Low-income Urban Population Research Articles

Lead Exposure Risk is Associated with Asthma in a Low-income Urban Hispanic Population: Results of the Communities Organized against Asthma and Lead (COAL) Project

Lead Exposure Risk is Associated with Asthma in a Low-income Urban Hispanic Population: Results of the Communities Organized against Asthma and Lead (COAL) Project

Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

BackgroundDrug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management.MethodsA population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval.ResultsAmong the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care.ConclusionLow utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Breast-Feeding Rates at an Inner-City Pediatric Practice

To determine rates of breast-feeding in the first 2 months of life at an inner-city pediatric practice. Using retrospective chart reviews, we examined all visits through 2 months of age for infants seen from April 1, 2007, to June 29, 2007, at the Pediatric Practice of Rainbow Babies and Children's Hospital, Cleveland, Ohio, which serves a low-income urban population. Rates of breast-feeding were analyzed by visit number and by infant age category. We reviewed all 557 visits occurring between birth and 2 months of age for all 223 eligible infants. At visit 1 (median age 5 days), the rates of exclusive and any breast-feeding were 22.0% and 40.8%, respectively. By visit 3 (median age 43 days), the rates of exclusive and any breast-feeding were 10.6% and 24.5%, respectively. These inner-city breast-feeding rates are substantially below reported regional and national rates. Barriers to implementing urgently needed interventions are discussed.

Prenatal Acetaminophen Use is a Risk for Wheeze at Age 5 Years in a Low Income Urban Population with a High Risk for Asthma

Prenatal acetaminophen use was associated with wheeze in a British birth cohort. The extent of prenatal acetaminophen use and its relationship to asthma and wheeze in US inner-city minority communities has not been studied previously. As part of an ongoing birth cohort study (CCCEH), mothers of Dominican and African-American children living in NYC completed prenatal and postnatal questionnaires regarding environmental exposures, medication use and symptoms (n = 712). ISAAC questionnaires were administered to parents of children who had reached age 5 (n = 280). Current wheeze was defined as occurring within the preceding 12 months. Regression was used to estimate the relative risk (RR) for current wheeze of prenatal acetaminophen use. Prenatal acetaminophen use was reported by 36% of mothers (17%, 16%, 14% in the 1st, 2nd, 3rd trimesters, respectively). Postnatal acetaminophen was reported for 56%, 32% and 27% of children in the 1st, 2nd and 3rd years of life, respectively. Current wheeze at age 5 years was common (27%). Prenatal acetaminophen was significantly associated with current wheeze at age 5 in unadjusted analysis (RR 1.9 [95% CI 1.3-2.8], P = 0.001) and after adjustment for maternal asthma, environmental tobacco smoke exposure and postnatal acetaminophen use (RR 1.7 [1.2-2.4], P = 0.006). Third trimester acetaminophen use had the strongest association with current wheeze (RR 1.9 [1.3-2.9], P = 0.002). There was no associations between postnatal acetaminophen use at ages 1, 2 or 3 years and wheeze (P values = 0.25-0.93). Third trimester acetaminophen use increased the risk for wheeze at age 5 in a US population with a high risk for asthma.

Internet-based monitoring of asthma symptoms, peak flow meter readings, and absence data in a school-based clinical trial

Asthma is the most common chronic childhood disease and has significant impact on morbidity and mortality in children. Proper adherence to asthma medication has been shown to reduce morbidity among those with asthma; however, adherence to medications is known to be low, especially among low-income urban populations. We conducted a randomized clinical trial to examine the effectiveness of an intervention designed to increase adherence to asthma medication among children with asthma that required daily collection of data. and A specifically designed web-based data collection system, the Asthma Agents System, was used to collect daily data from participant children at school. These data were utilized to examine the intervention's effectiveness in reducing the frequency of asthma exacerbations. This study examines the Asthma Agents System's effect on the frequency of missing data. Data collection methods are discussed in detail, as well as the processes for retrieving missing data. For the 290 children randomized, 97% of the daily data expected were available. Of the outcome data retrieved via the Asthma Agents System, 5% of those expected were missing during the period examined. Challenges encountered in this study include issues regarding the use of technology in urban school settings, transfer of data between study sites, and availability of data during school breaks. Use of the Asthma Agents System resulted in lower rates of missing data than rates reported elsewhere in the literature. Clinical Trials 2008; 5: 31-37. http://ctj.sagepub.com.

Enhancing the mineral and vitamin content of wheat and maize through plant breeding

More than half of the world's population suffers micronutrient undernourishment. The main sources of vitamins and minerals (iron, zinc, and vitamin A) for low-income rural and urban populations are staple foods of plant origin that often contain low levels or low bioavailability of these micronutrients. Biofortification aims to develop micronutrient-enhanced crop varieties through conventional plant breeding. HarvestPlus, the CGIAR's biofortification initiative, seeks to breed and disseminate crop varieties with enhanced micronutrient content that can improve the nutrition of the “hard to reach” (by fortification or supplementation programmes) rural and urban poor in targeted countries/regions. In attempting to enhance micronutrient levels in maize and wheat through conventional plant breeding, it is important to identify genetic resources with high levels of the targeted micronutrients, to consider the heritability of the targeted traits, to explore the availability of high throughput screening tools and to gain a better understanding of genotype by environment interactions. Biofortified maize and wheat varieties must have the trait combinations which encourage adoption such as high yield potential, disease resistance, and consumer acceptability. When defining breeding strategies and targeting micronutrient levels, researchers need to consider the desired micronutrient increases, food intake and retention and bioavailability as they relate to food processing, anti-nutritional factors and promoters. Finally, ex ante studies are required to quantify the burden of micronutrient deficiency and the potential of biofortification to achieve a significant improvement in human micronutrient status in the deficient target population in order to determine whether a biofortification program is cost-effective.

Prevalência de excesso de peso e hipertensão arterial, em população urbana de baixa renda

OBJETIVO: Estudar a relação entre massa corporal e pressão arterial em população urbana de baixa renda. MÉTODOS: Estudo transversal desenvolvido em amostra representativa de uma comunidade urbana de baixa renda, no período de julho a dezembro/1998. De um total de 224 quadras, 67(30%) quadras foram selecionadas com indivíduos de ambos os sexos, com idade > 30 anos. A pressão arterial, o peso e a altura foram medidos, e através de questionário, obtidas informações sobre sexo, idade, renda familiar, escolaridade e ocupação. Foi calculado o índice de massa corporal (IMC), dividindo-se o peso (quilograma) pela altura (metro) elevada ao quadrado e considerado normal IMC<25; como sobrepeso 25 <IMC < 30; como obesidade IMC> 30. Adicionalmente, excesso de peso foi definido como IMC> 25, hipertensão arterial foi definida como uma pressão sistólica > 140 mm Hg e diastólica > 90 mm Hg. RESULTADOS: Em 1078 domicílios, residiam 1.137 indivíduos elegíveis, e foram obtidas informações completas de 1.032 (91%) pessoas. A prevalência de hipertensão arterial e de excesso de peso foi 22,58% e 51,26% respectivamente. Antes de ajustar, o OR de hipertensão arterial foi 1,85 (IC 95%: 1,52-2,25) para os indivíduos com sobrepeso e 3,7 (IC 95%: 3,04-4,50) para os indivíduos obesos e, depois, respectivamente, 2,04 (IC 95%: 1,65-2,54) e 4,08 (IC 95%:3,30-5,08) CONCLUSÃO: Existe uma forte associação entre massa corporal e pressão arterial, que é independente do sexo, idade, renda familiar, escolaridade e ocupação.

Seven-year incidence and progression of obesity: Characterization of body fat pattern evolution in low-income Mexico city urban population

Background. There are no prospective data regarding the natural history of obesity in Mexico. The objective of this research was to investigate the incidence and progression of obesity in a low-income sector of Mexico City and to characterize evolution of body fat pattern distribution. Methods. We carried out a population-based, prospective survey. Total on-site population was 15,532 persons; we determined as eligible all 35 to 64-year-old men and nonpregnant women for a total of 3,505. We interviewed at baseline 3,319 (94.7%) individuals and examined 2,282 (65.1%). At follow-up approximately 7 years later, we interviewed 1,764 (77.3%) subjects and examined 1,594 (69.9%). Measurements for all participants included height, weight, body mass index (BMI), waist-hip circumference, and subscapular and triceps skinfold thickness. Overweight was defined as BMI ≥25 and ≤29.9 kg/m 2, while grade 1 obesity was BMI ≥30 and ≤34.9 kg/m 2, grade 2 was ≥35 and ≤39.9, and grade 3, ≥40 kg/m 2. Results. At baseline, prevalence of overweight was 48.6%, and grade 1 obesity, 22.7%, grade 2, 5.1%, and grade 3 obesity was 1.4%; at follow-up, these were 45.2, 25.8, 6.6, and 2.3%, respectively. At baseline, mean BMI in women was 29.1±0.16 kg/m 2 and in men, 27.3±0.15 kg/m 2; at follow-up, it reached 29.4±0.17 kg/m 2 in women and 27.4±0.16 kg/m 2 in men. Waist circumference increased from mean of 99.7±0.44 cm in women to 101.2±0.42 cm; in men, mean waist circumference rose from 95.2±0.38 to 96.7±0.39 cm. Conclusions. The obesity epidemic in this population possesses serious proportions that increase risk for severe metabolic consequences. There is a need for intervention.

A house-to-house survey of epileptic seizures in an urban community of Rio de Janeiro, Brazil.

To carry out a prevalence study about epileptic seizures and epilepsy in an urban low-income population. Prevalence study in a two-phase model: screening and diagnosis confirmation. It was applied a structured questionnaire in 982 people all effectively resident on March 1st 2000 based on a population census previously carried out by the Nurse Faculty. One neurologist interviewed all the suspected cases. It was detected 176 suspected cases of epileptic seizures: 156 with non-epileptic events, and 20 with epileptic seizures. The lifetime point prevalence was of 16.3 cases per 1000 inhabitants, and of active epilepsy, 5.1 / 1000. If we consider false negative diagnosis from the screening procedures, the lifetime point-prevalence rates until 20.8/1000. The prevalence data of epilepsy shows less impressive than in other Latin-American studies and even some Brazilian, but similar to other Brazilian studies. This suggests geographical diversity and/or methodological differences among studies. Anyway, probably the epilepsy prevalence in Rio de Janeiro is not so high as that found in the Latin countries rural areas.

Barriers to influenza immunization in a low-income urban population

Background: Athough influenza immunization significantly reduces mortality from influenza, over one third of elderly Americans are not immunized each year. Low rates of immunization are particularly concerning among African-American low-income populations. Preliminary interviews suggested that fear of undisclosed ingredients in the influenza vaccine may impede vaccine acceptance in this vulnerable population. Objectives: To assess the role of concern about vaccine contents and other factors in the use of influenza immunization among a predominantly African-American low-income urban population. Methods: Cross-sectional, health-system-population–based, telephone survey of a random sample of West Philadelphia residents aged ≥65 years. Results: Of 659 eligible individuals, 486 (73.8%) were successfully interviewed. Concern about undisclosed shot contents was reported by 132 (20%) respondents and was inversely associated with vaccine receipt (OR 0.49, 95% CI 0.26–0.91). This association was similar among African Americans and Caucasians. In addition, receipt of influenza vaccine was inversely associated with belief that immunization is inconvenient (OR 0.14, 95% CI 0.05–0.36), belief that immunization is painful (OR 0.21, 95% CI 0.08–0.54), and history of previous side effects (OR 0.33, 95% CI 0.18–0.60), and positively associated with physician recommendation (OR 3.22, 95% CI 1.76–5.93). Conclusions: In a low-income urban population, concern about undisclosed vaccine contents appears to impede acceptance of influenza immunization among both African Americans and Caucasians. Directly addressing this concern offers a new approach to increasing immunization in this vulnerable population.

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

Health risk and inequitable distribution of liquor stores in African American neighborhood

In this paper we examine whether the physical availability of alcohol is greater in predominantly African American communities compared to predominantly white communities as indicated by the presence of off premises liquor stores. We investigate the extent to which the income status of the residents of a community mediates the relationship between community racial composition and alcohol availability; and explore whether the intersection of race and class places low income African American communities at increased risk to have such stores located in their communities. Multivariate analytic techniques are used to examine the relationship between community racial composition, median income of neighborhood residents and per capita number of alcohol outlets in 194 census tracts in Baltimore, Maryland. The analysis found that liquor stores are disproportionately located in predominantly black census tracts, even after controlling for census tract socioeconomic status. Census tracts that are both low income and predominantly African American have substantially more liquor stores per capita than other census tracts. Although it is beyond the scope of the present study, our data reveal significant associations between the presence of liquor stores and the risk of health-related social problems in low income neighborhoods. More research needs to be done on the impact of alcohol on the social, psychological, and physiological health of low income urban populations.

Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low-income urban population.

We describe a prospective cross-sectional survey over a 12-month period in the principal maternity hospital of Kathmandu, Nepal, where over 50% of the local population deliver. The study aim was to estimate the contribution of birth asphyxia to perinatal mortality in this setting. During 1995, there were 14,371 livebirths and 400 stillbirths, a total stillbirth rate of 27 per 1000 total births. The fresh term (2000 g or more) stillbirth rate was 8.5 per 1000 total births [95% CI 7.1, 10.1]. Ninety-two cases of neonatal encephalopathy (NE) affecting term infants were detected (excluding those due to congenital malformations, hypoglycaemia and early neonatal sepsis). The birth prevalence of NE was 6.4 per 1000 livebirths [95% CI 5.2, 7.8]. There was evidence of intrapartum compromise in 63 (68%) of the cases of NE and 65 (76%) of the stillbirths, but only in 12 (12%) of controls. The cause-specific early neonatal mortality rate for NE was 2.1 per 1000 livebirths [95% CI 1.4, 3.0]. Combining the NE deaths and fresh stillbirths gives an upper estimate for term birth asphyxia perinatal mortality rate of 10.8 per 1000 total births [95% CI 9.2, 12.6], 24% of all perinatal deaths before hospital discharge. This study suggests that birth asphyxia remains an important cause of perinatal mortality in developing countries. The paper discusses the pros and cons of different strategies to reduce birth asphyxia in low-income countries.

Hepatitis B vaccination among children in inner-city public housing, 1991-1997.

In 1991, the Advisory Committee on Immunization Practices recommended universal vaccination of infants against hepatitis B virus (HBV), with series initiation within days of birth. To determine HBV vaccine coverage in a low-income urban population and to examine whether HBV immunization within the first month of life affects subsequent vaccine receipt. Cohort study based on immunization records collected in the Pediatric Immunization Program. Setting Large public housing development in Chicago, Ill. All 1143 children who were born between 1991 and 1997 and enrolled between 1993 and mid-1998, with follow-up to age 35 months. On-time vaccine receipt of HBV vaccine doses, diphtheria-tetanus-pertussis vaccine (DTP) dose 1, and the 4:3:1 series (4 doses of DTP vaccine, 3 doses of poliomyelitis vaccine, and 1 dose of measles-containing vaccine), analyzed by year. On-time HBV vaccination increased quickly following new guidelines and reached a plateau of about 50% coverage for those born in or after 1995. Since 1994, more children (64%) received the first HBV vaccine dose on time than any other vaccine. Children who received a dose of HBV vaccine during their first month of life were more likely to receive the first DTP vaccine dose on time (60.1%) than those who did not get an HBV vaccine dose during the first month (36.4%; chi2 = 53.7; P<.001). Children who received the first HBV vaccine dose during their first month were more likely than those receiving it at age 1 to 2 months to complete 3 HBV doses by 19 months (70.6% vs 51.1%; chi2 = 11.6; P = .001) and to complete the 4:3:1 series by age 19 months (49.8% vs 37.9%; chi2 = 4.0; P = .05). In this inner-city population, HBV vaccine has been received at rates similar to those of other vaccines within 3 years of issuance of new recommendations. Of note, immunization with HBV vaccine at birth was associated with timely receipt of other vaccines and, therefore, may have the potential to increase vaccination among groups less likely to be up-to-date on early childhood vaccines.

Accuracy of Self-Report of Mammography and Pap Smear in a Low-Income Urban Population

Background: Cancer screening history can often be obtained only by self-report, particularly for disadvantaged populations. We examined the accuracy of self-report of mammography and Pap smear for an urban, low-income population. Methods: Women attending non-primary care clinics (mostly surgery and orthopedics) at a large public teaching hospital in Minneapolis between July 1992 and May 1993 were queried about their screening history (n = 477). The women were interviewed by a trained peer-recruiter and asked whether they had ever heard of a Pap smear or mammogram, whether they had ever had one, where it was done, and when the last one was. We verified self-report by checking medical records where the test was performed. Results: The positive and negative predictive value of recall of mammography in the previous year was 72.4% and 90.6%, respectively. The figures for Pap smear recall were somewhat lower, 65.5% and 85.9%, respectively. We found a record of a mammogram in 88% of women able to recall the year. Of these, slightly over two-thirds recalled their mammogram in the same year as their record indicated. Inaccurate recalls were more commonly of the “telescoping” type, i.e., tests were recalled as having occurred more recently than was the case. Recall was substantially better for recent tests. Results for Pap smear recalls were broadly similar. Conclusions: The accuracy of self-report of mammography and Pap smear is relatively poor for medical practice but is acceptable in population surveys with appropriate correction for overreporting.

Viet Nam: The development of national health insurance

Since 1987, Viet Nam has been moving from a centrally planned to a market economy. The public sector became weaker, and public resources were no longer sufficient to respond to all healthcare needs. The government then recognized the need for cost‐sharing, and in August 1992 issued a national Health Insurance Decree calling for compulsory health insurance for salaried workers in both the public and private sectors. Voluntary membership for dependants, farmers and the self‐employed was also encouraged from the start. Currently, the number of insured persons reaches almost 9.5 million. Future challenges include the extension of coverage, especially to the low‐income rural and urban population, modification of provider payment methods so as to enhance cost‐containment, and organizational development in general.

High Prevalence of Obesity in Low Income and Multiethnic Schoolchildren: A Diet and Physical Activity Assessment

The objective of the study was to assess the prevalence of obesity and/or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population. A cross-sectional survey of 498 children aged 9–12 y from 24 schools in low income multiethnic neighborhoods in Montreal, Canada was undertaken. Height, weight, dietary intake, physical activity record, and lifestyle and demographic characteristics were measured. There was no evidence of undernutrition because linear growth was appropriate for age, but 39.4% of children were overweight (>85th percentile NHANES II). Dietary fat intake was higher in children from single-parent families (P< 0.001) and those with mothers born in Canada. Intake of vitamins A, C, iron and folate was directly related to income sufficiency. Children who did more physical activity had significantly higher intakes of energy, calcium, iron, zinc and fiber but were not heavier. Dietary intake was systematically underreported among overweight children, i.e., their reported intakes did not meet calculated energy needs. This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure.

Research and practice in an academic community nursing center.

To identify issues and describe strategies used in developing a successful program of clinical research focused on the vulnerable populations served by one urban academic nursing center. Academic community nursing centers provide ideal settings to implement programs of research. Understanding the challenges when integrating research into these practices and the strategies used is important. The University of Wisconsin-Milwaukee Silver Spring Community Nursing Center has provided primary health care services to a low-income urban population since 1987. A team of advanced practice nurse clinicians, community health nurses, and other health care professionals and community residents implemented a broad range of innovative, community-focused, clinical interventions that are routinely studied through an integrated program of nursing research. Their strategies for research implementation are analyzed. Factors affecting the integration of research into the center include (a) community mistrust, (b) the need for participatory recruitment strategies, and (c) the need for multiple data collection methods. Meeting these challenges requires that research agendas and methods are consonant with community goals. The inclusion of clinicians, other providers, and community residents as active members of research teams is critical to success. Reframing research and practice role in terms of team effort that incorporates the community can strengthen research and practice-and benefit professionals and the populations they serve.

The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries.

A criteria-based review of the literature. The literature on the epidemiology of low back pain is accumulating, but for the most part studies are restricted to high-income countries, which comprise less than 15% of the world's population. Little is known about the epidemiology of low back pain in the rest of the world. To address the imbalance in the literature and to review the relatively few studies on the epidemiology of low back pain in low- and middle-income countries. Rates from these studies are contrasted with rates from selected high-income countries. In reviewing the literature, a hypothesis is tested: low back pain rates are higher in low-income countries than in high-income countries, not only because hard physical labor is more prevalent in low-income countries, but also because, unlike high-income countries, hard physical labor for older workers in low-income countries often is unavoidable. Among other sources, articles for the review come from a search of the MEDLINE bibliographic database, with "back pain" and individual low- and middle-income countries entered as key words. To avoid recall biases, findings specifically on point prevalence are reviewed. Within the categories of low-income and high-income countries, low back pain rates vary twofold or more. In comparisons between these categories of countries, rates on the whole are higher among the general populations of selected high-income countries than among rural low-income populations; specifically, rates are 2-4 times higher among Swedish, German, and Belgium general populations than among Nigerian, southern Chinese, Indonesian, and Filipino farmers. Within low income countries, rates are higher among urban populations than among rural populations and still higher among workers in particular worksites, referred to as "enclosed workshops." The disparity in low back pain rates within categories of countries, high-income and low-income, calls attention to the high proportion of studies on the epidemiology of low back pain that are methodologically questionable. Recommendations are offered to improve the methodologic quality of this type of study. Conclusions may be drawn from comparisons between studies, although, in the absence of set methodologic standards, they are tentative. The considerably lower rates among populations of low-income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low-income populations as compared with rates in rural low-income populations and the sharply higher rates among workers in enclosed workshops of low-income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.

Accessibility of Nutritious African Foods for an Adequate Diet in Bulawayo, Zimbabwe

Despite being an agriculturally productive country, Zimbabwe has a high prevalence of undernutrition. Our purpose was to study the implications of food pricing policies on the accessibility of nutritious foods purchased through the formal market economy to the urban black (indigenous) population of Bulawayo, Zimbabwe. A validated food basket was created to calculate the cost of meeting the nutritional needs of a typical low-income urban family. Food prices were surveyed during July (winter) 1995 in three regions of Bulawayo. The mean monthly cost of the food basket in the high-density suburbs (low-income region) was Z$l,181.12 (± 74.60).This is 7% higher than in the city center (predominantly nonresidential; mean basket cost = $1,101.65 ± 52.83) and 10% higher than in the low-density suburbs (higher income region; mean basket cost = $1,069.46 ± 44.37). Comparison of monthly food basket costs in the high-density suburbs to government-stipulated minimum wages typical of employed low-income families revealed food costs 2.3 to 4.88 times the total monthly salary for one worker.The household food insecurity experienced by the low-income urban black population is discussed in relation to government policies adopted in response to structural adjustment programs.