Poor Urban Areas Research Articles

Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review

BackgroundThe impact of rapid urbanization taking place across the world is posing variegated challenges. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. This systematic review synthesizes evidence on the effective community-based interventions (CBIs) aimed at preventing and controlling infectious diseases among the urban poor in low- and middle-income countries (LMICs).MethodsThis systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search across five major databases was conducted to capture literature on CBIs published between 2011 and 2021. Scientific articles of any design that reported any type of CBIs effective in preventing and controlling infectious diseases (tuberculosis, diarrhea, typhoid, dengue, hepatitis B and C, influenza, and COVID-19) were included. Screening and selection of studies were done by two pairs of independent researchers using the predefined eligibility criteria. The risk of bias in included studies was assessed using the modified checklist outlined in the Cochrane Handbook for Systematic Reviews of Interventions and Effective Public Health Practice Project (EPHPP). Analysis of effective CBIs was guided by the conceptual framework for integrated CBIs for neglected tropical diseases (NTDs), and narrative synthesis was carried out. Geographical restrictions were limited to LMICs and papers published in English.ResultsOut of 18,260 identified papers, 20 studies met the eligibility criteria and were included in this review. Community-based screening and socio-economic support, community-based vector control, behavior change communication, capacity building of the community health workers (CHWs), health education, and e- and m-health interventions were found as effective CBIs. Diversified CBIs were found to be effective for specific diseases, including tuberculosis (TB), diarrhea, dengue, influenza and ARI, and hepatitis B and C. Bundling of interventions were found to be effective against specific diseases. However, it was difficult to isolate the effectiveness of individual interventions within the bundle. The socio-cultural context was considered while designing and implementing these CBIs.ConclusionThe effectiveness of an intervention is inextricably linked to social context, stakeholder dimensions, and broader societal issues. System approach is recommended, emphasizing context-specific, multi-component interventions that address social determinants of health. Integrating these interventions with public health strategies and community involvement is crucial for sustainable outcomes. These findings can guide the design of future interventions for better prevention and control of communicable diseases in urban poor areas.Systematic review registrationPROSPERO CRD42021278689.

Prevalence of unintentional injuries and its risk factors among under-five children residing in urban poor resettlements in Rishikesh.

A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries to undertake appropriate preventive measures. Therefore, the current study was conducted in urban poor resettlements of Rishikesh to estimate the prevalence of unintentional injuries and to document the sociodemographic risk factors associated with unintentional injuries among under-five children. Estimation of the prevalence of unintentional injuries and their risk factors among under-five children of urban poor resettlements in Rishikesh. A community-based cross-sectional study was conducted in urban poor resettlement areas of Rishikesh for a period of 1 year. It included 300 children selected using a simple random sampling technique to collect data on injury status. The prevalence of unintentional injury among study participants was 16%. Falls were (64.6%) the major cause of injury, followed by dog bites (12.5%). The major sites of the injury were the head (25%), face (22.9%), upper limb (27.1%), and lower limb (18.8%).75% of the injuries happened at home. 66% of injuries happened when the child was playing alone or playing with peers. About 20.8% of injuries were bruises or superficial injuries. 39.6% of children had cut/bite/open wound injuries. Fractures happened in 14.6% of injured children. More than half (54.2%) of children did not develop any physical disability due to injury. Among children who developed a disability, more than 90% are able to recover completely. The majority of study participants were taken to nearby hospitals (66.6%) or health centers (10.4%). Only one of them went to a traditional bone setter, rest all visited either a general practitioner or pharmacy. The median expenditure for the treatment of the injured child was INR 425 (175-2750). The age of the child and unintentional injury showed a statistically significant association. The prevalence of the injury was 16% (12-20.7%) similar to a number of similar studies. Although the majority of the injuries were mild in severity, injuries have also contributed to temporary disability among children and have led to loss of school days.

Exploring the “Urban Advantage” in Access to Immunization Services: A Comparison of Zero-Dose Prevalence Between Rural, and Poor and Non-poor Urban Households Across 97 Low- and Middle-Income Countries

Urban children are more likely to be vaccinated than rural children, but that advantage is not evenly distributed. Children living in poor urban areas face unique challenges, living far from health facilities and with lower-quality health services, which can impact their access to life-saving vaccines. Our goal was to compare the prevalence of zero-dose children in poor and non-poor urban and rural areas of low- and middle-income countries (LMICs). Zero-dose children were those who failed to receive any dose of a diphtheria-pertussis-tetanus (DPT) containing vaccine. We used data from nationally representative household surveys of 97 LMICs to investigate 201,283 children aged 12–23 months. The pooled prevalence of zero-dose children was 6.5% among the urban non-poor, 12.6% for the urban poor, and 14.7% for the rural areas. There were significant differences between these areas in 43 countries. In most of these countries, the non-poor urban children were at an advantage compared to the urban poor, who were still better off or similar to rural children. Our results emphasize the inequalities between urban and rural areas, but also within urban areas, highlighting the challenges faced by poor urban and rural children. Outreach programs and community interventions that can reach poor urban and rural communities—along with strengthening of current vaccination programs and services—are important steps to reduce inequalities and ensure that no child is left unvaccinated.

Climate Resilience, Vulnerability, Differential Impacts and Adaptive Capacity in Nigeria

This research investigates and promotes climate resilience in Nigeria’s vulnerable communities, which are disproportionately affected by climate change. How climate change worsens existing problems such as food insecurity, poverty, and conflict in Nigeria serve as the rationale to this study. Hence, defining climate resilience, reviewing relevant literature, and conducting a case study to generate evidence-based recommendations give insight into the objectives of this study. Therefore, reviewed literature shows the diverse impacts of climate change on disadvantaged groups, such as small-scale farmers and urban coastal dwellers. Vulnerability assessments highlight the need for adaptive capacity, integrating local knowledge in solutions. Case studies illustrate vulnerabilities in poor urban coastal areas, rural regions, and the Niger Delta. Differential impacts are examined, such as the gendered effects of climate change on women and the challenges faced by indigenous communities and urban slums. Adaptive capacity is discussed, stressing social capital, collective action, and the interrelation of adaptation, adaptive capacity, and vulnerability. Adaptive capacity assessment in Nigeria indicates difficulties in rural farming households and urban coastal communities, requiring enhanced capacities. Indigenous knowledge plays a vital role in adaptive measures, fostering resilience. Resilience enhancement strategies emphasize social justice, inclusive governance, and community-based adaptation, acknowledging the significance of local empowerment and participation. Technology and innovation provide possibilities but need context-specific methods. These strategies can help build climate resilience in Nigeria’s vulnerable communities, offering a basis for policymakers, practitioners, and stakeholders to tackle the complex challenges of climate change.

Decision-making process in seeking antenatal care: A cohort study in a poor urban and a typical rural area in Bangladesh.

Decision-making in choosing and using maternal health care among different care-seeking options is a complex process influenced by multilevel factors. Existing evidence on maternal health care-seeking behaviour stems primarily from cross-sectional studies with limited information. Therefore, we designed a cohort study to better understand the decision-making process in antenatal care (ANC) seeking. We conducted this mixed-methods study among pregnant women at <27 weeks of gestation in a poor urban area (n = 1320) and a typical rural area of Bangladesh (n = 1239) whom we followed up till eight weeks after delivery. In view of quantitative methods, we interviewed all enrolled women 5-6 times four weeks apart. For the qualitative approach, we conducted 70 case studies in the urban area and 46 in the rural area by interviewing the participants and their close family members. In the urban area, about one-third of the pregnant women (38.4%) sought ANC at non-governmental organisations, and nearly an equal proportion went to public facilities (36.6%). In both the situations, women preferred facilities with one-stop services at a reasonable cost. In contrast, the lack of readiness in public facilities of the rural area pushed women (77.8%) toward private facilities for ANC. The reputation of the facilities, availability of skilled care providers, diagnostic tests, and ultrasonography services therein were the key influencing factors in the participants' decisions to seek ANC services from specific facilities. The availability of one-stop services was a key factor for participants' choosing of a facility for ANC. For the urban setting, there is a need to establish large public facilities with one-stop service provision in different zones, along with supporting non-governmental organisations in poor areas. For the rural setting, there is an urgent need to strengthen ANC service provision in public facilities at the community- and the sub-district level to redirect women from the private to the public sector to ensure low cost, quality services.

Reading motivations, strategies, and interventions of teachers in bridging learning gaps

The changes in the education landscape due to the pandemic allowed an agency for an understanding of a situation in elementary schools located in an urban poor area in the Philippines to strengthen literacy particularly in reading. While most studies on reading especially in the Philippines investigated on reading performance and ways to increase reading fluency of learners, it is important to investigate as well teachers’ motivations, strategies, and interventions. This qualitative study described teachers’ motivation, strategies and interventions to bridge learning gaps in reading. These teachers are from selected elementary schools located in the Division of San Juan City, Philippines Based on the results, teachers are motivated because they want to teach the content better and that their concern for students motivates them. Moreover, the use of various reading strategies like free reading choice, phonological activities and empathy to level with students are strengthened by interventions that are teacher, student, and community oriented.

Seroprevalence and renal carriage of pathogenic Leptospira in livestock in Cotonou, Benin.

Leptospirosis is a zoonotic disease. It is particularly prevalent in tropical countries and has major consequences for human and animal health. In Benin, the disease's epidemiology remains poorly understood, especially in livestock, for which data are lacking. To characterise Leptospira seroprevalence and locally circulating serogroups in livestock from Cotonou and to estimate the prevalence of Leptospira renal carriage in cattle. We conducted a cross-sectional study in February 2020 during which livestock were sampled at an abattoir and in an impoverished city district. We analysed blood samples from 279 livestock animals (i.e. cattle, sheep, goats and pigs) using the microscopic agglutination test. Additionally, samples of renal tissue from 100 cattle underwent 16s rRNA (rrs) real-time PCR analysis. For the 131 cattle, 85 sheep, and 50 goats tested, seroprevalence was 18% (95% confidence interval [CI] [12%, 26%]), 9% (95% CI [4%, 17%] and 2% (95% CI [0%, 9%]), respectively, and most of the seropositive animals were associated with 1:100 titres. All 13 pigs were seronegative. Leptospira DNA was found in the renal tissue of 10% (95% CI [5%, 18%]) of the cattle tested (n=100). Leptospira borgpetersenii was the main species present (n=7), but Leptospira interrogans (n=2) and Leptospira kirschneri (n=1) were also detected. Various serogroups (Canicola, Grippotyphosa, Sejroe, Icterohaemorrhagiae, Pomona, Pyrogenes, Australis and Autumnalis) were detected using microscopic agglutination test without a clear predominance of any of them. These results suggest that abattoir workers and people living in close contact with livestock in poor urban areas are exposed to the risk of Leptospira infection.

Analyzing morphologic dynamics in poor urban areas through earth observation: The case of the Purulia, West Bengal, India

The slum is the shadow of urbanization, representing a lack of essential services, substandard housing, a congested, unhygienic environment, and poverty. Slum morphology depicts the structural arrangement of a slum area, including the road network, building arrangement, cultural artefacts, etc. Slums in megacities like Mumbai, Kolkata, Delhi, etc, have developed naturally or as a result of urbanization. However, apart from megacities, only some areas or few towns, particularly those serving as headquarters of the districts, have a considerable impact on their hinterlands. Purulia town, as the district headquarters, acts as a pull factor, which stimulates the growth of the slum area of its hinterland. Hence, Purulia was selected as a study area. The focus of this study is the morphological dynamicity of slums in Purulia, therefore the temporal analysis is necessary. Additionally, it aims to apprehend the trend and pattern of slum expansion over time in Purulia municipality. This study uses satellite images and secondary data sources (DPR for BLC under Housing for All in slums, Purulia Municipality, 2015–2016) to analyze the dynamicity of slum morphology. Structural appurtenance of the area was measured using spatial variables including, the number of buildings, and the size of the building, building orientation, building density, and heterogeneity. This spatiotemporal analysis depicts inter and intra-slum variation and detects distinct but predominantly high morphological transformation throughout the eight slums. A compact building structure with a particular heterogeneous pattern is shown in many slums. However, some slums remain almost static, experiencing minimal but haphazard morphological transformation. Street patterns, including lane-to-lane, road-to-lane, house-to-house connections, water bodies' presence, and urban planning regulations such as zoning restrictions on high-rise construction etc., influence the slum growth and transform the morphological dynamicity. Apart from structural morphology, it also reflects solid social bonding and cohesion among slum communities. Overall, this research emphasizes the intricate interplay of factors driving morphological dynamicity within the slum area, encompassing socio-economic conditions, population dynamics, neighborhood characteristics, and governmental policies. It emphasizes the need for extensive policy planning for slum upgrading and creating strategies for dwellers to secure land ownership. It also implements a systematic approach to constant monitoring of poor slum areas to capture morphological dynamicity using very high-resolution Earth observation data. This may provide a better understanding of morphological transformations over time and guide policy-making decisions.

PEMETAAN KANTONG KEMISKINAN DAN POTENSI WILAYAH UNTUK PEMBERDAYAAN KELUARGA MISKIN PASCA COVID-19 DI KABUPATEN KONAWE SELATAN

Poverty mapping is carried out by examining the economic characteristics of a region and household, such as the poverty of families whose livelihoods are fishermen, farmers, miners, the informal sector, trade and services. This is relevant to the National Economic Recovery Program (PEN) as one of a series of activities to reduce the impact of Covid-19 on the economy, one of which is mapping pockets of poverty and recovery and empowerment policy strategies for the community, including poor families, both in rural and urban areas. The aim of this research is to examine the potential of the region and produce a Post-Covid-19 Poor Family Empowerment Strategy in South Konawe Regency. This research use desciptive qualitative approach. Referring to this design, this research was carried out in South Konawe Regency, using purportive sampling technique. The data collection techniques used were document study, in-depth interviews, questionnaires and observation. This research data processing and analysis uses two methods, namely quantitatively and qualitatively. The research results show that the socio-economic conditions of poor families in South Konawe Regency are reflected in several items, namely employment conditions, income level, house type, house size, ownership and use of toilets, clean water sources, lighting sources, education level, and types of side jobs. Of these items, there are only two different items that occurred in the research sample village communities both before the pandemic and after the pandemic. These items are employment conditions and income level. Regional Potential for Empowering Poor Families Post-Covid-19 is divided into traditional fishermen (fish catchers using simple technology) in Tinanggea District, plantation farmers and cultivators with very limited access to agricultural land in Benua District, informal sector workers in Andoolo District, stone miners traditional in North Moramo District and commuters (travel workers from out-of-town residents working in Kendari City) in Ranomeeto district. The Post-Covid-19 Poor Family Empowerment Strategy can be divided into several things, namely existing policies for poor families during the pandemic, developing KUBE, empowering the community through developing institutions and social capital, maximizing the use of village funds, and providing ease of obtaining KUR facilities.

Health Providers' Response to Female Adolescent Survivors of Sexual and Gender-Based Violence and Demand Side Barriers in the Utilization of Support Services in Urban Low-Income Communities of Nigeria.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This has a significant effect towards the achievement of Sustainable Development Goal SDG Target 3.7. to ensure universal access to sexual and reproductive healthcare services. This study is focused on identifying some of the demand side barriers in accessing health care services, particularly among young girls who are survivors of SGBV within intimate relationships in poor urban areas in Nigeria. The study used an ethnographic approach to solicit information from health providers, adolescents, and young women (AYW) in 10 low-income communities in two major cities in Nigeria, Ibadan and Lagos. Findings showed that there are structural limitations within the primary health care (PHC) system that posed a great challenge for survivors of SGBV to access services. Some of these include non-existing counseling services, a lack of rehabilitation centers, poor referral, and a lack of training for health providers in handling survivors of SGBV. There is also a lack of skills among health service providers that have negative influence on support services to survivors of SGBV. On the demand side, poor knowledge of possible health seeking pathways, a lack of education, and social support are barriers to accessing appropriate services among adolescent and young SGBV survivors. The study concluded that integrated services at the PHC level should include adequate and timely treatment for survivors of SGBV and targeted intervention to upscale skills and knowledge of health care providers.

ECONOMIC ANALYSIS OF FUELWOOD CONSUMPTION IN YOBE STATE, NIGERIA

Since rural and urban poor areas in Nigeria depend mainly on fuelwood (Biomass) as their major energy source, this triggers fuelwood consumption and adversely affects the environment. The analysis focused on fuelwood production as a source of livelihood in rural areas of developing countries. The study employs a purposive sampling technique in selecting case study units within the study area. The selected units include Bade, Damaturu, and Potiskum, respectively. Their selection was based on the population’s size and the state’s zonal districts. Three hundred and ninety-five respondents from fuelwood collectors have been obtained through stratified and random sampling techniques. Data were collected using a questionnaire, focus group discussion, personal interview, and observations. The finding reveals that more than 85% of people living in the study area use fuelwood collection as their second major source of livelihood after farming. On identifying the importance of fuelwood collection, the study suggested encouraging massive campaigns on tree planting programs, coppicing practices, and applying protective rules safeguarding forests. On the other hand, provision of grant and empowerment projects, and access to modern fuels, among others. Thus, it improves people’s ways of living in rural areas, encourages livelihood generation, reduces forest exploitation, and maintains environmental protection.

Policing freedom campers: the place, class, and xenophobic dynamics of overtourism in Aotearoa New Zealand

The concept of ‘overtourism’ has boomed in the past five years as the latest term to refer to anti-tourist sentiment in tourist hotspots. News media’s widespread use of the term suffers from conceptual slippage and a tendency to incite moral panic. However, a deeper theorization of overtourism as embodied, place-based social conflicts shows that this phenomenon is not about absolute visitor numbers or particular tourist activities, but rather about the connection between place, class and the political economy of tourism. Drawing on Urban Political Ecology and qualitative case-studies of freedom camping in two urban areas of Aotearoa New Zealand, we examine how social conflicts between tourists and hosts erupted in poorer urban areas as NIMBYism in privileged areas with greater access to state resources pushed freedom campers out. Both hosts and tourists are agentic in these encounters. Locals frustrated with tourist behaviour they deem visually invasive and physically polluting ‘police’ freedom campers, ranging from facilitating formal police action and governance regulation to vigilante behaviour. Freedom campers subvert these acts of policing, often through the very rules and technologies that are in place to regulate and monitor them. At the heart of these issues is a problem of neoliberal governance which stresses tourism’s ‘economic benefit’ to the regions, while placing responsibility for managing tourist/host relations on local territories.

An exploratory investigation into the influence of risk factors on driver injury severity in angle crashes: A random parameter bivariate ordered probit model approach

Objective Angle crashes have been acknowledged as a concerning issue in the traffic safety field, though there is limited understanding of the contributions of risk factors to injury severity. This article aims to examine the impact of risk factors and unobserved heterogeneity on the severity of driver injuries in angle collisions by utilizing angle crash data in the United States from 2016 to 2021. Methods The relationship between risk factors and driver injury severities in angle crashes was investigated using a random parameter bivariate ordered probit model (RPBOP) with 4 categories of injury severity classified as outcome variables, including no injury, possible injury, minor injury, and serious jury. Risk factors were considered as explanatory variables, classified as driver characteristics, vehicle characteristics, road characteristics, environmental characteristics, time characteristics, and crash characteristics. Bayesian inference was used to assess the unobserved heterogeneity in risk factors, and marginal effects were computed to analyze the effect of each factor on injury outcomes. Results The findings demonstrate that risk factors have varying effects on driver involvement in angle crashes. Certain factors exhibited unobserved heterogeneity, including young drivers (ages 25–44), older drivers (over age 59), road grade, and collision point orientation. On the other hand, other factors, such as female gender, motorcycles, intersections, speed limit (>50 mph), poor lighting conditions, adverse weather, urban areas, and workdays, were shown to significantly increase the likelihood of driver injury in angle collisions, as well as increase susceptibility to fatal injury. Conclusions This article offers new insights into reducing driver injuries in angle crashes and has the potential to inform policy development aimed at preventing such incidents. Further research could utilize multisource data fusion and investigate the spatiotemporal stability of risk factors to enhance the generalizability of angle collision prevention strategies.

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review.

As the world continues to urbanize, particularly in low- and middle-income countries, understanding the barriers and effective interventions to improve urban immunization equity is critical to achieving both Immunization Agenda 2030 targets and the Sustainable Development Goals. Approximately 25 million children missed one or more doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2021 and it is estimated that close to 30% of the world's children missing the first dose of DTP, known as zero-dose, live in urban and peri-urban settings. The aim of this research is to improve understanding of urban immunization equity through a qualitative review of mixed method studies, urban immunization strategies and funding proposals across more than 70 urban areas developed between 2016 and 2020, supported by Gavi, the Vaccine Alliance. These research studies and strategies created a body of evidence regarding the barriers to vaccination in urban settings and potential interventions relevant to low- and middle-income countries (LMICs) with a focus on the vaccination of urban poor, populations of concern and residents of informal settlements. Through the document review we identified common challenges to achieving equitable coverage in urban areas and mapped proposed interventions. We identified 70 documents as part of the review and categorized results across (1) social determinants of health, (2) immunization service-delivery barriers and (3) quality of services. Barriers and solutions identified in the documents were categorized in these thematic areas, drawing information from results in more than 21 countries. Populations of concern such as migrants, refugees, residents of informal settlements and the urban poor face barriers to accessing care which include poor availability and quality of service. Example solutions proposed to these challenges include tailored delivery strategies, improved use of digital data collection and child-friendly services. More research is required on the efficacy of the proposed interventions identified and on gender-specific dynamics in urban poor areas affecting equitable immunization coverage.

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

ObjectiveTo analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. MethodsA prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. ResultsFGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04–2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10–2.96; p = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08–3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05–2.48; p = 0.02). ConclusionCorroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

Perspectives of women on availing antenatal services in urban poor areas of Rishikesh, Uttarakhand.

Background Antenatal care (ANC) is the essential regular care of women that prevents potential health problems during pregnancy. In India, the proportion of women who received four or more antenatal visits was only 51% (National Family Health Survey, 2015-2016). An even worse situation prevails in urban areas where women from poor communities face greater health risks. We assessed various barriers women residing in these areas come across in availing ANC services. Methods This study is a part of a mixed-methods, community-based study, and we report its qualitative component. We conducted the study at the residence of the study participants in September-October 2019. The study participants were women who had less than four antenatal visits throughout the pregnancy. Twelve in-depth interviews were conducted based on data saturation. Data were transcribed and themes were drawn concerning the gender analysis framework. Results Through this study, we found how gender relations affect the utilization of antenatal services concerning access to resources, division of labour, social norms including the belief of husband and other family members towards pregnancy and decision-making power of women. Conclusion Our findings underline the importance of making the urban health system gender-sensitive and responsive to the needs of women during pregnancy. There is a need to educate men regarding maternal health so as to allay such social norms that label pregnancy as a woman's responsibility and encouraging them to accompany their wives during pregnancy visits, thus making men a part of antenatal services.

Increasing Contraceptive Use Through Free Family Planning Special Days in Poor Urban Areas in Francophone West Africa.

In francophone West Africa (FWA), contraceptive uptake remains limited, often due to geographic, economic, and social barriers. With technical support from The Challenge Initiative (TCI), municipalities and health systems implemented Family Planning Special Days (FPSDs) to improve family planning (FP) uptake and reduce high unmet need. The FPSD intervention consisted of organizing free FP services on a monthly or quarterly basis over 2 to 5 consecutive days within health facilities or sites close to the population. These events helped to educate, inform, and mobilize the community around FP and improve geographic and financial access to FP services. We describe the process of implementing FPSDs in FWA countries and analyze the results. We used several techniques and data sources in our descriptive analysis, including document review of activity reports, analysis of health management information system data, and retrospective data collection on the profile of FPSD users and implementation costs. Between July 2020 and June 2021, municipalities and health systems collaborated to hold 1,046 FPSDs in 452 health facilities in 10 FWA cities. This collaboration was made possible through the establishment of city-level management and coordination units composed of municipal, health system, and TCI focal points. In the 10 FWA cities, 181,792 people were made aware of the FPSDs and 71,669 contraceptive users were served. The overall cost of organizing the FPSDs was about 145382501 Central African CFA francs (US$252839), 35% of which came from the municipalities' local financial contribution. Results from our analysis showed that, with appropriate financial support from municipalities, the health system could offer high-quality free FP services. Nonetheless, there are still challenges to the sustainability of conducting FPSDs, including the availability of contraceptive products and continued financing of the strategy during system shocks such as the COVID-19 pandemic.

Determinants of utilization of antenatal care services among recently delivered women residing in urban poor areas of Rishikesh, Uttarakhand, India-a cross-sectional study.

Objective: To determine the proportion of women having four or more antenatal care (ANC) visits and to assess associated factors (utilization of ANC services) in poor urban settlements in Rishikesh, Uttarakhand. Material and Methods: This was a community-based cross-sectional study. The study population included females who delivered during the last year residing in the target location. The data were collected through the house-to-house method in the four selected areas using a structured pre-tested expert-validated questionnaire. Data analysis was performed using SPSS version 23 using descriptive and multivariate statistical techniques. Results: There was a 59.66% prevalence of four or more antenatal visits (52.01%-66.97%). Only 26.44% of the participants confirmed their husbands' company during their antenatal visits. Socioeconomic status, type of family, mother's educational status, parity, husband's company during the visit, and mother's autonomy were significant factors (P<0.005) associated with the number of ANC visits. In logistic regression, after adjusting for other covariates, the autonomy of the participants and the husband's involvement during the visit were found to be significantly associated with four or more ANC visits. Conclusions: Approximately 60% of participants in poor urban settlements had four or more ANC visits. The findings of our study affirm the involvement of husbands in antenatal visits and women's autonomy as significant determinants of antenatal care utilization.

Converting ordinary resistance into collective action: Visibility struggles, discreet antiracist mobilisations and intermediation work in the French banlieues

ABSTRACT Working-class neighbourhoods are often seen as political deserts, but can one identify discreet mobilisations that might prefigure broader movements? During fieldwork in poor urban areas in France, we observed different ways of opposing the everyday injustices of discrimination. These practices differ from the infrapolitics analysed by James Scott: the actors manifest forms of publicisation closer to what Asef Bayat calls ‘the art of presence’. The article starts out from an analysis of these non-organised practices and then examines the processes that enable feelings of injustice to be converted into more structured collective actions. Based on ethnographic studies in three working-class neighbourhoods in France over three years, the investigation highlights the conditions of emergence and publicisation of collective action by focusing on the role of intermediaries and re-placing discreet mobilisations in their institutional context of emergence.

A study on initiation of postpartum family planning in India based on NFHS-4: does urban poor differ significantly from rural?

ObjectiveTo explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates.MethodsThe data for this study is taken from the 4th round of NFHS survey conducted in India during 2015–16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log–log multilevel model was applied. ResultsThe results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study.ConclusionThere is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.