the kernel density estimator of the quadratic smoothing function (weighted). SaTScan software was applied for the calculation of risk based on a discrete Poisson model.ResultsThere were 2163 cases of acquired syphilis, 738 cases of syphilis in pregnant women and 1279 cases of congenital syphilis. Kernel density maps showed that the occurrence of cases is more prevalent in peripheral areas and in areas with more precarious urban infrastructure. In 2011–2014 and 2015–2018, seven statistically significant clusters of acquired syphilis were identified. From 2011 to 2014, the most likely cluster had a relative risk of 3.54 (log likelihood ratio [LLR] 38 895; p<0.001) and from 2015 to 2018 the relative risk was 0.54 (LLR 69 955; p<0.001).ConclusionsIn the municipality of Natal, there was a clustered pattern of spatial distribution of syphilis, with some areas presenting greater risk for the occurrence of new cases.

Spatial Variability in the Effect of High Ambient Temperature on Mortality: An Analysis at Municipality Level within the Greater Athens Area.

Spatial variability in temperature exists within metropolitan areas but very few studies have investigated intra-urban differentiation in the temperature-mortality effects. We investigated whether local characteristics of 42 Municipalities within the Greater Athens Area lead to modified temperature effects on mortality and if effect modifiers can be identified. Generalized Estimating Equations models were used to assess the effect of high ambient temperature on the total and cause-specific daily number of deaths and meta-regression to investigate effect modification. We found significant effects of daily temperature increases on all-cause, cardiovascular, and respiratory mortality (e.g., for all ages 4.16% (95% CI: 3.73,4.60%) per 1 °C increase in daily temperature (lags 0–3). Heterogeneity in the effect estimates between Municipalities was observed in several outcomes and environmental and socio-economic effect modifying variables were identified, such as % area coverage of buildings, length of roads/km2, population density, % unemployed, % born outside the EU countries and mean daily temperature. To further examine the role of temperature, we alternatively used modelled temperature per Municipality and calculated the effects. We found that heterogeneity was reduced but not eliminated. It appears that there are socioeconomic status and environmental determinants of the magnitude of heat-related effects on mortality, which are detected with some consistency and should be further investigated.

Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh?

Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh?

Intraurban differentials of perinatal mortality: modeling for identifying priority areas

Abstract Objective: To analyze the intraurban spatial distribution of perinatal mortality, its avoidability, and relationship with socioeconomic indicators in Recife, Pernambuco, Brazil, in the period from 2013 to 2015. Method: An ecological study with data from the Information Systems on Mortality and Live Births and the Brazilian Institute of Geography and Statistics, using neighborhoods as the analysis unit. We elaborated an indicator of social deprivation formed by variables from the demographic census. We estimated the Kernel density of the deaths and calculated the Moran index of the perinatal mortality coefficients in the spatial analysis. We elaborated thematic maps of avoidable perinatal mortality and social deprivation. Results: The global statistical analysis of the mortality distribution indicated evidence of spatial aggregation. Moran's index was 0.18. We found clusters of perinatal mortality in neighborhoods of the Central, North, Northwest, and South Regions. In the North, Northwest, Southwest, and South Regions we identified neighborhoods with greater social deprivation and avoidable mortality coefficients. The primary cause of death was of fetuses and newborns affected by hypertensive maternal disorders. Conclusion: We demonstrated intraurban differentials in perinatal mortality among neighborhoods. The stratification of the urban space according to the social deprivation indicator presented a relation with the perinatal mortality and its avoidability.

Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh?

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.

MAPEAMENTO DE DIFERENCIAIS INTRAURBANOS DE VULNERABILIDADE EM SAÚDE

Considering census tracts of urban situation as area units, this study employed an ecological approach to identify and map intra-urban differentials of health vulnerability in Divinópolis, a mid-sized municipality from Minas Gerais State, Brazil. The study evaluated variables from different socioeconomic databases, municipal health indicators and research findings carried out in UFSJ, and classified census tracts in scores. Results showed high sanitary coverage ratios in contrast to health indicators, income-and-literacy levels mostly intermediate and low. It was built a choropleth map for health vulnerability patterns, which made it possible to visualize the distribution of intra-urban differentials and specific urban areas with high health vulnerability that require prioritization of municipal public administration. It was concluded that sanitary improvements gained with socioeconomic development and urbanization policies may not protect populations from unsafe levels of health risk exposure and vulnerability. Score classification methodology seemed to be a fairly simple tool, with wide-range applicability and potentially efficient to identify intra-urban differentials in health vulnerability.

Energy Vulnerability in the Grain of the City: Toward Neighborhood Typologies of Material Deprivation

Geographers are increasingly engaging with the driving forces and implications of energy poverty—a specific but relatively unknown form of material deprivation that emerges at the nexus of sociodemographic inequalities and built formations. In this article, we argue that an improved understanding of the urban embeddedness of energy poverty can provide novel insights into the systemic underpinnings of injustice. We thus develop a conceptual framework focusing on the links between the sociodemographic and housing vulnerabilities to energy poverty on the one hand and wider patterns of urban social inequality on the other. This approach is applied to the study of several postcommunist cities in eastern and central Europe (ECE), where energy poverty has expanded rapidly over the past two decades. Using evidence from extensive custom-built neighborhood surveys, we interrogate the sociodemographic, housing, and infrastructural features of households that experience a lack of adequate domestic energy services. Our results point to the existence of distinct landscapes and typologies of energy vulnerability in the urban fabric. Material deprivation—a phenomenon that has rarely been studied in infrastructural terms—creates new sociospatial inequalities that might supplant patterns and processes of intraurban differentiation.

Périurbanisation et transformation du gradient de la mortalité urbaine en Suisse

Alors que les différences régionales d’espérance de vie se sont estompées en Suisse, quels sont les effets de la périurbanisation sur la géographie de la mortalité ? À partir des données de l’état civil et des recensements, on observe un accroissement des différentiels intra-urbains de mortalité depuis 1980, en particulier dans les villes les plus grandes ou qui se sont récemment étendues. Un gradient non linéaire émerge : l’espérance de vie est plus faible dans les centres-villes et les zones rurales que dans la ceinture des agglomérations urbaines. Les profils de mortalité par âge et cause suggèrent que cela tient à la fois aux styles de vie propres aux populations des centres-villes et à la concentration spatiale des groupes défavorisés. Pour la mortalité entre 20 et 64 ans, un modèle multiniveau appliqué à des données de mortalité couplées aux recensements montre que la moindre mortalité observée dans les zones périurbaines résulte de la concentration d’individus très instruits et de familles. À l’inverse, la surmortalité des 20-64 ans dans les centres-villes reflète des désavantages matériels et sociaux. Cependant, ces conséquences socioéconomiques de la périurbanisation ne suffisent pas à rendre compte du gradient de la mortalité urbaine observé chez les personnes âgées.

Health Vulnerability Index and newborn hearing screening: urban inequality.

To analyze the intra-urban differentials related to the outcome of the Newborn Hearing Screening (NHS) of children living in Belo Horizonte tested in a reference service using the Health Vulnerability Index (HVI). cross-sectional study with children living in Belo Horizonte evaluated by a Newborn Hearing Screening Reference Service (NHSRS) between 2010 and 2011. The HVI of the census tract of each child was obtained by the georeferencing of their respective addresses. Multivariate analysis was conducted using the decision tree technique, considering a statistical model for each response. A thematic map of points representing the geographic distribution of the children evaluated by the NHS program was also developed. The NHS failure rate for children living in areas with very high HVI, or without HVI data, was 1.5 times higher than that for children living in other census tracts. For children living in areas of low, medium, and high HVI, who underwent NHS after 30 days of life, the NHS failure rate was 2.1 times higher in children that presented Risk Indicator for Hearing Loss (RIHL) (17.2%) than in those who did not (8.1%). Uneven distribution was observed between areas for children that underwent the NHS and those who failed it. Significant intra-urban differentials were found in Belo Horizonte, indicating correlation between health vulnerability and NHS outcomes.

Intra Urban Differentials of Fetal Mortality Rates in Sao Paulo City, Brazil.

Intra Urban Differentials of Fetal Mortality Rates in Sao Paulo City, Brazil.

Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out

BackgroundWe describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials. MethodsWe use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). ResultsBetween 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. ConclusionsThe narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums.

Social determinants of intra-urban differentials of admissions by respiratory diseases in Salvador (BA), Brazil.

Respiratory diseases (RD) represent a significant cause of hospitalization in Brazil, occupying the first position in the rank by group of diseases. To identify social determinants (SD) of intra-urban differentials of hospitalizations by RD and their main types (asthma and pneumonia) a study of spatial aggregation was carried out in Salvador (BA), between 2001 and 2007, taking Information Zones (IZ) as unit of analysis. Data on hospitalizations were provided by the Health Department of Bahia State. Socioeconomic indicators were obtained from the Demographic Census carried out in 2000, and the number of health centers was acquired from the National Register of Health Services. Multiple linear regression analysis indicated association between spatial variation of the rates of hospitalization due to RD and income (β = 0.54, p < 0.001) and rate of health facilities per 10,000 inhabitants (β = 2.91, p < 0.001). Crowding was not associated. The identification of variation in SD in hospitalizations by RD in the IZ of Salvador will help in the decision-making process by public managers in defining goals and effective measures to reduce inequities in health.

Índice de Saúde Aplicado ao Município de Araraquara, SP: um instrumento para o acompanhamento da Atenção Básica

The improvement of the process of evaluation and monitoring of the Primary Care Attention has been yearned by the managers of the different spheres in the context of the Unified System Health - UHS. Thus, in the order to identify the conditions of the health assistance in the city of Araraquara/SP, based on the particular features presented in the inscribe areas of each unit of health. It was adopted by means of a composed indicator aiming to favor a broader view which contemplates the emergency of phenomena from a more including vision. It was used the methodology developed in the Index of Health of Drumond Jr, whose final value of the Index is gotten by the average of the values of the components of each health district. To the components originally adopted - Coefficient of Infant Mortality, Coefficient of Tuberculosis Incidence, Coefficient of Mortality by External Causes and Coefficient of Precocious Mortality by Chronic Diseases - was still added in this study, the Tax of Alphabetization and the Monthly Nominal Average Income of Responsible People for the Domiciles. The 24 Units of Health had been classified according to values obtained in the relation among its components. The results point intra-urban differentials in relation to the majority of the components and lower values for the Health Units located at the periphery of the city. Knowing this fact municipal administration is of fundamental importance to progress in improving the process of evaluation of primary care in the county.

Unscripted (in)Justice: Exposure to Ecological Hazards in Metropolitan Accra

The author examines geographies of environmental hazards in Accra, declared a Millennium City on I5 January 2010. With the aid of both primary and secondary data, it is shown how environmental governance has shifted under neoliberalism, and the author demonstrates how a review of Accra's waste disposal problems could elucidate how such paradigm shift has contributed to urban social injustice. Current practices are seen as a symptom of poor governance and the value of understanding intraurban differentials is interrogated. It is posited that the current representations as to who bears the brunt of any possible health-risk outcomes appear abstract, incomplete, and poorly understood. The author illustrates how ineffective and insufficiently attentive governance can exacerbate health risks facing the entire society, and suggests that addressing inequalities may be among the most effective interventions to ensure sustainable environmental management, improve health, and guarantee social cohesion in the urban space.

Diferenciais intraurbanos na distribuição de dengue em Cuiabá, 2007 e 2008

Cuiaba presents a huge number of cases of dengue in the endemic periods as well as in the cyclical epidemics. The aim of the study was to analyze the intra-urban differentials of the incidence in 2007 and 2008 relating them with socio-economical and environmental life conditions. study of ecological approach using secondary data. The characterization of the life conditions was gotten from the Demographic Census (IBGE, 2000) and the epidemiologic data from the Surveillance National System (SINAN). The socio-economical index was based on school level and income of the head of family and overcrowding; the socioambiental index used information about sanitation and proportion of precarious domiciles. The variables were classified in quintis and points were attributed for each one. The score for neighborhood was resultant of the addition of the points for each variable. The neighborhoods had been classified in stratus of risk from the combination of results of the two indexes. The incidence was lesser in stratus of average and low risk and very high in the stratum of the highest risk but was bigger then expected in the stratum classified at minimum risk indicating dissociation between life conditions and occurrence of the illness. Higher incidences of the dengue fever in Cuiaba in 2007 and 2008 have been observed in places with precarious conditions of sanitation and inhabited by populations with lesser level of income and education level but there is no linear correlation between life conditions and incidence.

When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana

Intraurban differentials in safe drinking water in developing cities have been exacerbated by rapid population growth that exceeds expansion of local water infrastructure. In Accra, Ghana, municipal water is rationed to meet demand, and the gap in water services is increasingly being filled by private water vendors selling packaged “sachet” water. Sachets extend drinking water coverage deeper into low-income areas and alleviate the need for safe water storage, potentially introducing a health benefit over stored tap water. We explore correlates of using sachets as the primary drinking water source for 2093 women in 37 census areas classified as slums by UN-Habitat, and links between sachet water and reported diarrhea episodes in a subset of 810 children under five. We find that neighborhood rationing exerts a strong effect on a household's likelihood of buying sachet water, and that sachet customers tend to be the poorest of the poor. Sachet use is also associated with higher levels of self-reported overall health in women, and lower likelihood of diarrhea in children. We conclude with implications for sachet regulation in Accra and other sub-Saharan cities facing drinking water shortages.

Intra-urban differentials in the utilization of reproductive healthcare in India, 1992-2006.

This paper examines trends in three reproductive healthcare indicators- namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992-1993 and 2005-2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in all three indicators has increased in the country, among both the urban poor and non-poor. However, the utilization of reproductive health services is concentrated among the urban non-poor cutting across the states, with the exception of Kerala. While the non-poor/poor gap in antenatal care and medical assistance at delivery remained large over the years, the gap in contraceptive use has narrowed down cutting across states. After adjusting for other confounders, household poverty was found to be a significant barrier in the utilization of reproductive healthcare services across the states. It has been observed that the utilization of reproductive healthcare services followed a continuum of rural total, urban poor, and urban non-poor.

Demarcation of local neighborhoods to study relations between contextual factors and health

BackgroundSeveral studies have highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the target outcomes. Political and administrative divisions of urban areas are the most commonly used definition, although they suffer limitations in their ability to fully express the neighborhoods as social and spatial units.ObjectiveThis study presents a proposal for defining the boundaries of local neighborhoods in Rio de Janeiro city. Local neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators.MethodologyLocal neighborhoods were created using the SKATER method (TerraView software). Criteria used for socioeconomic homogeneity were based on four census tract indicators (income, education, persons per household, and percentage of population in the 0-4-year age bracket) considering a minimum population of 5,000 people living in each local neighborhood. The process took into account the geographic boundaries between administrative neighborhoods (a political-administrative division larger than a local neighborhood, but smaller than a borough) and natural geographic barriers.ResultsThe original 8,145 census tracts were collapsed into 794 local neighborhoods, distributed along 158 administrative neighborhoods. Local neighborhoods contained a mean of 10 census tracts, and there were an average of five local neighborhoods per administrative neighborhood.The local neighborhood units demarcated in this study are less socioeconomically heterogeneous than the administrative neighborhoods and provide a means for decreasing the well-known statistical variability of indicators based on census tracts. The local neighborhoods were able to distinguish between different areas within administrative neighborhoods, particularly in relation to squatter settlements.ConclusionAlthough the literature on neighborhood and health is increasing, little attention has been paid to criteria for demarcating neighborhoods. The proposed method is well-structured, available in open-access software, and easily reproducible, so we expect that new experiments will be conducted to evaluate its potential use in other settings. The method is thus a potentially important contribution to research on intra-urban differentials, particularly concerning contextual factors and their implications for different health outcomes.