Urban Poor Population Research Articles

Choice of primary healthcare providers among population in urban areas of low- and middle-income countries—a protocol for systematic review of literature

IntroductionStrengthening and reforming the urban primary healthcare (PHC) system is essential to efficiently deliver need-based healthcare services to the rapidly increasing urban poor population. Such reforms of PHC system need to emphasize the opinion of patients in co-designing services in order that delivery of services can be accessed effectively by the urban population in a timely and low-cost way. Hence, it is important to identify the preference of urban population while choosing healthcare providers. The aim of this proposed protocol is to summarize a planned systematic review of existing evidence on the attributes considered for choosing PHC providers in urban settings of low- and middle-income countries (LMICs), as classified by the World Bank.Methods and analysesAn inclusive literature search will be conducted in electronic databases including Pubmed/MEDLINE, Embase, Global Health, Cochrane Library, Web of Science, and Scopus. Databases will be searched from the earliest date of entry until March 30, 2024. Database search will be supplemented by manual search of citations, reference lists, and grey literature sources. Following the pre-set inclusion and exclusion criterion, two researchers will independently screen all the retrieved studies in Covidence. Any discrepancies will be resolved through a discussion between two researchers, and if disagreements persist, a third reviewer will be consulted. The methodological quality of included studies will be appraised using checklist for Conjoint Analysis studies and the Mixed Methods Appraisal Tool (MMAT). An Excel-based data extraction table will be developed, piloted, and refined during the review process. Preference attributes will be identified and analyzed according to their types. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines.DiscussionThe identification of attributes, their influence on preference, and heterogeneity with socioeconomic characteristics of the population will help the policymakers and researchers to design targeted PHC interventions. Such evidence will be also useful to design choice experiment studies to quantify the preferred attributes of PHC providers in urban context of LMICs.Systematic review registrationPROSPERO CRD42023409720.

Spatio-temporal tendencies of urban land surface temperature on the Andean piedmont under climate change: A case study of Metropolitan Lima, Peru (1986–2024)

The increase in land surface temperature (LST) in megacities has contributed to global warming due to poor urban planning and high population concentration. This study analyzes spatio-temporal trend patterns of LST in the city of Metropolitan Lima, Peru, during the summers of 1986–2024. The Mann-Kendall tests and the Theil-Sen Slope method were used to analyze the spatio-temporal trends of LST, relating R2 and the Mann-Kendall p-value of the annual average LST in each district. A hierarchical cluster analysis was performed to group districts according to their average yearly LST. Urban heat islands were identified based on basin configuration and distance to the sea at 1 km intervals. The results reveal a significant increase in LST (p < 0.001) related to El Niño-Southern Oscillation phenomena, in addition to urban growth and land cover change. The significant positive trend of LST showed a heterogeneous distribution in all districts. The districts were grouped into three clusters with statistically significant differences in LST (p < 0.001), spatially configured radially from the sea to the foot of the Andes, up to 1179 m a.s.l. Urban heat islands did not correlate with significant positive trends in basins. Still, they showed a considerable increase in LST in areas of high economic activity, including dense commercial, industrial, and residential areas. This information is crucial to managing climate change adaptation and mitigation measures and contributing to sustainable urban planning focused on the population's well-being.

Contextual awareness, response and evaluation (CARE) of diabetes in poor urban communities in Ghana: the CARE diabetes project qualitative study protocol

ABSTRACT Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The ‘Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana’ project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.

Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia.

Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges.

Reproductive health service access and utilisation among migrant women in Dhaka’s urban slums: a qualitative study

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18–49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.

O atraso como instrumento de poder – o caso de Tefé no Amazonas no início do século XXI

Esse artigo visa discutir a partir de um contexto histórico o uso reiterado do território e dos recursos naturais na Amazônia por projetos que nunca se concluíram conduzidos pelo binômio governo e iniciativa privada. Os entraves provenientes da instalação de uma termelétrica movida à biomassa de dendê e dos interesses de agricultores, indígenas, da Igreja e agentes internacionais na região de Tefé no Amazonas são discutidos à luz da teoria da obra “O poder do atraso: ensaios da sociologia da história lenta” de José de Souza Martins. A metodologia se baseou no levantamento bibliográfico e no trabalho de campo com visitas institucionais e entrevistas. Evidencia-se a partir desse artigo que algumas iniciativas que visam promover projetos de desenvolvimento regional em espaços periféricos, como a Amazônia, não se concluem em função da produção de informações distorcidas e relações alienadas entre agentes mundiais e do Estado; isso acarreta conflitos de terras, desigualdades sociais e exclusão de grupos étnicos, agricultores e pobres populações urbanas.

Missed opportunities: Reducing zero dose children among the urban poor after COVID, Mumbai India, 2022

Reaching urban poor populations poses challenges for equitable immunization coverage. Furthermore, COVID disrupted routine immunization services. In Mumbai, India, first dose diphtheria tetanus pertussis containing vaccine (DTPCV1)coverage dropped from 88% (2019) to 76% (2021).We identified and characterized 125 zero-dose (those withoutDTPCV1)migrant children in urban Mumbai in October 2022.Almost half were born elsewhere than Mumbai; 53% resided at their present location for less than a year. More than half were 12–59 months of age, well-beyond the age for first routine childhood immunizations.Three of four zero dose children had received birth dose vaccination in the hospital; but failed to receive DTPCV1. Vaccine hesitancy, awareness gaps and operational issues were common reasons for non-vaccination. Despite frequent visits to health facilities for illness,only a third of facility staff asked or advised parents about vaccination.Missed opportunities were much more common in private than government facilities.For the vast majority (88%), residential sites were included in local routine immunization micro-plans and distances to immunization sites were short (less than 1 km for 94 % of families).However, planned session frequency was inadequate half of the time.Expanded efforts to reach migrant urban poor children are needed to ensure vaccine equity.

Irony of Urban Food Basket and Rural Wild Edible Resources- A Case from India

This article sheds light on the current system of urban food gamut, future vulnerabilities, and interventions. Wild edible plants for urban consumers a prospects and encounters for sustainable innovation which creates a win-win situation. The term “Wild Food Plants” refers to non-cultivated wild edible plants gathered from natural forests and agricultural land. It is food for thought as the urban poor population increasing exponentially. It is also a very good alternative and chief source of nutritive food which has been practiced by indigenous people since immemorial. It could be a local substitute for global high-carbon food available in urban markets. Moreover, wild food plants have many ailments aiding in getting nutritive elements locally instead of globally produced food that is alien to our gut system.

What is missing in our understanding of urban slum environments and maternal, infant and young child nutrition from publicly available data in Asia and the Pacific?

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large-scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum-dwellers in large-scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN.

The effect of urbanization on the structure of comorbid pathology in patients with community-acquired pneumonia

Urbanization is one of the leading global trends that has a significant impact on the health of the population. The rapidly growing process of urbanization, on the one hand, is able to create new opportunities for cities, and on the other hand has a negative impact on the health and well -being of urban citizens, and undoubtedly the poor urban population is most vulnerable in obtaining proper medical services. The uneven distribution of assets - human, financial and environmental - can be so significant that it leads to significant differences in the health of the inhabitants, depending on income, gender, place of residence, cultural and ethnic origin. The purpose of this study was to analyze the prevalence of comorbid pathology in patients with community-acquired pneumonia and to establish the risk of concomitant diseases depending on the place of residence. A retrospective study was conducted by analyzing the medical records of 213 patients, of whom 134 live in the city, 97 in the village. The analysis of the structure of comorbidity and the calculation of the relative risk of comorbidity in patients with community-acquired pneumonia showed a probable probability of its combination with arterial hypertension and coronary heart disease in patients living in the city, with an increase in the relative risk of their comorbidity, respectively, by 7.2 times and 6.0 times. Similar statistically significant associations were established between community-acquired pneumonia and arterial hypertension and coronary heart disease with an increase in the relative risk of their comorbidity by 11.3 and 6.3 times, respectively, among villagers with community-acquired pneumonia. It is also worth noting that the prevalence of arterial hypertension is probably higher in rural residents with community-acquired pneumonia compared to urban residents. At the same time, the incidence of type 2 diabetes was likely higher in patients with community-acquired pneumonia living in the city compared to rural residents with community-acquired pneumonia. Keywords: arterial hypertension, coronary heart disease, diabetes mellitus, comorbidity.

Consumer willingness to pay a premium for orange-fleshed sweet potato puree products: a gender-responsive evidence from Becker–DeGroot–Marschak experimental auction among low- and middle-income consumers in selected regions of Nairobi, Kenya

Vitamin A deficiency (VAD) is a major public health problem affecting people of all ages, particularly women of reproductive age and young children in the Global South. Nutrient-enriched (biofortified) orange-fleshed sweet potato (OFSP) has promising potential as a sustainable food vehicle to combat VAD. Part of ongoing efforts to combat VAD, particularly among the urban poor populations, include the introduction of innovative OFSP puree, which is utilized as a functional and substitute ingredient in widely consumed baked and fried products. In Kenya, the OFSP puree is used to make commercial products that are affordable by low- and middle-income households. However, there is limited knowledge of consumer awareness, willingness to pay (WTP), and/or how gender plays a role in the uptake of these products. Following a multistage sampling technique, this study employs the Becker–DeGroot–Marschak (BDM) experimental auction method to assess if men and women consumers—from selected, highly populated low- and middle-income areas of Nairobi County in Kenya—are aware and if they would be willing to pay for OFSP puree products. Integrating gender considerations, we use three of the most widely consumed OFSP puree products, bread, buns, and chapati, and three treatment categories, naive, nutritional information, and OFSP puree substitute products' references prices to deduce the WTP for OFSP puree products among men and women. Results showed limited awareness of OFSP and OFSP puree products among men and women. However, both men and women were willing to pay a premium for the OFSP puree products. The intergender comparison showed that women were more willing to pay a premium for the OFSP puree products than men. Gender, age, education, knowledge of OFSP puree products, income category, availability of nutritional information, and reference pricing stand out as significant determinants of WTP.

Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality. A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms. A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth. Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits. DFID/MRC/Wellcome Trust/ESRC.

Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews

BackgroundInequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs.MethodsWe searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization’s (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107).ResultsIn a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed.ConclusionThe generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.

Socio-Economic Assessment of Value for Climate Services Case Study, Uganda and Kenya

Socio-Economic Assessment of Value for Climate Services Case Study, Uganda and Kenya

Seasonal variation in food security, lifestyle, nutritional status and its associated factors of the urban poor adolescents in Kuala Lumpur, Malaysia: research protocol of a prospective cohort study

BackgroundClimate change, obesity and undernutrition have now become a worldwide syndemic that threatens most people’s health and natural systems in the twenty-first century. Adolescent malnutrition appears to be a matter of concern in Malaysia, and this is particularly relevant among the urban poor population. Mounting evidence points to the fact that underlying factors of malnutrition are subject to climate variability and profoundly affect nutritional outcomes. Hence, it is interesting to examine seasonal variation in nutritional status and its associated factors of urban poor adolescents in Malaysia.MethodsThis is a prospective cohort study following urban poor adolescents aged 10–17 years living in low-cost high-rise flats in Kuala Lumpur, Malaysia, across two monsoon seasons. The baseline assessment will be conducted during the onset of the Northeast Monsoon and followed up during Southwest Monsoon. Climate data will be collected by obtaining the climatological data (rainfall, temperature, and relative humidity) from Malaysia Meteorological Department. Geospatial data for food accessibility and availability, and also built (recreational facilities) environments, will be analyzed using the QGIS 3.4 Madeira software. Information on socio-demographic data, food security, lifestyle (diet and physical activity), and neighbourhood environment (food and built environment) will be collected using a self-administrative questionnaire. Anthropometric measurements, including weight, height, and waist circumference, will be conducted following WHO standardized protocol. WHO Anthro Plus was used to determine the height-for-age (HAZ) and BMI-for-age (BAZ). Anaemic status through biochemical analyses will be taken using HemoCue 201+® haemoglobinometer.DiscussionThe study will provide insights into the seasonal effects in nutritional status and its associated factors of urban poor adolescents. These findings can be useful for relevant stakeholders, including policymakers and the government sector, in seizing context-specific strategies and policy opportunities that are seasonally sensitive, effective, and sustainable in addressing multiple challenges to combat all forms of malnutrition, especially among urban poor communities.Trial registrationThe protocol for this review has not been registered.

NURSING BABIES TO FIGHT POVERTY: WAGES OF WET NURSES OF SPANISH FOUNDLING HOSPITALS IN THE 18THAND 19THCENTURIES

ABSTRACTFoundling hospitals spread across Europe in the 18thand 19thcenturies, taking in hundreds of thousands of children each year. In Spain, the hospitals of major cities had staffs of more than 1,000 external wet nurses, who worked mainly in rural localities. Their cash wages were key for the household economies of the poor rural and urban populations. This article presents a methodology to interpret wet-nurse wages and explains their utility with respect to other occupations for men and women. Our results include a series of nominal and real wages for wet nurses and a calculation of their contributions to family income. The level of wages these institutions could offer was a major determinant in the supply of wet-nurse labour.

Exploring the influence of multidimensional variables on access to electricity in rural areas of the Global South

Electricity plays a fundamental role in sustainable development by facilitating the provision of basic services and improving the quality of life for poor urban and rural populations. The dominant approach to rural electrification research in the Global South has been to focus on economic and social indicators, resulting in a limited understanding of rural electrification. This research diversifies the current literature by including technical and environmental criteria in the analysis of electricity access in rural areas. This paper aims to understand the criteria that have a significant impact on access to electricity in rural areas across the Global South, specifically in Latin America and the Caribbean. This paper examines the influence of multidimensional variables (e.g. social, economic, environmental and technical) on access to electricity in rural areas. This study encompasses two sets of data: the first from a group of countries of the Global South and the second from the Latin American and Caribbean region, using mostly countries with low and middle human development index. To understand the behavior of these multivariable relationships, this paper uses a linear regression methodology and penalizes regression (i.e., LASSO and Ridge). For the countries of the Global South, the model shows a negative correlation between access to electricity in rural areas and population growth rates. For the Latin American and Caribbean countries the model indicates a negative correlation between access to electricity in rural areas and electricity consumption per capita. These results possibly indicate that countries of the Global South that have high population growth rates have challenging paths towards universalizing electricity access, and raise the question if Latin American and Caribbean countries have prioritized their access to electricity agendas in non-rural areas. This paper confirms that population growth rates and electricity consumption per capita are criteria that have a strong impact in access to electricity rates in rural areas of the Global South, and Latin America and the Caribbean, respectively.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey.

Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan. The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake. Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities. We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study.

Poor mental health may diminish a mother's capacity to adequately care for her child, resulting in a negative impact on the child's nutrition. This study aims to determine the association between maternal mental health and child nutritional status in a poor urban population in Bangladesh. We carried out a cross-sectional study among 264 mother-child pairs in an urban slum area of Bangladesh. The Self-Reporting Questionnaire-20 (SRQ-20) was used to assess maternal mental health. An SRQ-20 score ≥7 was considered a common mental disorder (CMD). Anthropometric measurements were performed to assess nutritional status of the children. The prevalence of maternal CMD was 46.2%. Maternal CMD was associated with poorer child feeding practice (p<0.001), poorer hygiene practice (p<0.001), poorer preventive care service use (p = 0.016), and suffering from diarrheal diseases (p = 0.049). The prevalence of stunting, wasting and underweight in children was 44.3%, 18.2% and 33.7%, respectively. A poorer child feeding practice was associated with wasting (p = 0.004) and underweight (p<0.001) but not with stunting. Poorer hygiene practices and suffering from diarrheal diseases were associated with stunting and underweight, but not with wasting. In multivariable analysis, maternal CMD was associated with child wasting (adjusted odds ratio, aOR = 2.25, 95% CI = 1.15-4.43). The association between maternal CMD and child underweight found in the bivariate analysis was attenuated and no longer statistically significant after multivariable analysis (aOR = 1.77, 95% CI = 0.94-3.33). No statistically significant association was observed between maternal CMD and stunting in this study (aOR = 1.46, 95% CI = 0.84-2.54). Maternal mental health affects nutritional status of the children where child feeding practice, hygiene practice and preventive care use might play a role. Interventions to address maternal mental health in child nutrition programs might improve child nutritional status.

Psychosocial factors associated with mental health and quality of life during the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia.

Mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms and quality of life among Malaysia's multi-ethnic urban lower-income communities. This is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age ≥18 years with a monthly household income ≤RM6960 (estimated $1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life, respectively. Multivariable logistic regression was performed for the final analysis. A total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy. A high proportion of the sampled urban poor population reported mild to severe anxiety and depression symptoms. The psychosocial determinants should inform policymakers and shape future work within this underserved population.