Poor Urban Areas Research Articles

Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014

Examining national trends in asthma treatment and control is essential to inform treatment and public health initiatives. Explore national trends in asthma control and treatment over time among children and those residing in poor-urban areas. This was an analysis of trends from 2003 to 2014 among children (aged 1-17 years) in the Medical Expenditure Panel Survey. Indicators of poor control included use of more than 3 canisters of short-acting β-agonists (SABAs) in 3 months, asthma attack, emergency department/inpatient hospitalization, and systemic corticosteroids. Treatment included inhaled corticosteroids, controller medications, SABAs, and greater than or equal to 0.7 ratio of controller-to-total prescriptions. Other measures included the number of asthma medications, outpatient visits, asthma-specific drug, and total expenditures per-patient-per-year. There were 8.4 million children with asthma in the United States in 2014; 11.1% lived in poor-urban areas. There was a statistically significant decrease in the percentage of children using inhaled corticosteroids, controller medications, daily preventive medications, systemic corticosteroids, SABAs, more than 3 canisters of SABAs (in 3 months), overall asthma prescriptions, and outpatient visits. There was a significant increase in the percentage of children reporting having an asthma attack. Trends for children residing in poor-urban areas were compared with all others; however, limited data and variability in annual estimates prevent clear conclusions. Results suggest lack of improvement in treatment and control since 2003 among children with asthma in the United States. There is significant room for improvement in asthma control and disease management among children.

Abstract TP516: Mobile Health mHealth for Secondary Stroke Prevention is Feasible and Effective

Background: Evidence indicates inadequate access to secondary stroke prevention (SSP) in rural and poor urban areas. While self-management support (SMS) soon after stroke results in improvements, the best mode of delivery and its use in underserved populations is understudied. Methods: A pre/post repeated measures design was applied to determine feasibility and effectiveness of mHealth to deliver SMS to stroke survivors in community based urban clinics and in rural South Texas. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The telehealth SMS program, Video-teleconference - Self-management TO Prevent stroke (V-STOP) was delivered by trained staff on a video teleconferencing mobile application (see Table 1). Participants received up to 3 stroke follow-up clinic visits and 3 group SMS sessions at home on their mobile device. Primary outcomes were feasibility (attendance and satisfaction); blood pressure, disability, psychosocial measures, and stroke knowledge. Paired t-test was used to determine improvement in outcomes at baseline, 6, 12, 18 weeks. Results: V-STOP was delivered using mHealth to 66 participants over 1 year. Mean age: 57, 42% female, 17% Black and 62% Hispanic: annual income of less than $25,000 (54%) and no health insurance (63%). Attendance rate was 40% for all 6 sessions. Satisfaction with the program and mHealth delivery was high, mean score of 4.88 out of 5. Improvements from baseline to 18 weeks were observed in systolic blood pressure, mean reduction 19 mmHg, ( p =0.015); stroke knowledge, ( p = 0.001); self-efficacy, ( p =0.004); exercise ( p =0.03); activity limitations ( p =0.001); anxiety ( p =0.025); disability ( p =0.024). Conclusions: Implementation of SMS using mHealth is feasible for SSP among medically underserved stroke survivors. mHealth increases post stroke follow-up and helps stroke survivors improve risk factors.

The prevalence of hypocalcemia in children with dengue infection: A 1-year cross-sectional study

INTRODUCTION: According to WHO, Dengue is fast emerging pandemic-prone viral disease affecting mainly urban poor areas in tropical and subtropical countries. One of the important electrolyte disturbance documented in critical phase of severe dengue is hypocalcaemia. Hypocalcaemia is seen in cases with severe dengue and has been claimed to be linked with the immune response and severity of infection. OBJECTIVES: To study the prevalence of hypocalcaemia in children suffering from dengue infection. To study the association between the degree of hypocalcaemia and the severity of the illness. SETTINGS AND DESIGN: This study was a one year cross sectional study, conducted in a tertiary care hospital. METHODS AND MATERIAL: 100 subjects aged 1 month to 18 years suffering from dengue fever were included in the study. iCa and other biochemical parameters were done for all the subjects within 24 hour of admission. The collected data was coded and analyzed using ANOVA and chi-square tests. RESULTS: The mean age was 9.65 yr. The subjects were classified as per 2009 WHO criteria. The prevalence of iCa was found to be 59.0%. 11.7% subjects with dengue without warning signs, 83.7% subjects of dengue with warning signs and 100% of the subjects of severe dengue had hypocalcaemia. CONCLUSIONS: This study proves the association of the hypocalcaemia with the severity of dengue infection in the paediatric population and potentiates the use of ionic calcium as a biochemical marker to detect severe dengue infection early.

Cost-Effective Public Daycare in a Low-Income Economy Benefits Children and Mothers

This paper evaluates the impacts of a public program that introduced access to part-time childcare centers for children younger than four years of age in poor urban areas in Nicaragua. We explore the effects of this program on several measures of children's and parental outcomes. Our identification strategy exploits the original randomization and the distance to the centers, using Instrumental Variables (IV) and Marginal Treatment Effects (MTE) methods to tackle imperfect compliance with the original treatment assignments. We present a theoretical model to rationalize our IV assumptions. We find a positive impact of 0.35 standard deviations on the personal-social domain of a widely used development test, and an impact of 14 percentage points on mothers' work participation. Our results are robust to different econometric specifications. We also find suggestive evidence that quality greatly matters for the impacts at the child level, but not at the mother level.

Conservation of the Functional Properties of Okra Powder by Local Storage Techniques

Okra is an essential vegetable plagued by postharvest losses with a total of 25-30% loss accrued between handling and consumption. Drying is one process that can reduce postharvest losses. Sadly, several chemicals and structural changes occur during drying, which are not accounted for, and some moisture mediated biological reactions are halted. The current research was poised to determine the functionality of the functional properties of okra powder under diverse processing techniques/local storage conditions. Standard food assessment techniques were conducted using the principles of AOAC. There was no significant difference (P<0.05) in the water absorption capacity [WAC] and water solubility index [WSI] of the freshly prepared okra powder and those stored in cupboards and on the shelf for one month. The bulk density of Kubewa okra powder [stored on the Shelf (0.76cm3) and in the Cupboard (0.76cm3), respectively] showed no significant difference with that of the freshly prepared okra powder [sun-dried (0.79cm3) and oven-dried (0.78cm3), respectively] regardless of the drying technique used in the removal of moisture from the raw okra samples. The current research was able to determine a suitable storage method for processing okra powder in places where there are power insurgences, poor urban amenities or rural areas with poor market facilities.

Urbanization and Its Impact on Urban Poor Housing Policies Based on Some Experiences of Third World Countries

Many third world countries have experienced a process of rapid urbanization. The rapid rural–urban migration and the lack of proactive planning have resulted in the expansion of slums and squatter settlements inhabited by low-income and the poor, excessive house rents and poor or total absence of infrastructural facilities. The problem more recently exacerbated in most cities of the third world as a result of the failure of governments to respond adequately to the urban development challenges by adopting adequate housing policies to the urban poor. This paper focuses on the study of urbanization and the impact of poverty and deprived urban living conditions on urban areas. It aims to find out the correlation between the poor urban areas and the housing policies, pinpoints the most successful housing policies to be taken to provide an adequate environment, and proposes basic guidelines for housing policies of the poor in the countries of the third world.&#x0D; Keywords: Urban poor, Urbanization, Housing policies, Third world countries.

Urbanization and Its Impact on Urban Poor Housing Policies Based on Some Experiences of Third World Countries

Many third world countries have experienced a process of rapid urbanization. The rapid rural–urban migration and the lack of proactive planning have resulted in the expansion of slums and squatter settlements inhabited by low-income and the poor, excessive house rents and poor or total absence of infrastructural facilities. The problem more recently exacerbated in most cities of the third world as a result of the failure of governments to respond adequately to the urban development challenges by adopting adequate housing policies to the urban poor. This paper focuses on the study of urbanization and the impact of poverty and deprived urban living conditions on urban areas. It aims to find out the correlation between the poor urban areas and the housing policies, pinpoints the most successful housing policies to be taken to provide an adequate environment, and proposes basic guidelines for housing policies of the poor in the countries of the third world.&#x0D; Keywords: Urban poor, Urbanization, Housing policies, Third world countries.

Prevalence of child underweight, maternal malnutrition and pregnancy weight gain of urban poor of Dhaka and Chittagong, Bangladesh: an analysis of growth monitoring and promotion cards

Child and maternal malnutrition is a major public health problem in Bangladesh. The study assessed children and pregnant women malnutrition, and pregnancy weight gain in urban poor areas of Dhaka and Chittagong City, Bangladesh. This longitudinal study analyzed data of children &lt;2 years and pregnant women using growth monitoring and promotion (GMP) cards. A total of 4223 GMP cards of urban static and satellite clinics were included in this study. The study found that the prevalence of low birth weight (LBW) was about 15% and that underweight was about 25%; male children were significantly more underweight than the female children. Underweight was high among children aged 18-23 months followed by &gt;&lt;6 months. More than one third of the pregnant women (36.4%) suffered from malnutrition (BMI&gt;&lt;18.5) at their first trimester. Overall, 23% of the pregnant women were malnourished based on mid upper arm circumference (MUAC) &gt;&lt;21.5 cm, irrespective of their pregnancy status. Median pregnancy weight gain was 7.0 kg. Almost two-third of the pregnant women (63.6%) failed to gain desired weight (&gt;4 kg) during the third trimester. Overall, 35.4% of pregnant women conducted 3 or more antenatal care visits throughout her pregnancy period. Prevalence of child and maternal malnutrition was significantly high in urban poor areas of Dhaka than those in Chittagong areas. Lack of continued participation in GMP program is a great challenge. Nutrition intervention programs should be intensified in the urban poor areas to address maternal and child nutrition problems. Bangladesh J. Nutr. Vol. 28-31, December 2018, P: 73-80

Policing the war on drugs and the transformation of urban space in Manila

This article explores policing and urban ordering in the Philippine war on drugs. With an empirical point of departure in ethnographic fieldwork conducted in Bagong Silang, a poor urban area on the outskirts of Metro Manila, the article highlights the perspective of the state police in an area that has been heavily exposed to the drug war and can be considered as one of its hot spots. It is examined how inspirations from counter-insurgency strategies are implemented in policing the war on drugs and discussed how this form of policing is negotiated and what implications it produces on the ground. In doing so, the article asks, ‘how have counter-insurgency policing strategies transformed urban space and the possibility of life in the poorer sections of Manila’? Drawing on a conceptual framework on borders, policing and the production of fear, the article argues that there exists an intimate connection between the employed policing strategies and the transformation of urban space with the potential of fundamentally reconfiguring urban sociality in areas such as Bagong Silang.

Urban flood modelling combining cellular automata framework with semi-implicit finite difference numerical formulation

Urban flooding is increasingly pervasive, with dreadful impacts on people and development assets. Whilst the frequency of occurrence of this hazard, mainly from pluvial events, is of fundamental importance in climate change and earth sciences research, the severity of its impacts motivates major debates within the context of flood risk management and sustainable urban development. The present study focuses on the development of a novel flood model, as a contribution to meeting the challenges of flood risk assessment within data poor urban areas such as in Nigeria. The new model combines the full functionality of cellular automata (CA) framework with a semi-implicit finite difference numerical scheme (SIFDS), whilst the resulting algorithms were programmed within MATLABTM programming platform. In this study, computation complexity and distributed topographic data requirement, both which are associated with flood modelling, and which tend to present a major limitation to flood modelling in the developing countries (DCs) are being addressed. A highly urbanized area within the Lagos metropolis of Nigeria was chosen as a case study to validate the model and to simulate the July 10th, 2011 flooding event. A 2-m horizontal resolution LiDAR DEM, published Manning's friction coefficients and rainfall intensity, were used as data inputs into the new flood model. Simulated results compared well with actual flooding inundations, reported by urban residents, and detailed in some literature and by the media. The Pearson correlation coefficient (r) between predicted flood depth and estimated values is 0.968. It is expected that the challenges of urban flooding in Lagos particularly and in the DCs generally will be better addressed if robust, but low-cost flood models are developed and utilized in the assessment of flood damage.

Temporal and spatial changes of urban impervious surface and its influence on urban ecolo-gical quality: A comparison between Shanghai and New York

The urban spatial expansion has led to the considerable substitution of natural vegetation-dominated land surfaces by impervious surfaces, especially in large cities, with great impacts on urban ecological quality. Two most heavily populated cities, Shanghai of China and New York of USA, were chosen as the study cases. Based on Landsat images obtained in 1989, 2002, 2015 in Shanghai and in 1991, 2001, 2015 in New York, normalized difference impervious surface index (NDISI) was used to extract impervious surface (IS) information. The remote sensing based ecolo-gical index (RSEI) was then applied to evaluate the changes of urban ecological quality caused by the increased impervious surface. Furthermore, landscape pattern indices were used to analyze the differences of spatial structure of impervious surface between Shanghai and New York and their influences on urban ecological quality. The results showed a significant difference in urban expansion rate and pattern between Shanghai and New York from the early 1990s to 2015. The IS expansion area in Shanghai was 17.4 times as much as that in New York. The annual IS increase rate of Shanghai was 62.2 times as much as that of New York. Shanghai had experienced an expansion from urban center to the surrounding countryside in a concentric ring pattern, whereas New York showed no much expansion but had IS increase mainly within the inner city through space filling pattern. These differences in IS change rate and spatial distribution pattern had resulted in the difference in urban ecological quality of the two cities. The mean RSEI in Shanghai dropped from 0.717 in 1989 to 0.453 in 2015, with a decrease of 36.8%. In contrast, the RSEI of New York had a decline of 6.9% from 0.552 in 1991 to 0.514 in 2015. The poor ecological condition urban area tended to have large IS patches that were well connected and aggregated.

How lymphatic filariasis was eliminated from an urban poor setting in Santo Domingo, Dominican Republic.

BackgroundWhile progress has been made in the elimination of lymphatic filariasis, challenges that call for innovative approaches remain. Program challenges are increasingly observed in ‘hard-to-reach’ populations: urban dwellers, migrant populations, those living in insecurity, children who are out of school and areas where infrastructure is weak and education levels are low. ‘Business-as-usual’ approaches are unlikely to work. Tailored solutions are needed if elimination goals are to be reached. This article focuses on mass drug administrations (MDAs) in urban settings.MethodsWe selected the urban poor area of Santo Domingo, Dominican Republic. With three rounds of MDA and with good coverage, elimination was achieved. We wanted to understand contributing factors to achieving good coverage. A qualitative study analyzed context, barriers and facilitators using a predefined framework based on review of the literature.ResultsResults show that barriers commonly reported in urban settings were present (population density, lack of organization in household layout, population mobility, violence, shortage of human resources and challenges in monitoring treatment coverage). Tactics used included strong visibility in the community leading to high levels of awareness, the use of laminated photo sheets during house-to-house visits and a 1:4 supervision strategy. The importance of working through community leadership structures and building relationships with the community was evident.DiscussionThe approach developed here has applications for large-scale treatment programs for lymphatic filariasis and other diseases in urban settings.

Describing the Health Service Delivery Network of an Urban Poor Area and a Rural Poor Area

Objectives. This study aimed to assess the health workforce’s service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.&#x0D; Methods. This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.&#x0D; Results. SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.&#x0D; Conclusion. In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.

Heterogeneous Effects of Urban Land Titling: A Replication of ‘Property Rights for the Poor’

We replicate the analysis of Sebastian Galiani and Ernesto Shargrodsky’s (GS) influential 2010 article ‘Property rights for the poor: effects of land titling’. GS use a natural experiment in a poor urban area of Buenos Aires to find that land titling increases housing investment, reduces household size, and increases child education, but does not do so through increased use of credit. The original questionnaires and raw data are not available and the existing variables provided by GS allow only a limited replication analysis. Despite these limitations, we successfully reproduce the original findings published by GS, and find these results are robust to alternative specifications. We also find heterogeneous effects regarding gender and education level of the original squatter.

Pathways to school completion for young mothers: Are we winning the fight?

Background. Policy initiatives in South Africa are directed at promoting the educational and developmental outcomes of girls and young women (age 15 - 24 years). These include decreasing the incidence of HIV infection, teenage pregnancy and gender-based violence, and increasing school attendance and economic empowerment. This article explores the contexts of pregnancy, motherhood and schooling in a sample of young mothers in an urban area in Johannesburg, South Africa. Methods. This ethnographic study, based in a poor urban area in Johannesburg, South Africa, recruited 30 young mothers aged 18 - 20 years with whom open-ended interviews were conducted. Each mother was contacted 3 months after the first interview, and again 3 months later. In addition to the first round of 30 interviews, 9 young mothers were interviewed in the second round, and 6 young mothers in a third round. A total of 45 interviews were conducted. Results. The findings illustrate how young mothers mediate constraints and challenges to continue and complete their schooling when confronted with a mistimed and unintended pregnancy. A combination of factors converge to facilitate or impede school continuation and completion. Key barriers include school policy and discrimination against pregnant learners, limited options for childcare, and high levels of poverty and unemployment that strain existing scarce family resources. Conclusions. The pathway to school completion is complex and non-linear. Three particular interventions that support school attendance and completion for young mothers have value: the child support grant, the availability of creches in the community, and a school policy that upholds the principle of inclusivity for pregnant learners and young mothers.

Identifying the geography of online shopping adoption in Belgium

The widespread adoption of the internet as retail channel is impacting a range of stakeholders. Retailers are expected to sell online, logistics operators are required to reconfigure their supply chain and public authorities try to keep local retail competitive while simultaneously attempt to manage the increase in freight transport. Within this context, a growing body of research is studying the socio-economic profile of the online shopper and the spatial variation in the demand for B2C goods. Yet, as can be expected for a relatively new evolution, little consensus exist. Therefore, in this paper, with data from the national retail federation on online shopping behaviour, we add to this growing field by first analysing the relation between socio-economic characteristics and the willingness to shop online. By mapping these characteristics, we then construct the geography of online shopping adoption in Belgium. Finally, we assess the impacts of this specific geography for the stakeholders that are adapting to this new reality. We conclude firstly that the well-educated man in his thirties with a well-paid job has the highest probability to shop online, independent of the level of urbanisation of the area he resides. Secondly, we predict over- and underestimations of the potential online buyers of up to 50% when assuming a homogeneous e-commerce penetration, especially in poorer urban areas. This implies a serious negligence for e-commerce practitioners and academics when ignoring the specific geography of the online shopping adoption.

Are the Poor Digitally Left Behind? Indications of Urban Divides Based on Remote Sensing and Twitter Data

Every city is—quoting Plato—divided into two, one city of the poor, the other of the rich. In this study we test whether the economic urban divide is reflected in the digital sphere of cities. Because, especially in dynamically growing cities, ready-to-use comprehensive data sets on the urban poor, as well as on the digital divide, are not existent, we use proxies: we spatially delimit the urban poor using settlement characteristics derived from remote sensing data. The digital divide is targeted by geolocated Twitter data. Based on a sample of eight cities across the globe, we spatially test whether areas of the urban poor are more likely to be digital cold spots. Over the course of time, we analyze whether temporal signatures in poor urban areas differ from formal environments. We find that the economic divide influences digital participation in public life. Less residents of morphological slums are found to be digitally oriented (“are digitally left behind”) as compared to residents of formal settlements. However, among the few twitter users in morphological slums, we find their temporal behavior similar to the twitter users in formal settlements. In general, we conclude this discussion, this study exemplifies that the combination of both heterogeneous data sets allows for extending the capabilities of individual disciplines for research towards urban poverty.

Mitigating Climate Change Related Floods in Urban Poor Areas: Green Infrastructure Approach

Mitigating Climate Change Related Floods in Urban Poor Areas: Green Infrastructure Approach

Barriers to Food Security and Community Stress in an Urban Food Desert

By analyzing data from focus groups in a poor, mostly African American neighborhood in a large U.S. city, we describe how residents in urban food deserts access food, the barriers they experience in accessing nutritious, affordable food, and how community food insecurity exacerbates prior social, built, and economic stressors. Provided the unwillingness of supermarkets and supercenters to locate to poor urban areas and the need for nutritious, affordable food, it may be more efficient and equitable for government programs to financially partner with ethnic markets and smaller locally-owned grocery stores to increase the distribution and marketing of healthy foods rather than to spend resources trying to entice a large supermarket to locate to the neighborhood. By focusing on improving the conditions of the neighborhood and making smaller grocery stores and markets more affordable and produce more attractive to residents, the social, built, and economic stressors experienced by residents will be reduced, thereby possibly improving overall mental and physical health.

Health Disparities Among Children with Asthma in the United States by Place of Residence

Children residing in poor-urban areas may have greater asthma morbidity. It is unclear whether this is due to individual characteristics such as race and ethnicity or place of residence. Assess indicators of control and treatment by residence. This was a cross-sectional analysis of children (aged 1-17 years) in the 2000-2014 Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of more than 3 canisters of short-acting beta agonist (SABA) in 3 months, asthma attack, and emergency department (ED) or inpatient (IP) visit during the year. Treatment measures included use of controller medications and a ratio of controller-to-total prescriptions of 0.7 or more. There were 15,052 children with asthma in the MEPS 2000-2014 data, reflecting 8.4 million children in 2014. After controlling for covariates, children with asthma residing in poor-urban areas had lower odds of using controller medications (odds ratio [OR]= 0.77), having a controller-to-total ratio of 0.7 or more (OR= 0.75), and reporting an asthma attack (OR= 0.75) and higher odds of having an ED/IP visit (OR= 1.3) compared with those living elsewhere. Black race and Hispanic ethnicity were associated with greater odds of excessive SABA use (OR= 2.11) and ED/IP visits (OR= 2.03) and lower odds of controller-to-total ratio of 0.07 or more (OR= 0.50). Poor-urban residence may be independently associated with asthma control and treatment even after controlling for individual characteristics such as race and ethnicity. Future research is needed to understand the sources of these geographic health disparities to more successfully target public health interventions.