Brazilian Slum Research Articles

Making Films in a Brazilian Slum with Children: a Participant Observation Research

This article stands for innovative learning opportunities to social inclusion by film education. The theoretical model is a combined structure coming from approaches and projects of social inclusion by film education. The aim is to describe and analyze the film education process in a project outside school. This research is based on a participant observation research conducted on children in a Brazilian slum. Cinema, as other art forms, is a political and ideological tool that can be used with different purposes. Film education is a strong mediator to facilitate transformative learning, changing one’s dysfunctional views and beliefs about oneself and the world by revising their frames of reference (Mezirow & Taylor, 2009). Films have a unique ability to promote empathy towards a role model, and promote resilience in situations similar to those the role model goes through. Furthermore, media, such as films, is capable of reaching people that might otherwise be uninterested (Buckingham, 2007; Gonnet, 2007; Silverstone, 2005; UNESCO, 2013).

Work, Slums And Informal Settlements Traditions

Work, Slums And Informal Settlements Traditions

Sharing Authority: The Politics and Practice of Community Policing in the Brazilian Slum

Over the last decade, Community Policing (CP) secured a central place in Brazilian public security policy, challenging traditional policing modalities known more for their lethal violence than their efficacy. But as the CP model moved from wealthy societies to the Brazilian favela (urban slum), it faced far greater challenges. Tasked with displacing the deeply rooted authority of drug gangs, it sought to extend state authority territorially, as well as to curb criminal violence. Paradoxically, it succeeded at the latter without achieving the former. Drawing on evidence from the Rio de Janeiro's Pacifying Police Units and Bahia's Community Security Bases, this study asks how Brazil's CP programs achieved their goals of reducing violence without displacing criminal authority. I argue that a common interest among police and locally embedded drug gangs in limiting violence led to tacit arrangements between them to share authority as a condition of peace.Related ArticlesMoreno‐Jaimes, Carlos. 2011. “Is Local Spending Responsive to the Poor? An Appraisal of Resource Allocation and Electoral Rewards in Mexico.” Politics & Policy 39 (6): 1021‐1052. https://doi.org/10.1111/j.1747-1346.2011.00328.xOndetti, Gabriel. 2008. “Up and Down with the Agrarian Question: Issue Attention and Land Reform in Contemporary Brazil.” Politics & Policy 36 (4): 789‐815. https://doi.org/10.1111/j.1747-1346.2008.00120.xSpalek, Basia. 2010. “Community Policing, Trust, and Muslim Communities in Relation to ‘New Terrorism.’” Politics & Policy 38 (4): 789‐815. https://doi.org/10.1111/j.1747-1346.2010.00258.x

Slums in Brazil: Where are they located, who lives in them, and do they ‘squeeze’ the formal housing market?

Making use of data from the Brazilian Census, this paper presents descriptive evidence on Brazilian slums while attempting to test the squeezing hypothesis from the squatting literature. A comparison of mean values for a host of household and neighborhood variables often shows wide, and usually predictable, differences in values between neighborhoods designated as slums by the Census and nonslum neighborhoods that lack this designation. The paper presents a variety of descriptive regressions making use of these rich data, while providing evidence consistent with the squeezing hypothesis in city-level regressions showing that a higher population share or land share in slums leads to higher formal rents.

Community wellbeing: The impacts of inequality, racism and environment on a Brazilian coastal slum

This article applies the 3-dimensional wellbeing lens (based on material, relational and subjective dimensions of wellbeing) to examine the factors that affect wellbeing in a slum community (Vila dos Pescadores, in the city of Cubatão, Southeast Brazil). This wellbeing framework proves useful in understanding how community wellbeing is impacted by several negative factors: the perceptions of slums, the presence of systemic racism and growing inequality, and a range of environmental impacts arising from industrial and urban pollution, and environmental disasters. Within this mix of environmental and social impacts are links between poverty and exposure to environmental hazards, and effects of environmental racism. On the positive side, these threats to community wellbeing are countered to some extent through targeted measures carried out by the community association and its partnerships, and through beneficial governmental policy measures. Together, these responses help to reduce the detrimental effects of an unhealthy and dangerous environment, and of social concerns such as exclusion, poverty, urbanization and inequality. Key to the success of response measures are the contributions of the community leadership to improve the wellbeing of slum-dwellers by counterbalancing the effects of racism and social inequality, and implementing social programs and community facilities, thereby filling the gaps created by a lack of state support to slums. These actions illustrate what impoverished communities can do to improve livelihoods and wellbeing, and to combat problems such as environmental degradation and racial discrimination. This article also draws lessons for improving wellbeing analysis, particularly in slum communities, through a greater focus on (1) collective wellbeing and a community-focused view of wellbeing, (2) impacts of racism and inequality, and (3) interactions between community wellbeing and community leadership.

Slum: Comparing municipal and census basemaps

Slum identification and mapping are fundamental to support public policies. However, slum data is affected by differences in definition, identification, spatial delimitation, sample and data collection periods. This study compares slum maps in Sao Mateus (a peripheral region of Sao Paulo city) from the 2010 demographic census and the Sao Paulo municipal government. The census and the municipal basemaps and orthophotos were overlaid in a Geographic Information System (GIS) to evaluate their similarities and differences, the reasons for inconsistencies between them. Of the 68 districts with subnormal agglomerates (EDSAs; special enumeration districts for slum areas in the Brazilian demographic census), 59% are in the categories ‘high coincidence’ or ‘partial coincidence’ with the perimeters of favelas (the main type of slum in Brazil) delineated by the Sao Paulo municipal government; the names of the residential area (favela/EDSA) are the same in only 51.5% of the subnormal agglomerates, while 26.5% of the EDSAs include residential areas not considered favelas by the municipality. Many Brazilian researchers state that the underestimation of EDSA census data is accentuated by the exclusion of favelas smaller than 51 dwellings from the census. However, at least in Sao Mateus, the exclusion of small favelas (3.6%) was not the only reason for census underestimation of favelas.

Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil

ObjectiveTo analyze the fecal microbiota composition of children living in an urban slum in Brazil, with or without small intestinal bacterial overgrowth, and to investigate the occurrence of stunting and anemia. MethodsA total of 100 children were studied, aged 5–11 years, from the municipality of Osasco, São Paulo. Small intestinal bacterial overgrowth was screened through hydrogen and methane breath test with lactulose. Weight and height were measured, and the height‐for‐age and body mass‐for‐age anthropometric indexes were calculated. The occurrence of anemia was investigated by capillary hemoglobin. Analysis of bacterial phylum, genus, and species was performed by real‐time polymerase chain reaction in fecal samples. ResultsSmall intestinal bacterial overgrowth was identified in 61.0% of the children. A lower mean of height‐for‐age Z‐score ([−0.48±0.90] vs. [−0.11±0.97]; p=0.027), as well as capillary hemoglobin ([12.61±1.03g/dL] vs. [13.44±1.19g/dL]; p<0.001) was demonstrated in children with SIBO when compared with children without small intestinal bacterial overgrowth. Children with small intestinal bacterial overgrowth presented a higher frequency of Salmonella spp., when compared to those without small intestinal bacterial overgrowth (37.7% vs. 10.3%; p=0.002). Higher counts of total Eubacteria (p=0.014) and Firmicutes (p=0.038) were observed in children without small intestinal bacterial overgrowth; however, a higher count of Salmonella (p=0.002) was found in children with small intestinal bacterial overgrowth. ConclusionChildren who lived in a slum and were diagnosed with small intestinal bacterial overgrowth showed lower H/A Z‐scores and hemoglobin levels. Furthermore, differences were observed in the fecal microbiota of children with small intestinal bacterial overgrowth, when compared to those without it; specifically, a higher frequency and count of Salmonella, and lower counts of Firmicutes and total Eubacteria.

Fine-scale GPS tracking to quantify human movement patterns and exposure to leptospires in the urban slum environment.

BackgroundHuman movement is likely an important risk factor for environmentally-transmitted pathogens. While epidemiologic studies have traditionally focused on household risk factors, individual movement data could provide critical additional information about risk of exposure to such pathogens. We conducted global positioning system (GPS) tracking of urban slum residents to quantify their fine-scale movement patterns and evaluate their exposures to environmental sources of leptospirosis transmission.Methodology/Principal findingsWe recruited participants from an ongoing cohort study in an urban slum in Brazil and tracked them for 24 hours at 30-second intervals. Among 172 subjects asked to participate in this cross-sectional study, 130 agreed to participate and 109 had good quality data and were included in analyses. The majority of recorded locations were near participant residences (87.7% within 50 meters of the house), regardless of age or gender. Similarly, exposure to environmental sources of leptospirosis transmission did not vary by age or gender. However, males, who have higher infection rates, visited a significantly larger area during the 24-hour period than did females (34,549m2 versus 22,733m2, p = 0.005). Four male participants had serologic evidence of Leptospira infection during the study period. These individuals had significantly larger activity spaces than uninfected males (61,310m2 vs 31,575m2, p = 0.006) and elevated exposure to rodent activity (p = 0.046) and trash deposits (p = 0.031).Conclusions/SignificanceGPS tracking was an effective tool for quantifying individual mobility in the complex urban slum environment and identifying risk exposures associated with that movement. This study suggests that in addition to source reduction, barrier interventions that reduce contact with transmission sources as slum residents move within their communities may be a useful prevention strategy for leptospirosis.

Going beyond the “T” in “CTC”: Social Practices as Care in Community Technology Centers

Community technology center (CTC) is a term usually associated with facilities that provide free or affordable computer and internet access, and sometimes training, to people in underserved communities. Despite the large number of studies done on CTCs, the literature has focused primarily on the use of ICTs as the main, if not the only, activity in these centers. When it comes to addressing social concerns, the literature has often seen them as an outcome of ICT use. It does not highlight CTCs as an inherent and important social space that helps to tackle social issues. Thus, in this study, I present an ethnographic account of how residents of favelas (urban slums in Brazil)—who are from understudied and marginalized areas—used these centers beyond the “T” (technology) in order to fulfill some of their social needs. I highlight the social practices afforded by the CTCs that were beneficial to the underserved communities. By social practices, I focus exclusively on the acts of care performed by individuals in order to address self and community needs. I argue that CTCs go beyond the use of technology and provide marginalized people with a key social space, where they alleviate some of their social concerns, such as lack of proper education, violence, drug cartel activities, and other implications of being poor.

Dispersion and oviposition of Aedes albopictus in a Brazilian slum: Initial evidence of Asian tiger mosquito domiciliation in urban environments.

Aedes albopictus, originally considered as a secondary vector for arbovirus transmission, especially in areas where this species co-exist with Aedes aegypti, has been described in most regions of the world. Dispersion and domiciliation of Ae. albopictus in a complex of densely urbanized slums in Rio de Janeiro, Southeastern Brazil, was evidenced. In this study, we tested the hypotheses that 1) Ae. albopictus distribution in urban slums is negatively related to distance from vegetation, and 2) these vectors have taken on a domestic life style with a portion of the population feeding, ovipositing, and resting indoors. To do this, we developed an integrated surveillance proposal, aiming to detect the presence and abundance of Aedes mosquitoes. The study, based on a febrile syndrome surveillance system in a cohort of infants living in the slum complex, was performed on a weekly basis between February 2014 and April 2017. A total of 8,418 adult mosquitoes (3,052 Ae. aegypti, 44 Ae. albopictus, 16 Ae. scapularis, 4 Ae. fluviatilis and 5,302 Culex quinquefasciatus) were collected by direct aspiration and 46,047 Aedes spp. eggs were collected by oviposition traps. The Asian tiger mosquito, Ae. albopictus, was aspirated in its adult form (n = 44), and immature forms of this species (n = 12) were identified from the eggs collected by the ovitraps. In most collection sites, co-occurrence of Ae. aegypti and Ae. albopictus was observed. Key-sites, such as junkyards, thrift stores, factories, tire repair shops and garages, had the higher abundance of Ae. albopictus, followed by schools and households. We collected Ae. albopictus at up to 400 meters to the nearest vegetation cover. The log transformed (n+1) number of females Ae. albopictus captured at each collection point was inversely related to the distance to the nearest vegetation border. These results show that Ae. albopictus, a competent vector for important arboviruses and more commonly found in areas with higher vegetation coverage, is present and spread in neglected and densely urbanized areas, being collected at a long distance from the typical encounter areas for this species. Besides, as Ae. albopictus can easily move between sylvatic and urban environment, the entomological monitoring of Ae. albopictus should be an integral part of mosquito surveillance and control. Finally, key-sites, characterized by high human influx and presence of potential Aedes breeding sites, should be included in entomological monitoring.

Quantification of pathogenic Leptospira in the soils of a Brazilian urban slum.

BackgroundLeptospirosis is an important zoonotic disease that causes considerable morbidity and mortality globally, primarily in residents of urban slums. While contact with contaminated water plays a critical role in the transmission of leptospirosis, little is known about the distribution and abundance of pathogenic Leptospira spp. in soil and the potential contribution of this source to human infection.Methods/Principal findingsWe collected soil samples (n = 70) from three sites within an urban slum community endemic for leptospirosis in Salvador, Brazil. Using qPCR of Leptospira genes lipl32 and 16S rRNA, we quantified the pathogenic Leptospira load in each soil sample. lipl32 qPCR detected pathogenic Leptospira in 22 (31%) of 70 samples, though the median concentration among positive samples was low (median = 6 GEq/g; range: 4–4.31×102 GEq/g). We also observed heterogeneity in the distribution of pathogenic Leptospira at the fine spatial scale. However, when using 16S rRNA qPCR, we detected a higher proportion of Leptospira-positive samples (86%) and higher bacterial concentrations (median: 4.16×102 GEq/g; range: 4–2.58×104 GEq/g). Sequencing of the qPCR amplicons and qPCR analysis with all type Leptospira species revealed that the 16S rRNA qPCR detected not only pathogenic Leptospira but also intermediate species, although both methods excluded saprophytic Leptospira. No significant associations were identified between the presence of pathogenic Leptospira DNA and environmental characteristics (vegetation, rat activity, distance to an open sewer or a house, or soil clay content), though samples with higher soil moisture content showed higher prevalences.Conclusion/SignificanceThis is the first study to successfully quantify the burden of pathogenic Leptospira in soil from an endemic region. Our results support the hypothesis that soil may be an under-recognized environmental reservoir contributing to transmission of pathogenic Leptospira in urban slums. Consequently, the role of soil should be considered when planning interventions aimed to reduce the burden of leptospirosis in these communities.

Spatial and temporal dynamics of pathogenic Leptospira in surface waters from the urban slum environment

Leptospirosis has emerged as an important urban health problem as slum settlements have expanded worldwide. Yet the dynamics of the environmentally transmitted Leptospira pathogen has not been well characterized in these settings. We used a stratified dense sampling scheme to study the dynamics of Leptospira abundance in surface waters from a Brazilian urban slum community. We collected surface water samples during the dry, intermediate and rainy seasons within a seven-month period and quantified pathogenic Leptospira by quantitative PCR (qPCR). We used logistic and linear mixed models to identify factors that explained variation for the presence and concentration of Leptospira DNA. Among 335 sewage and 250 standing water samples, Leptospira DNA were detected in 36% and 34%, respectively. Among the 236 samples with positive results geometric mean Leptospira concentrations were 152 GEq/mL. The probability of finding Leptospira DNA was higher in sewage samples collected during the rainy season when increased leptospirosis incidence occurred, than during the dry season (47.2% vs 12.5%, respectively, p = 0.0002). There was a marked spatial and temporal heterogeneity in Leptospira DNA distribution, for which type of water, elevation, and time of day that samples were collected, in addition to season, were significant predictors. Together, these findings indicate that Leptospira are ubiquitous in the slum environment and that the water-related risk to which inhabitants are exposed is low. Seasonal increases in Leptospira presence may explain the timing of leptospirosis outbreaks. Effective prevention will need to consider the spatial and temporal dynamics of pathogenic Leptospira in surface waters to reduce the burden of the disease.

The helminth community of a population of Rattus norvegicus from an urban Brazilian slum and the threat of zoonotic diseases.

Urban slums provide suitable conditions for infestation by rats, which harbour and shed a wide diversity of zoonotic pathogens including helminths. We aimed to identify risk factors associated with the probability and intensity of infection of helminths of the digestive tract in an urban slum population of Rattus norvegicus. Among 299 rats, eleven species/groups of helminths were identified, of which Strongyloides sp., Nippostrongylus brasiliensis and, the human pathogen, Angiostrongylus cantonensis were the most frequent (97, 41 and 39%, respectively). Sex interactions highlighted behavioural differences between males and females, as eg males were more likely to be infected with N. brasiliensis where rat signs were present, and males presented more intense infections of Strongyloides sp. Moreover, rats in poor body condition had higher intensities of N. brasiliensis. We describe a high global richness of parasites in R. norvegicus, including five species known to cause disease in humans. Among these, A. cantonensis was found in high prevalence and it was ubiquitous in the study area - knowledge which is of public health importance. A variety of environmental, demographic and body condition variables were associated with helminth species infection of rats, suggesting a comparable variety of risk factors for humans.

Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil

ObjectiveTo analyze the fecal microbiota composition of children living in an urban slum in Brazil, with or without small intestinal bacterial overgrowth, and to investigate the occurrence of stunting and anemia. MethodsA total of 100 children were studied, aged 5–11 years, from the municipality of Osasco, São Paulo. Small intestinal bacterial overgrowth was screened through hydrogen and methane breath test with lactulose. Weight and height were measured, and the height-for-age and body mass-for-age anthropometric indexes were calculated. The occurrence of anemia was investigated by capillary hemoglobin. Analysis of bacterial phylum, genus, and species was performed by real-time polymerase chain reaction in fecal samples. ResultsSmall intestinal bacterial overgrowth was identified in 61.0% of the children. A lower mean of height-for-age Z-score ([−0.48±0.90] vs. [−0.11±0.97]; p=0.027), as well as capillary hemoglobin ([12.61±1.03g/dL] vs. [13.44±1.19g/dL]; p<0.001) was demonstrated in children with SIBO when compared with children without small intestinal bacterial overgrowth. Children with small intestinal bacterial overgrowth presented a higher frequency of Salmonella spp., when compared to those without small intestinal bacterial overgrowth (37.7% vs. 10.3%; p=0.002). Higher counts of total Eubacteria (p=0.014) and Firmicutes (p=0.038) were observed in children without small intestinal bacterial overgrowth; however, a higher count of Salmonella (p=0.002) was found in children with small intestinal bacterial overgrowth. ConclusionChildren who lived in a slum and were diagnosed with small intestinal bacterial overgrowth showed lower H/A Z-scores and hemoglobin levels. Furthermore, differences were observed in the fecal microbiota of children with small intestinal bacterial overgrowth, when compared to those without it; specifically, a higher frequency and count of Salmonella, and lower counts of Firmicutes and total Eubacteria.

Violência em favelas e saúde

Resumo O trafico de drogas tornou-se o principal fator para a crescente escalada da violencia e um dos maiores obstaculos para o sucesso dos servicos publicos de saude nas favelas. O Brasil ocupa o primeiro lugar no mundo como o pais com mais anos de vida perdidos pela violencia. As favelas brasileiras surgiram nas colinas do Rio de Janeiro no inicio do seculo XX e foram construidas por ex-escravos. Nas ultimas decadas, a velocidade de seu crescimento se intensificou. Entre 2000 e 2010, o crescimento de favelas foi doze vezes maior que o aumento anual das familias brasileiras. O numero de pessoas vivendo nessas condicoes (61% afro-brasileiras) aumentou de 6,5 milhoes em 2000 para mais de 14 milhoes em 2010. Sao Paulo abriga 27% de todas as favelas no Brasil. Desde a decada de 2000, essas comunidades foram ocupadas por trabalhadores pobres (65% com permissao de trabalho) que nao tem renda suficiente para pagar o aluguel. Aproximadamente dois milhoes de pessoas residem nas favelas de Sao Paulo. Esses territorios tem a maior prevalencia de subnutricao entre as criancas causada por moradia insalubre e a maior prevalencia de obesidade em adultos causada pelo consumo de alimentos ultraprocessados ​​de baixo custo. A coexistencia dessas duas doencas representa uma carga dupla para a intervencao na saude e aumenta consideravelmente o custo de implementacao de politicas publicas. Este artigo apresenta evidencias de que a violencia esta aumentando os efeitos negativos da vizinhanca nas favelas brasileiras, condicao que implica intervencoes mais complexas e especificas, direcionadas para esses territorios.

Avaliação de Satisfação em Intervenção Pública Realizada em um Aglomerado Subnormal por meio do Programa de Aceleração do Crescimento (PAC)

O Programa de Aceleração do Crescimento do governo federal brasileiro (PAC) realizou diversas intervenções urbanas entre 2008 e 2012. Analisa-se a percepção de satisfação de beneficiários de uma intervenção urbana realizada na favela Nova Esperança, Macaé, Rio de Janeiro, RJ, Brasil, utilizando uma abordagem multimetodológica potencializada por um processo de triangulação entre quatro métodos. No referencial teórico, o artigo problematiza os processos de urbanização e favelização historicamente estabelecidos no Brasil desde a segunda metade do século XX e discute métodos para avaliação de impactos em intervenções urbanas. No estudo de caso concluiu-se que há serviços que melhoraram, porém outros não. Por fim, discute-se o contraste encontrado entre a avaliação geral e a avaliação serviço a serviço no caso Nova Esperança, apontando-se implicações para a pesquisa e para a prática.

O Dia de Dona Maria – Using technology and community based participatory research to improve healthcare delivery in a Brazilian urban slum

O Dia de Dona Maria – Using technology and community based participatory research to improve healthcare delivery in a Brazilian urban slum

Rethinking social change: The promises of Web 2.0 for the marginalized

This paper focuses on the uses of Web 2.0 platforms by residents of favelas, urban slums in Brazil, in order to expand our understanding of what Web 2.0 can and cannot do in terms of social change. To explore this problem space, I draw on a 10-month ethnography in the favelas of Vitória, Brazil to study slum residents’ Web 2.0 practices and engagements. I show how Web 2.0 afforded favela residents the ability to protest and cross social boundaries, but when that happened they faced something much stronger: social exclusion, police brutality against the blacks and poor, and limited civic engagement.

Of Cities and Slums

The emergence of slums is a common feature in a country's path towards urbanization, structural transformation and development. Based on salient micro and macro evidence of Brazilian labor, housing and education markets, we construct a simple model to examine the conditions for slums to emerge. We then use the model to examine whether slums are barriers or stepping stones for lower skilled households and for the development of the country as a whole. We calibrate our model to explore the dynamic interaction between skill formation, income inequality and structural transformation with the rise (and potential fall) of slums in Brazil. We then conduct policy counterfactuals. For instance, we find that cracking down on slums could slow down the acquisition of human capital, the growth of cities (outside slums) and non-agricultural employment. The impact of reducing housing barriers to entry into cities and of different forms of school integration between the city and the slums is also explored.

Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk.

BackgroundFew studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease.Methodology/Principal FindingsFrom 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk.Conclusions/SignificanceThis study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor geographic access to health services may be a barrier to identifying both dengue and non-dengue AFI cases. Therefore, further spatial studies should account for this potential source of bias.