Indian Slum Research Articles

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BackgroundIndia is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.MethodsA community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.ResultsThe prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02–1.09). Physical inactivity (AOR 1.68, 95% CI 1.027–2.77) and lack of social support (AOR 1.57, 95% CI 1.01–2.45) also increased the likelihood of multimorbidity.ConclusionThere is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Parental perception of neonatal care in urban slums of Jammu city

Background: India is undergoing rapid urbanization and many rural residents relocate to urban regions in search of employment, better living conditions and access to education and health care facilities. Neonatal morbidity and mortality are attributed to misperceptions in the community about newborn care. In many parts of urban slums in India, care seeking from multiple providers and use of traditional/home remedies hampered appropriate and timely medical care seeking. Aim was to study awareness, knowledge and practice of newborn care among postnatal mothers in Urban slums of Jammu city. Methods: This observational study was conducted in Urban slums of Jammu city. A total of 100 mothers of newborns residing in urban slums participated in the study after taking Informed Consent from them. A self-structured proforma was used to collect data. Results: Most of the deliveries were conducted in hospital (82%) and 18% were home deliveries. Regarding newborn care practices 88 % had wrapped the newborn with clean cloth immediately after birth. 58% of newborns were given first bath within 2-7 days. 39% of mothers-initiated breast feeding within 6-24 hours. Majority (68%) newborns were fed with colostrum. Regarding cord cutting procedures among home deliveries, it was observed that clean blade was used in 15 newborns while in 3 cases aseptic practice for cord cutting was not followed. Conclusions: Good newborn practices like promotion of warmth, cord care, hygiene and early breastfeeding should be the main focus of community-based health workers. The present study concluded that some unhealthy neonatal care practices were still found to be prevalent which can be mitigated by increasing awareness among parents through IEC activities.

Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India

IntroductionThere are around 250 million adolescents (10–19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those...

Self-Care Practices and Health-Seeking Behaviors Among Older Adults in Urban Indian Slums: A Mixed Methods Study.

Background Effective self-care is crucial for maintaining health among older adults in resource-constrained communities. This study examined self-care practices, health-seeking behaviors, and associated factors among older adults in urban slums in India. Materials and methods A mixed methods study was conducted among 432 adults aged ≥65 years. Participants were selected through multistage random sampling from five slum areas. Self-care practices, health-seeking behaviors, demographic information, chronic conditions, self-efficacy, and health literacy were assessed through interviews. The qualitative data was explored through in-depth interviews with 30 participants. Results Inadequate health literacy (194, 45%) and low self-efficacy (162, 37.5%) were common. While 324 (75%) had an adequate diet and 378 (87.5%) took medications properly, only 86 (20%) monitored diabetes complications. Only 194 (45%) of the patients underwent recommended cancer screening, and 324 (75%) of the patients saw doctors ≥twice a year. Age, sex, education, income, comorbidities, self-efficacy, and health literacy had significant associations. Alongside facilitators such as social support, barriers such as limited healthcare access and suboptimal prevention orientation emerged. Conclusion Suboptimal prevention orientation and overreliance on secondary care instead of self-care among elderly people are problematic given the limited use of geriatric services. Grassroots health workers can improve health literacy and self-efficacy through home visits to enable self-care. Healthcare access inequities for vulnerable groups merit policy attention.

Biometric Monitoring, Service Delivery and Misreporting: Evidence from Healthcare in India

Abstract We examine the impact of biometric monitoring devices placed in tuberculosis treatment centers in Indian slums. The devices record health worker attendance and patient visits. Combining survey data, random center visits, and hospital registers, we find that patients at biometric-equipped centers are 25 percent less likely to interrupt treatment, reflecting increased efforts by health workers and greater daily adherence by patients. The technology also improves the quality of public data by reducing overreported patient numbers and underreported treatment interruptions. Overall, our results suggest that real-time monitoring of service delivery can strengthen the state's capacity to serve poor and marginalized populations.

There are no Such ‘Bad Women’: Reading Text and Politics of ‘Conscious or Intended Pleasure’

Television serials are widely acclaimed as the most entertaining genre in India. Focusing on the characters’ family lives in different settings gave the female audience a more profound and engaging experience. However, watching women in specific roles is not seen as a reflection of everyday reality by the female audience in the Anand Nagar slum in India but rather as un-existing characteristics or traits. However, such characters are actively watched and argumentatively recalled as ‘bad women’. Watching female characters in negative roles triggered the respondents’ emotional imbalance and negative feelings, but the audience reasoned that it was still entertaining to watch. Within the parameters of entertainment and reading text, this article examined the relationship between reading soaps and women’s lives in the slums of Bhopal city in India. Leaning towards qualitative approaches and ethnography, this article looked into text, reception and the politics of pleasure in how women’s audiences intersected with bad women characters and oppositional readings for deriving ‘conscious or intended pleasure’. Thus, this study examined the paradoxical interaction between societal notions of ‘bad women’, conscious pleasure derived from women’s portrayals and the realities of women in slums.

A qualitative study of mental health problems among children living in New Delhi slums.

Children living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., "madness or anger," "pain in the heart and mind") not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.

Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study

BackgroundAdolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents’ Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints.MethodsIn the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed.ResultsThe anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO’s mhGAP algorithm, built into the digital health application.ConclusionThe formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups.Trial RegistrationThe trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022.

Issue of Slums in India: High Rise Constructions as Solutions

Issue of Slums in India: High Rise Constructions as Solutions

Community health workers to reduce unmet surgical needs in an urban slum in India: an implementation study.

The Surgical Accredited & Trained Healthcare Initiative (SATHI) project demonstrates how community healthcare workers (CHWs) with merely 8 y of formal schooling and training for a short period can reduce unmet surgical needs. A pilot study was carried out in the slums of a metropolitan city in India to know the effectiveness of a SATHI in reducing the burden of unmet surgical needs. In total, 12 730 people from 3000 households were included in the study for a duration of 6months. We found 10% surgical needs (n=293) out of which 57% had unmet surgical needs. Out of total surgical needs, about half of the needs were cataract and abdominal, followed by extremities and chest conditions. SATHIs were able to convert 99 patients (60%) from unmet to met needs, who underwent surgery/treatment. The conversion from unmet to met among all surgery needs was highest for abdominal conditions (29%) followed by cataracts (17%). SATHIs with short training can reduce the burden of unmet surgical needs. SATHIs were able to convert a significant proportion of unmet to met needs by trust building, facilitating access to healthcare and ensuring post-operative adherence. Scaling up could help in the achievement of equitable healthcare across India.

Unmet Surgical Needs and Trust Deficit in Marginalized Communities in India: A Comparative Cross-Sectional Survey

IntroductionWe carried out a household study of surgical unmet needs and trust in the physician and perception of quality in the health system in a rural Tribal area and an urban slum in India. MethodsA community-based, cross-sectional study was carried out in a Tribal and in an urban slum in Gujarat, India. We surveyed 7914 people in 2066 households in urban slum and 5180 people of 1036 households in rural Tribal area. The Surgeons Overseas Assessment of Surgical need was used to identify surgical met and unmet needs. Two instruments for trust deficit ‘the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting’ and ‘Patient perceptions of quality’ were also administered to understand perception about healthcare. Frequencies and proportions (categorical variable) summarized utilization of surgical services and surgical needs. P < 0.05 was statistically significant. ResultsSlums and Tribal areas were significantly different in sociodemographic indicators. Unmet surgical needs in Tribal area were less than 5% versus 39% in the urban slum. Major need of surgery in Tribal area was for eye conditions in older population, while surgical conditions in extremities and abdomen were predominant in the urban area. Trust level was high for physicians in both areas. ConclusionsSurgical unmet needs were significantly lower in Tribal versus urban area, possibly due to high priority given by the Indian government to alleviate poverty, social deprivation and participation of NGOs. Our study will give impetus to study unmet surgical needs and formulation of health policies in India and low-and-middle- income countries.

A cross-sectional survey of climate and COVID-19 crises in young people in Indian slums: context, psychological responses, and agency.

COVID-19 and the climate crisis have caused unprecedented disruptions across the world. Climate change has affected the mental health and wellbeing of children and adolescent. Young people with a mental illness and without social support are at an increased risk of climate change induced mental ill-health. COVID-19 resulted in a marked increase of psychological distress. Increase in depression, anxiety and insomnia have increased due to the upheavals that people were experiencing including loss of livelihood and breaking of social bonds. This exploratory study adopted a cross sectional survey design using quantitative methods to understand the perceptions, thoughts, and feelings of young people on both the climate and COVID-19 crises, their concerns, and desires for the future and to understand their sense of agency to contribute to the changes that they want to see. The findings show that most of the respondents from the sample studied reported nearly similar interference of climate change and COVID-19 on their mental wellbeing. Their climate concern and COVID-19 concern scores were comparable. Tangible experiences of extreme weather events, that were personally experienced or that impacted their family members had a negative impact on their lives, while action around improving the environment had a positive impact.Loss of income, loss of mobility and loss of social contact due to COVID-19 had negative impacts on the respondents, while indulging in leisure activities and bonding with the family had positive impacts. Although the majority of the participants reported having both climate and COVID agency, it did not translate into action to improve the environment. Young people's activism on climate change and COVID-19 has a positive impact on their mental wellbeing hence more opportunities and platforms must be provided to enable young people to take action on both these crises. None.

How Do Fieldworkers in Poverty Craft Meaningful Roles to Achieve Social Impact? Female Teachers in Slums in India

Prior research has adopted a job-crafting perspective to explain why employees attempt to craft their roles meaningfully (Wrzesniewski & Dutton, 2001). We explore this theoretical lens in a new context that is particularly challenging for workers and where it would seem unlikely to apply: poverty. More specifically, we study female teachers in slums in India. We use a mixed-methods approach—first qualitative research, then quantitative research—to contextualize job-crafting theorizing by identifying, conceptualizing, and testing situational challenges and enablers in regard to meaningful work in this context. More specifically, we develop and corroborate new theory suggesting that poverty- and gender-related stressors deplete teachers’ energy and resources, limiting relational job crafting, but that teachers’ identification with the community helps to counteract this challenge, ultimately increasing their social impact. More fundamentally, we show how job-crafting theorizing, contextualized in a poverty setting, helps to understand how social organizations, through their fieldworkers (e.g., female teachers), create social impact.

Feeding practices among under two years children in urban slum, Bengaluru: a cross sectional study

Background: Exclusive breastfeeding is the optimum method of feeding in first 6 months of life. It meets nutritional requirement of baby. There are practices of early introduction of top feeds and late introduction of semi-solid feed in urban slums in India. This study was conducted to assess feeding practices among under 2 years children in an urban slum area. Methods: A community based cross sectional study was conducted in one of the urban slums in Bengaluru among 190 caregivers of children aged from 6 months to 2 years from January 2023 to March 2023. Questionnaire was used to collect information regarding feeding practices and data was analysed using JAMOVI v2.3.26. Results: Among 155 (81.58%) of the mothers were literates, 97 (51.06%) belongs to class IV socioeconomic status. Regarding feeding practices, 65 (34.21%) of them initiated breastfeeding between 1-4 hours after delivery, 137 (72.11%) of them fed colostrum to the babies, pre-lacteal feeds were given in 46 (24.21%) of children, exclusive breastfeeding was done in 106 (55.79%) of babies. There was significant association between exclusive breastfeeding with caregivers’ socioeconomic status, type of family (p&lt;0.05). There was significant association between pre-lacteal feeds with mothers’ education status, socio-economic status (p&lt;0.05). Conclusions: There is a need for health education regarding importance of exclusive breastfeeding and ill-effects of pre-lacteal feeds. Sociodemographic factors also play an important role in these feeding practices. Hence government should take necessary steps to improve some of the demographic factors who are living in urban slums.

Development of an Artificial Intelligence–Guided Citizen-Centric Predictive Model for the Uptake of Maternal Health Services Among Pregnant Women Living in Urban Slum Settings in India: Protocol for a Cross-sectional Study With a Mixed Methods Design

Pregnant women are considered a "high-risk" group with limited access to health facilities in urban slums in India. Barriers to using health services appropriately may lead to maternal and child mortality, morbidity, low birth weight, and children with stunted growth. With the increase in the use of artificial intelligence (AI) and machine learning in the health sector, we plan to develop a predictive model that can enable substantial uptake of maternal health services and improvements in adverse pregnancy health care outcomes from early diagnostics to treatment in urban slum settings. The objective of our study is to develop and evaluate the AI-guided citizen-centric platform that will support the uptake of maternal health services among pregnant women seeking antenatal care living in urban slum settings. We will conduct a cross-sectional study using a mixed methods approach to enroll 225 pregnant women aged 18-44 years, living in the urban slums of Delhi for more than 6 months, seeking antenatal care, and who have smartphones. Quantitative and qualitative data will be collected using an Open Data Kit Android-based tool. Variables gathered will include sociodemographics, clinical history, pregnancy history, dietary history, COVID-19 history, health care facility data, socioeconomic status, and pregnancy outcomes. All data gathered will be aggregated into a common database. We will use AI to predict the early at-risk pregnancy outcomes (in terms of the type of delivery method, term, and related complications) depending on the needs of the beneficiaries translating into effective service-delivery improvements in enhancing the use of maternal health services among pregnant women seeking antenatal care. The proposed research will help policy makers to prioritize resource planning, resource allocation, and the development of programs and policies to enhance maternal health outcomes. The academic research study has received ethical approval from the University Research Ethics Committee of Dehradun Institute of Technology (DIT) University, Dehradun, India. The study was approved by the University Research Ethics Committee of DIT University, Dehradun, on July 4, 2021. Enrollment of the eligible participants will begin by April 2022 followed by the development of the predictive model by October 2022 till January 2023. The proposed AI-guided citizen-centric tool will be designed, developed, implemented, and evaluated using principles of human-centered design that will help to predict early at-risk pregnancy outcomes. The proposed internet-enabled AI-guided prediction model will help identify the potential risk associated with pregnancies and enhance the uptake of maternal health services among those seeking antenatal care for safer deliveries. We will explore the scalability of the proposed platform up to different geographic locations for adoption for similar and other health conditions. PRR1-10.2196/35452.

How the largest slum in India flattened the COVID curve? A Case Study

Mumbai-The economic capital of India, shrivelled with panic as its infamous slum ‘Dharavi’ recorded its first positive case of COVID-19 on 1st April 2020. Dharavi is the largest slum in India and one of the most densely populated areas in the world. Its narrow lanes, teeming with people and chock-a-block with settlements, make physical distancing practically impossible- posing as an excellent breeding ground for the deadly virus. However, with a policy of ‘chasing the virus’ based on strategy of ‘Tracing Tracking Testing and Treating’ Dharavi flattened its epidemic curve within a hundred days. This was achieved through the immediate public health response with strict containment measures, aggressive active and passive surveillance and integration of resources from government and private sectors to provide essential services. In this paper, we have summarized the ongoing measures for successful prevention and control of COVID-19 in Dharavi, which could provide useful learning for other similar settings worldwide.

State wise status of urban slums in India: Census data

The word “slum” is often used to describe informal settlements within cities that have inadequate housing and miserable living conditions. They are often overcrowded, with many people crammed into very small living spaces. The slum population enumerated constitutes 5.4 percent of the total population of the country. As per Census of India 2011, Tamil Nadu has the largest number of cities and towns (507) reporting slum population, Andhra Pradesh has the highest proportion (36.1%) of slum population to the total population. Slums in the 189 towns of Maharashtra accounts for 2499948 slum households, which is 17.96 percent of the total slum households of the country. The Government of India started programmes towards inclusive city development with focus on slums, including the provision of basic services and affordable housing to the urban poor people.

Does financial inclusion impact socio-economic stability? A study of social safety net in Indian slums

PurposeThe study aims to examine the impact of social assistance schemes introduced by the Indian government on poverty alleviation in urban slums.Design/methodology/approachTo accomplish the study's objectives, primary data were collected from 585 beneficiaries of government schemes operating in India's northwestern state using a multistage sampling technique (Punjab). The exploratory factor analysis (EFA) technique reduced the total dataset to its minimum factors. Then, using second-order confirmatory factor analysis, the data's validity and reliability were determined. The data were analyzed using statistical techniques such as one-way ANOVA, t-test and structural equation modeling (SEM).FindingsThe study's findings indicate that social assistance provided by the Government of India has a direct and substantial influence on poverty alleviation in urban slums. The study demonstrates how access to basic credit financial services through social assistance programmes has improved the lives of urban poor households living in slums and assisted them in escaping poverty.Research limitations/implicationsThe investigation was undertaken among a few limitations. First, the in-depth investigation of the study is restricted to only the northwestern state of India solely because of limited resources and time availability. Second, the study focuses primarily on the perspectives of beneficiaries of the social assistance schemes in India. Still, it might be expanded in the future to include additional stakeholders such as bank executives, business colleagues and municipal town panchayats.Practical implicationsDue to policymakers' increased emphasis on poor households living in urban slums, this topic is critical for studying many issues.Social implicationsThe research explores gaps in social welfare schemes to direct policymakers and government authorities to take appropriate steps to aid the urban poor people in sliding out of poverty.Originality/valueBy examining the influence of the Indian government's social welfare schemes on poverty reduction in slums, this study contributes to the literature on public assistance schemes and poverty alleviation. This article can assist policymakers in developing nations in increasing financial capability among disadvantaged urban families on a national and international level.

Engaging with adolescents to navigate the Adolescents’ Resilience and Treatment nEeds for Mental health in Indian Slums (ARTEMIS) trial

Adolescence causes rapid changes at physical, mental, and social levels rending adolescents vulnerable to stress, depression, and increased risk of self-harm/suicide [1] In India, mental illness is one of the leading causes of death and disability for this age group [2]. Many adolescents with mental disorders worldwide are left untreated and unidentified [3] due to […]

Feminist Resistance Through the Lens of Everyday Lived Experiences of Young Women in India

In this article, I examine the lived experiences of two young women from urban slums in India who participated in an after-school program focusing on issues of gender inequality within their homes, communities, and schools. Through unstructured and semi-structured interviews and observations, this paper argues that young women from marginalized spaces resist patriarchal structures of society through everyday acts of resistance. Using narrative inquiry, the data reveal that young women use different yet interconnected means to resist oppression in their daily lives. The article makes a case for expanding feminist resistance scholarship to be inclusive of young women at the periphery and their everyday resistance for finding a voice. Keywords: youth activism, narrative inquiry, lived experiences, pedagogical praxis, feminist resistance