Poor Urban Areas Research Articles

Tuberculosis: A biosocial study of admissions to a children's sanatorium (1936–1954) in Stannington, Northumberland, England

This study considers the biosocial profile of children admitted to the Philipson Children's Sanatorium at Stannington, Morpeth, Northumberland, England (1936-1954). The objective was to understand the differential impact of TB on male and female admissions at Stannington, according to a number of variables. A total of 1987 medical files were analysed. More females than males were admitted, peaks of admission at age six and 13 were documented, and the majority of children derived from poor urban areas. Over 60% (1199, 63.5%) of children had pulmonary TB, and 12% (230) had bone or joint involvement. The implementation of chemotherapy (streptomycin) at Stannington (1946), the end of the 2nd World War (1945), and the founding of the National Health Service (1948) did not have any great effect on the biosocial profile of children admitted to the sanatorium and treated (age, sex, origin, type of TB suffered, and socioeconomic status). Reasons for these finding are discussed.

Availability of and Accessibility to Maternal Healthcare Services in the Northern Bangladesh

Poor women, in both rural and urban areas in the northern region of Bangladesh, suffer from high maternal mortality rates, and compared to other regions, this group also has a low proportion of up-taking ante natal care (ANC) and of births assisted by skilled attendants. This endeavour therefore took an attempt to critically examine the availability of and accessibility to maternal health care (MHC) services, provided by government and non-government organisations (NGOs) in the northern part of Bangladesh, with the specific objective of finding out how far poor women had the availability of and accessibility to MHC services. The study used both primary and secondary data to meet its objectives. Triangulation of methods (questionnaire interviews of service users and providers, and observations) were employed to collect primary data. A large number (160) of mothers who were pregnant or delivered at least one baby during the last ten years and the heads of relevant health centres were interviewed. An assortment of articles, reports, theses and books were consulted in complementing and substantiating the arguments in this study. The main findings of the study suggest that there has been an increase in the availability of and accessibility to MHC services. However, the increment varies across regions and social groups. Lastly, it concludes that rural, poor and less educated mothers have less availability of and access to MHC services compared to urban, non-poor and better educated women.

EARLY MOTHERHOOD IN SOWETO: THE NEXUS BETWEEN THE CHILD SUPPORT GRANT AND DEVELOPMENTAL SOCIAL WORK SERVICES

In this article we ask whether the child support grant can mitigate the vulnerability of early motherhood, and if so, in what ways and what are its limits. Using data from a study on CSGs in a poor urban area of Johannesburg, we report on the circumstances of young women recipients. We find that the grant has positive outcomes for the women, but these are limited in the face of the range of needs and support necessary to give the young women a chance to successfully negotiate both motherhood and their own transition to adulthood. We suggest areas where social workers can engage positively with these issues

Social capital and violence in poor urban areas of Honduras

Abstract Honduras has the highest murder rate in the world: the high level of violence threatens the economic and social development of the country as it erodes human and social capital and limits trust among people in poor urban areas. However, neither a detailed consideration of the complex manner in which distinct dimensions of social capital interrelate with violence, nor the potential for double causality has received much attention. Objectives The study examines the influence of structural social capital (social organization characteristics) and cognitive social capital (social trust and cohesion characteristics) on risk of violence in poor urban areas of Honduras. Methods The study was carried out in two urban communities of Tegucigalpa experiencing high levels of violence and insecurity. For the quantitative analysis, 1000 individuals older than 18 answered a structured questionnaire. Violence exposure was evaluated based on respondents' self-reporting. Social capital was defined based on the use of the short version of the Adapted Social Capital Assessment Tool. Results Our results support previous evidence from Guatemala showing that cognitive and structural social capital were inversely related to risk of violence: people with high cognitive social capital had a lower risk of violence (OR 0.46 CI 95: 0.28–0.76) compared to people with low cognitive social capital, whereas people with high structural social capital had a higher risk of violence (OR 1.68 CI 95: 1.04–2.71) compared to people with low structural social capital. Conclusions Social trust and social activism exhibit significant associations with risk of violence, however, these dimensions are consequences as well as causes of violence. Implications for practice In an intervention perspective it is important to recognize the difference between social organization and cooperative action for creating change, as these concepts represent very dissimilar levels of collective action toward violence. It is thus important to link the items of social capital, primarily within the structural dimension, to the specific objectives of a given intervention.

Electricity access in urban slum households of Bangladesh: A case of Dhaka

Dhaka, the capital city of Bangladesh, is one of the fastest growing cities in Southern Asia, having population of more than 13 million, and is expected to accommodate more than 20 million by 2025. This growth has been accompanied by the growth of urban slums and the subsequent challenges to access basic urban services like water, sanitation, clean energy, and transport for the urban poor. Despite its importance for basic survival, electricity supply is not recognized as a basic urban service, as a result of which, the poverty alleviation and basic infrastructure provision programs have not addressed this issue completely. On the basis of a stakeholder interaction approach, following a set of logically sequenced questions to assess the availability, accessibility, affordability, reliability and continuity of usage of electricity, this study assesses the current status of electricity access in an urban poor area of Dhaka and identifies barriers to electricity access from both demand and supply side. Barriers specific recommendations are also suggested based on the experiences from field visit and the best practices outside Bangladesh are also identified.

Learning from the Corner Store

The problem of changing food habits has once again become a major public issue in the past decade in the United States. One of the main strategies developed by food reformers to change popular eating habits is to increase access to fresh food in poor urban areas identified as “food deserts,” in an attempt to address the obesity epidemic and to revitalize the local economy by creating “healthy,” “sustainable” environments. Based on a participant observation study in a large city in the Southeastern United States, I will start by discussing two of these initiatives: a farmers' market and a Community Supported Agriculture program. Although both were located in underserved communities, they failed to reach their poor black residents, attracting instead a clientele of white middle class professionals. To account for the urban poor's resistance to alternative food practices, I then turn to the results of an ethnographic study of consumption practices in an inner-city convenience store, where economic constraints and distinction strategies help to shape its customers' tastes for energy-dense, high-calorie foods. While these data are consistent with quantitative studies underlying the importance of economic access over physical access to food, the ethnographic method has the advantage of bringing food consumption back into its social setting, allowing it to reveal its significance in the competition for status and respectability, which take on different meanings in different classes and cultures.

Tropical influenza and weather variability among children in an urban low-income population in Bangladesh

BackgroundInfluenza seasonality in the tropics is poorly understood and not as well documented as in temperate regions. In addition, low-income populations are considered highly vulnerable to such acute respiratory disease, owing to limited resources and overcrowding. Nonetheless, little is known about their actual disease burden for lack of data. We therefore investigated associations between tropical influenza incidence and weather variability among children under five in a poor urban area of Dhaka, Bangladesh.DesignAcute respiratory illness data were obtained from a population-based respiratory and febrile illness surveillance dataset of Kamalapur, a low-income urban area in southeast Dhaka. Analyzed data were from January 2005 through December 2008. Nasopharyngeal wash specimens were collected from every fifth eligible surveillance participant during clinic visits to identify influenza virus infection with viral culture and reverse transcriptase–polymerase chain reaction. Time series analysis was conducted to determine associations between the number of influenza cases per week and weather factors. Zero-inflated Poisson and generalized linear Poisson models were used in the analysis for influenza A and B, respectively.ResultsInfluenza A had associations with minimum temperature, relative humidity (RH), sunlight duration, and rainfall, whereas only RH was associated with influenza B. Although associations of the other weather factors varied between the two subtypes, RH shared a similar positive association when humidity was approximately 50–70%.ConclusionsOur findings of a positive RH association is consistent with prior studies, and may suggest the viral response in the tropics. The characteristics of settlement areas, population demographics, and typical overcrowding of urban poverty may also contribute to different impacts of rainfall from higher economic population. Further investigations of associations between tropical influenza and weather variability for urban low-income populations are required for better understanding.

Validation of a BMI cut-off point to predict an adverse cardiometabolic profile with adiposity measurements by dual-energy X-ray absorptiometry in Guatemalan children.

To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point. Cross-sectional study. Two public schools in poor urban areas on the outskirts of Guatemala City. A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years). Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)). Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.

English

The proximate compositions, minerals and amino acids contents of Detarium microcarpum, Gardenia erubescens, Parkia biglobosa, Adansonia digitata pulp, seeds of Boscia senegalensis and leaves of A. digitata were studied and quantified in Burkina Faso. Using the conventional procedures described by the Association of Official Analytical Chemists, proximate analysis was done. The minerals were determined by spectrometry and photometry. The profile and total amount of amino acids were determined by reverse phase HPLC using Pico-Tag method. The results showed that the protein content were ranged from 1.10 ± 0.20 to 24.23 ± 0.15%, total carbohydrate varied from 6.7 ± 0.11 to 79.73 ± 1.69%, lipids varied from 1.11 ± 0.08 to 4.65 ± 0.12% and ash from 1.16 ± 0.1 to 11.76 ± 0.10%. These results allowed distinguishing species which are potential sources of protein, calories and micronutrients. Consumption of these tree products can help to overcome nutrients deficiency that is prevalent in poor urban and rural areas of Burkina Faso.   Key words: Food composition, nutrition, food insecure, wild trees, Burkina Faso. &nbsp

Sport Mega-Events and Public Opposition

This article examines the diverse forms of public opposition, protest, criticism, and complaint in the United Kingdom on the staging of the 2012 Olympic and Paralympic Games in London. Our discussion draws heavily on empirical research, primarily fieldwork and interviews in East London with local residents, opposition groups, business people, politicians, and other stakeholders. The article is separated into three main parts. First, we explore the setting and political–economic context for London 2012. The main Olympic setting—the London Borough of Newham—features very high levels of poverty and ethnic diversity. We argue that London 2012 represented a form of “festival capitalism” that was part of a broader set of “New Right two-step” policies in poor urban areas, involving initial Keynesian investment, followed by a deeper and far-reaching array of neo-liberal measures. Second, in the main part of the article, we identify and examine, in turn, six forms of public conflict, criticism, and complaint that centered on the Games, specifically national criticisms (e.g., on distribution of Olympic resources), local criticisms (e.g., on lack of jobs and business benefits), issue-specific campaigns (e.g., on the environment), “glocal” protests against specific nations and sponsors (e.g., campaigns against BP, Dow, and Rio Tinto), neo-tribal transgressions and situationist spectacles (e.g., mass cycle rides near Olympic venues), and anti-Olympic forums and demonstrations (e.g., critical web sites, multi-group marches). Third, we set out briefly the importance of conducting research into critics and opponents of sport mega-events, and discuss different arguments on how the social impact of protest movements might have been intensified at London 2012. The findings in this article may be extended to examine critical public responses to the hosting of other mega-events in different settings.

IL10 Single Nucleotide Polymorphisms are Related to Upregulation of Constitutive IL‐10 Production and Susceptibility to Helicobacter pylori Infection

Helicobacter pylori infection is a strong risk factor for gastric cancer, likely due to the extensive inflammation in the stomach mucosa caused by these bacteria. Many studies have reported an association between IL10 polymorphisms, the risk of gastric cancer, and IL-10 production. The aim of the study was to evaluate the association between IL10 genetic variants, Helicobacter pylori infection, and IL-10 production by peripheral blood leukocytes in children. We genotyped a total of 12 single nucleotide polymorphisms in IL10 in 1259 children aged 4-11years living in a poor urban area in Salvador, Brazil, using TaqMan probe based, 5' nuclease assay minor groove binder chemistry. Association tests were performed by logistic regression for Helicobacter pylori infection and linear regression for IL-10 spontaneous production (whole-blood cultures) including sex, age, and principal components for informative ancestry markers as covariates, using PLINK. Our results shown that IL10 single nucleotide polymorphisms rs1800896 (OR=1.63; 95% CI=1.11-2.39), rs3024491 (OR=1.71; 95% CI=1.14-2.57), rs1878672 (OR=1.79; 95% CI=1.19-2.68), and rs3024496 (OR=1.48; 95% CI=1.05-2.08) were positively associated with Helicobacter pylori infection. Eight single nucleotide polymorphisms were associated with spontaneous production of IL-10 in culture, of which three (rs1800896 and rs1878672, p=.04; rs3024491, p=.01) were strongly associated with infection by Helicobacter pylori. Our results indicate that IL10 variants rs1800896, rs3024491, rs1878672, and rs3024496 are more consistently associated with the presence of anti-H.pylori IgG by inducing increased production of IL-10. Further studies are underway to elucidate the role of additional genetic variants and to investigate their impact on the occurrence of gastric cancer.

Asset planning for climate change adaptation: lessons from Cartagena, Colombia

In studies of climate change vulnerability, an important constraint relates to the uncertainty of the climate projections that local governments need to estimate precisely the risks and impacts climate events have on different parts of a city. In addition, the lack of “downscaled”, or local, climate information makes it very difficult to compare how individual communities and households adapt to severe and extreme weather events and, more importantly, what actions local governments can carry out to increase resilience in poor urban areas. Based on a conceptual and operational framework developed in recent years by the authors in collaboration with partners in the global South, this paper illustrates how “bottom-up” community asset planning for climate change adaptation can help to address this gap and be mainstreamed into “top-down” citywide strategic and operational planning. The paper describes the process by which community members and representatives of local government, the private sector and NGOs working in the city of Cartagena, Colombia, set up a dialogue space that enables them to identify, negotiate and agree climate change adaptation solutions that are legally, financially, socially and technically feasible.

HIV in (and out of) the clinic: Biomedicine, traditional medicine and spiritual healing in Harare

Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean's own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in connection with biomedicine and how this may influence HIV treatment and prevention.

Cost of ambulatory care by mobile health clinic run by a Medical College in India for the year 2008-09.

The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. The MHC can be considered as a viable option to provide services to urban poor.

Inter-generational study of educational achievement in the poor urban areas in Sub-Saharan Africa: evidence from the Nairobi informal settlements

Using data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), this paper compares the educational achievement of children of slum residents to that of their parents. Using ordered probit models, the study finds that the second-generation children of slum-dwellers fare better than their parents. Although father and mother’s educational attainment have positive effects on the probability of higher educational achievement, the coefficients were not statistically significant. Differences across ethnic groups were also found in the study. Although relatively small, Kamba (10%), Embu/Mberu (4%) and Kisii (6%) have the highest likelihood ratio coefficients, suggesting that these groups have higher probability of achieving higher educational level relative to other groups. Finally, in spite of the encouraging news about progress made at the primary school level, more needs to be done at the secondary and higher school levels for the children of the slum residents to reach their full potential.

Effects of helminth co-infections on atopy, asthma and cytokine production in children living in a poor urban area in Latin America.

BackgroundHelminths are modulators of the host immune system, and infections with these parasites have been associated with protection against allergies and autoimmune diseases. The human host is often infected with multiple helminth parasites and most studies to date have investigated the effects of helminths in the context of infections with single parasite or types of parasites (e.g. geohelminths). In this study, we investigated how co-infections with three nematodes affect markers of allergic inflammation and asthma in children. We selected Ascaris lumbricoides and Trichuris trichiura, two parasites that inhabit the human intestine and Toxocara spp (Toxocara canis and/or T. cati), intestinal roundworms of dogs and cats that cause systemic larval infection in humans. These parasites were selected as the most prevalent helminth parasites in our study population.Results36.4% of children were infected with one parasite; 12.7% with 2 and 5.2% with 3. Eosinophilia >4% and >10% was present in 74.3% and 25.5% of the children, respectively. Total IgE > 200 IU/mL, sIgE ≥ 0.70 kU/L and SPT positivity were present in 59.7%, 37.1% and 30% of the children, respectively. 22.7% had recent asthma (12.0% non-atopic and 10.7% atopic). Helminth infections were associated in a dose-dependent way to decrease in the prevalence of SPT and increase in eosinophilia, total IgE, and the production of the regulatory cytokine IL-10 by unstimulated peripheral blood leukocytes. No association with asthma was observed.ConclusionsHelminth co-infections in this population were associated with increased markers of the Th2 immune response, and with a host immune regulatory phenotype that may suppress allergic effector responses such as immediate hypersensitivity reactions in the skin.

Perceptions of Health, Health Care and Community-Oriented Health Interventions in Poor Urban Communities of Kinshasa, Democratic Republic of Congo

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored.

Risk factors for death among hospitalised tuberculosis patients in poor urban areas in Manila, The Philippines

To determine the mortality rate and risk factors for in-hospital death among hospitalised human immunodeficiency virus (HIV) negative tuberculosis (TB) patients in poor urban areas in the Philippines. A cross-sectional study was conducted at a national infectious disease hospital in Manila City. The target population was patients aged ≥ 13 years with all forms of HIV-negative TB admitted from October to December 2009. Demographic and clinical information was collected from medical charts, and risk of in-hospital death was measured. Of 407 HIV-negative TB patients, four were excluded due to missing records, and 403 were included in the analysis. The majority were poor urban residents (90%), and 66% were males. Overall, 37.5% of hospitalised patients died in the hospital (151/403), 30% of whom died before the third day of hospitalisation. Risk factor analysis demonstrated that complications of bacterial pneumonia had the greatest effect on in-hospital death (aOR 4.53, 95%CI 2.65-7.72), followed by anorexia (aOR 3.01, 95%CI 1.55-5.84), anaemia (haemoglobin <10 g/dl, aOR 2.35, 95%CI 1.34-4.13) and older age (aged ≥ 50 years, aOR 1.85, 95%CI 1.08-3.17). The presence of haemoptysis (aOR 0.44, 95%CI 0.25-0.80) was associated with improved survival. Mortality among hospitalised HIV-negative TB patients was extremely high in poor urban areas in the Philippines.

Introducing a model of cardiovascular prevention in Nairobi's slums by integrating a public health and private-sector approach: the SCALE-UP study

IntroductionCardiovascular disease (CVD) is a leading cause of death in sub-Saharan Africa (SSA), with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited.ObjectiveTo develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches.Study designTwo non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD) and African Population and Health Research Center (APHRC), collaborated with private-sector Boston Consulting Group (BCG) to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility.ResultsThe final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year). The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO), and leading non-governmental organizations (NGOs).ConclusionThrough the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by relevant policymakers and NGOs.

Disturbed by ‘the stranger’: state crafting remade through educational interventions and moralisations

This article addresses two questions. First, how does a state, in casu the Danish welfare state, based on universalism and social rights as regards its citizens, deal with immigrants and their descendants through education? Second, how does such a state manage to make its differential treatment of human beings work legitimately, that is, what arguments, what interventions and moralisations, are used through the workings of school education? The article carries out an analysis of policies since the 1980s and depicts the construction of ‘the stranger’ parallel to an analysis of the state crafting processes that go on in terms of professional educational interventions in Højmarken School, a school placed in an urban poor area.