Children In Urban Slum Research Articles

Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India

Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

Soil‐transmitted helminthic infection and nutritional status among urban slum children in Kenya

To evaluate the impact of soil‐transmitted helminth (STH) infection on nutritional status, we conducted a survey of 206 preschool (PSC) and 499 school‐aged children (SAC) randomly selected from CDC's population surveillance platform in the Kibera slum, Nairobi, Kenya. Hemoglobin, ferritin, inflammatory markers, retinol binding protein and malaria were measured from capillary blood; anthropometry and analysis of 3 stools for STH ova were performed. Approximately 40% of children had STH infection (39.9% PSC, 39.7% SAC), primarily Ascaris and Trichuris spp. Only 2.9% PSC and 1.0% SAC had heavy infection. Indicators of malnutrition among PSC and SAC were as follows: anemia 37.4% and 14.4%, iron deficiency (ID) 19.3% and 4.4%, vitamin A deficiency (VAD) 15.1% and 5.9%, and stunting 28.8% and 16.5%. Among PSC, STH was associated with VAD but not anemia, ID, stunting or inflammation. PSC with Trichuris infection were more likely to have ID than those without Trichuris (p=.04). The association between any STH and VAD remained significant in multivariate analysis, adjusting for age, sex, inflammation, maternal education and income (aOR=2.3, p=0.04). Our results suggest that STH infection is associated primarily with VAD, which may inform deworming and micronutrient supplementation programs.

Prevalence of underweight, stunting and wasting among children in urban slums of Delhi

Prevalence of underweight, stunting and wasting among children in urban slums of Delhi

Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city

Undernutrition remains the largest contributor to the global disease burden. Different factors affecting the nutritional status of children need to be studied to determine those to be targeted in a country like Nigeria, characterized by widespread poverty and inequitable distribution of wealth. This study was aimed at ascertaining the relationship between prevailing socioeconomic and environmental factors, and the nutritional status of children residing in a typical urban slum. A cross-sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage random sampling method from public primary schools in slum and non-slum areas of Onitsha was carried out. Their nutritional status was determined using anthropometric measures. The socioeconomic and environmental variables of interest were analyzed to determine their relationship with undernutrition in the children. Socioeconomic status was the major determinant of nutritional status in this study. Poor housing also affected the nutritional status of the slum children who were significantly from poorer families than those residing in non-slum areas (χ2 = 66.69, P = 0.000). This study highlights the need for an effective nutrition program targeted at school children in urban slums surrounded by factors predisposing them to undernutrition.

A Study of Knowledge, Attitude and Practices on Immunization of Children in Urban Slums of Bijapur City, Karnataka

The immunization coverage is not uniform in India. In Karnataka, except for Uttar Kannada District (very high immunization coverage of 95%) and 14 districts that have shown a better immunization coverage (>85% coverage), the remaining 15 districts (including Bijapur District) have poor coverage. The United Nations Children's Fund (UNICEF) 2002 report on Bijapur district shows that only a little over one fourth of the children were fully immunized (25.8%). The state's fully vaccinated figure was more than two and a half times higher than that of the district. In this prevailing scenario, it becomes the need of the hour to find factors which influence routine immunization in Bijapur district, which will help the planners in implementing the immunization programme in a better way, to achieve >85% coverage. To determine the knowledge, attitude and practices of respondents among guardians of children aged 12-23 months with respect to immunization. A community based, cross-sectional study was conducted in the urban slums of Bijapur city, India. Out of the 20 enlisted slums, 7 slums were chosen by using convenience sampling. House to house survey was done. After obtaining oral consents, information regarding knowledge, attitude and practices was collected by using a semi-structured proforma. A total of 155 mothers/ responsible guardians of children in the age group of 12 to 23 months were included in the study. Children of 54 out of 155 respondents (34.84%) were fully immunized, 97 (62.58%) were partially immunized and 4 (2.58%) were unimmunized. The main reason for partial and non-immunization was found to be lack of information. Immunization coverage in the urban slums of Bijapur is still way short of the 85% coverage mark. A lack of information and motivation among the parents is the main reason for this dismal scenario, that needs to be rectified at the earliest.

Improving health of children in urban slums through an integrated model based approach — a case study from Chennai

An integrated model based approach was used to improve health status of children in an urban slum. An urban slum was selected based on fixed criteria and health needs were assessed. The environmental conditions were improved. Health care needs were taken care of and self-help groups were started to make them financially independent. This model was evaluated in 204 families with 350 under-five children. Survey revealed that 88% of them used safe garbage disposal and 95% of them had household latrines. Only 24% of under-five children had water borne morbidity in past one year and there were no vector borne diseases. 71% of the eligible couples followed some contraception. Mean duration of exclusive breast feeding was 7 months and average total duration of breast feeding was 15 months. Integrated model based approach based on principles of primary health care works in urban slum with effective community participation.

Oral polio vaccination failure in urban slum children is associated with malnutrition and evidence of chronic inflammation (166.2)

Abstract Oral vaccines for polio (OPV) and rotavirus have been shown to be much less effective in poor children in the developing world. The reason(s) for oral vaccine failure in this setting has been unknown. We hypothesized that failure of orally administered vaccines such as OPV was due to tropical enteropathy and resultant inflammation from endotoxin exposure. We tested this hypothesis in a cohort of children followed from birth in an urban slum of Dhaka Bangladesh. Response to oral poliovirus vaccine was measured in the children who received the recommended minimum of three doses of OPV by age 6 months. Diminished antibody responses to OPV were associated with malnutrition, serum endotoxin-specific antibodies, and shorter breastfeeding duration. In a subset of these children, we investigated the mechanism for vaccine failure using a systems-immunology approach, performing comprehensive cellular assays on peripheral blood mononuclear cells, including a single-cell mass-spectrometry based assessment of cellular phenotypes and functional capacities. From this analysis, children with vaccine failure exhibited globally reduced cellular responsiveness to a range of cytokine stimulations, as well as elevated pro-inflammatory cytokine expression. These data indicate that oral vaccine failure in this at-risk group is related to malnutrition, gut barrier dysfunction and shorter duration of breast-feeding in early childhood, and is associated with a chronic inflammatory immune phenotype.

Indoor Air Pollution

Outdoor air pollution in developing-country cities is difficult to overlook. Indoor air pollution caused by burning such traditional fuels as wood, crop residues, and dung is less evident, yet it is responsible for a significant part of country and global disease burdens. The main groups affected are poor women and children in rural areas and urban slums as they go about their daily activities. This note reviews the evidence on health effects from indoor air pollution in developing countries, looking in detail at India. It outlines possible solutions and concludes that the only feasible long-term remedy is improved access to cleaner modern energy.

Nutritional Quality of Diets fed to Young Children in Urban Slums can be Improved by Intensive Nutrition Education

Almost half of India's children under 3 years of age are undernourished and at risk for illness and death. Poor complementary feeding practices contribute substantially to the problem. Promoting appropriate feeding practices is critical for ensuring child survival, health, and nutrition. Nutrition education is a feasible intervention and has the potential to help achieve the Millennium Goals, provided it is implemented appropriately. However, in existing programs, education is too generalized and based on information transfer. To develop and implement a need-based, situation-specific education program for mothers to bring about changes in complementary feeding practices, with emphasis on the quantity and nutritional quality of complementary feeds. Four hundred fourteen mothers or caregivers from five slums in Mumbai participated in a 3-month intervention study. Gaps in complementary feeding practices were identified at baseline. Education was given by trained fieldworkers, first to groups of 8 to 10 mothers or caregivers using innovative modules and demonstrations, followed by weekly monitoring and reinforcement. A simple checklist was used at each follow-up to assess impact, identify practices not adopted, and provide further inputs. Data collected at three follow-ups were compared with baseline and analyzed by SPSS using the chi-square test, the t-test, and ANOVA to assess whether feeding practices of the mothers or caregivers were altered favorably. The intervention process used in this study, the modules used, and the use of the checklist as a monitoring tool were successful in favorably changing complementary feeding practices. Incorporation of these in existing Growth Monitoring and Promotion programs would help to improve child nutrient intakes and thus reduce the prevalence of undernutrition.

Letters to the Editor

17 June 2008 Dear Editor, UNDERWEIGHT AND STUNTING AMONG SLUM CHILDREN OF MIDNAPORE, INDIA India accounts for about 40% of undernourished children in the world, which contribute to high morbidity and mortality in the country.1 Most of these malnourished children are underprivileged and many reside in slums. Slums are those areas which are characterised by insecure residual status, poor structural quality of house, overcrowding, inadequate access to safe water and sanitation.2 Therefore, slum dwellers are more vulnerable to infections which results in deterioration of their nutritional status. Hitherto, data are lacking on malnutrition,3 as assessed by WHO-recommended Z-score method, of urban slum children of West Bengal. The present study reports the prevalence of underweight and stunting among urban slum children in Midnapore town of West Bengal. Data were collected in a slum area in Midnapore town of West Bengal during November–December, 2005. All information was collected by a trained investigator (SD). Parents were informed about the objectives of the study and their written consent was obtained. The protocol of the study was approved by the institutional ethical committee. Information on age, sex, weight and height was recorded with the help of structured questionnaire. Childrens' age were recorded as reported by mothers and verified further with other senior members of the household. Weight and height measurements were made following standard technique4 using weighing scale and anthropometer rod to the precession of 0.5 kg and 0.1 cm, respectively. Underweight and stunting was assessed as weight-for-age and height-for-age Z-score <−2.0 from the National Center for Health Statistics reference population5 using EPI6 Software (Centers for Disease Control and Prevention, Atlanta, CA, USA). Severe and moderate malnutrition was considered as Z-score <−3.0 and Z-score between ≥−3.0 and <−2.0, respectively. Risk was measured based on odds ratio (OR) between age groups based on nutritional status, that is, undernutrition versus normal. The data from the present study comprised of 316 children aged 6–18 years, out of whom 44.0% were boys and 56.0% were girls (Table 1). They were grouped according to three different stages of growth as late childhood (6–9 years), early adolescent (10–14 years) and late adolescent (15–18 years), respectively. The overall (sex combined) prevalence of underweight was 47.8%. Of these, 7.6% and 40.2% children were found to be severely and moderately underweight, respectively. Similarly, the overall prevalence of stunting was 45.6%, with 17.7% and 27.8% children found to be severely and moderately stunted, respectively. Results revealed that prevalence of underweight was higher among boys (48.9%) compared with girls (46.9%). In contrast, prevalence of stunting was higher in girls (49.7%) compared with boys (40.3%). The girls had 1.47 (OR = 1.47 95% confidence interval: 0.91–2.36) fold higher risk to be stunted compared with boys, indicating that girls were suffering from long-term nutritional stress. It was important to note that children in the age group of 10–14 years had lower risk to be underweight and stunted compared with age groups 6–9 years and 15–18 years (except for stunting among girls). The prevalence of stunting among girls was lower in 6–9 years age group and these rates increased with advancement of age (χ2 = 13.06, P < 0.01). They were 43% and 167% less likely to be stunted compared with age groups of 10–14 and 15–18 years, respectively. Based on the WHO classification of severity of malnutrition,6 the overall prevalence of underweight and stunting were very high (≥30% and ≥40.0%). In conclusion, the nutritional status of the slum children in this area is critical. There is an urgent need for steps to be taken to improve nutritional status of these slum children. The authors express their thanks to the guardian for providing their time and cooperation during the study period.

Prevalence and Determinants of Xerophthalmia in Preschool Children in Urban Slums, Pune, India—A Preliminary Assessment

Purpose: International and national programs to control vitamin A deficiency disorders (VADD) among children in developing countries are reducing the magnitude but VADD still occurs in deprived populations. The purpose of the study was to estimate the prevalence of and identify risk factors for xerophthalmia in children aged 6–71 months living in slums in Pune, India in 2003. Methods: Children were enrolled into a cross sectional study from randomly selected Anganwadis (kindergartens) in selected slums using proportional to size sampling. Parents/caregivers were interviewed by social workers about night blindness, risk factors for VADD at individual and household levels, intake of vitamin A rich foods, and history of vitamin A supplementation. Children were examined for signs of xerophthalmia by an ophthalmologist. Risk factors for xerophthalmia were explored using univariate and multivariate regression analysis. Results: 1,589 children were examined (response rate 80.2%) 22 of whom had xerophthalmia, prevalence 1.32% (95% confidence interval [CI] 0.76–1.88%). There were no gender differences. Independent risk factors for xerophthalmia were having an illiterate mother [Odds ratio [OR]15.4 (95% CI 4.4–64.1)] and lack of a safe water supply [OR 6.11, 95% CI 2.5–5.1)]. Only 11.3 and 13.3% of children in different slums had taken vitamin A supplements. Conclusions: Xerophthalmia was at a level of public health significance in children living in slums in Pune. This study highlights the importance of female education and indicates that vitamin A supplementation and other approaches to control need to be improved in children living in deprived areas like urban slums.

Water disinfection and hygiene behaviour in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs

In this research project, we studied factors that presumably affect the incidence of diarrhoea among young children in urban slums in developing countries: consumption of safe drinks, hygiene behaviour, cleanliness of household surroundings and the quality of raw water. Beliefs concerning the causes of diarrhoea were also related to health-improving behaviour, namely the application of the water-treatment method SODIS (solar water disinfection) and hygiene behaviour. We conducted a survey in a shanty town in Nairobi, Kenya. Field workers interviewed 500 households. Analysis with regression models revealed that two out of the four postulated factors were significant: children have a lower risk of contracting diarrhoea when they consume high percentages of safe drinks and live in households with good hygiene. As regards beliefs, we found that biomedical knowledge of children's diarrhoea as well as the perceived social norm for treating water was associated with the use of SODIS and good hygiene.

How Insecurity impacts on school attendance and school drop out among urban slum children in Nairobi

This paper discusses how perceptions of personal security can impact on school enrolment and attendance. It mainly focuses on threats of physical harm, crime, and community and domestic violence. These security fears can include insecurity that children suffer from as they go to school, maybe through the use of unsafe routes; insecurity that children feel at school; and the insecurity they suffer from in their homes. Although poverty can be a source and/or an indicator of insecurity, this paper does not focus solely on poverty as it is well covered elsewhere in the literature. The paper relies on qualitative data col- lected in Korogocho and Viwandani slum areas in Nairobi, Kenya between October and November 2004. The paper analyses data from individual interviews and focus group interviews and focuses on the narrative of slum dwellers on how insecurity impacts on educational attainment. The conclusion in this paper is that insecure neighbourhoods may have a negative impact on schooling. As a result policies that address insecurity in slum neighbourhoods can also improve school attendance and performance.

Influenza A and B Infection in Children in Urban Slum, Bangladesh

Influenza A and B Infection in Children in Urban Slum, Bangladesh

A study on determinants of immunization coverage among 12-23 months old children in urban slums of Lucknow district, India

To find out the suitable factors for raising the coverage of immunization. To determine the coverage and to identify the various factors of primary immunization. Urban slums of Lucknow district. WHO 30-cluster sampling technique was used for the selection of the subjects. Mother, father or relative of a total of 510 children with 17 children per cluster were interviewed in the study. Chi-square test, binary logistic regression and multinomial logistic regression analysis were done to test the statistical significance of the association. About 44% of the children studied were fully immunized. Multinomial logistic regression analysis revealed that an illiterate mother (OR=4.0), Muslim religion (OR=2.5), scheduled caste or tribes (OR=2.3) and higher birth order (OR approximately 2) were significant independent predictors of the partial immunized status of the child; while those associated with the unimmunized status of the child were low socioeconomic status (OR=10.8), Muslim religion (OR=4.3), higher birth order (OR=4.3), home delivery (OR=3.6) and belonging to a joint family (OR=2.1). The status of complete immunization is about half of what was proposed to be achieved under the Universal Immunization Program. This emphasizes the imperative need for urgent intervention to address the issues of both dropout and lack of access, which are mainly responsible for partial immunization and nonimmunization respectively.

School enrollment among urban non-slum, slum and rural children in Kenya: Is the urban advantage eroding?

For long now, the urban child has been considered to be more likely than his/her rural counterpart in being able to realize the dream of fully participating in school. This observation has mainly been attributed to what is commonly known as the “urban advantage”. This “urban advantage” is associated with increased access to facilities such as schools in urban areas. Recent work documenting population health in urban and rural areas has however begun to suggest that some sections of the urban population do not benefit from the “urban advantage”. For example, a child in the slums of Nairobi is more likely to suffer from diarrhea than a child in rural Kenya. In addition, a child from the richest household in the slums is more likely to suffer from diarrhea than a child from the poorest family in rural Kenya. This paper explores patterns of school enrollment comparing urban slum, urban non-slum and rural children. The paper uses data from the Kenya Demographic and Health Survey (KDHS) for 1993, 1998 and 2003. A contrast with school enrollment in Nairobi slums is done using the KDHS-type Nairobi Cross Sectional Slum Survey for 2000. Data from focus group discussions collected in the slums of Nairobi provide the context for discussion. The results suggest that school enrollment is higher in urban non-slum than in urban slum areas, and is higher in slums than in rural areas at younger ages. However, this is only true up to age 9 for females and 11 for males, from which school enrollment for slum children declines and the rate of decline is faster than among their rural counterparts. The corresponding ages at which the enrollment among the rural children begins to visibly decline are 13 years for males and 14 years for females. Factors contributing to these results point to the poor quality of primary schools in slums, limited access to secondary school for slum children, increased vulnerability to coercion into sexual activity and other ills that hinder school participation, disabling environment at home and increased child labor.

Gender Discrimination Among Children in Urban Slums

Gender bias continues to manifest itself in Indian society in spite of the right to equality enshrined in the constitution and the various laws. The girl child does not always enjoy the rights of childhood for reasons extraneous to her. It is the gender and culture that determines the position of girl child in the Indian social structure. This study analyzes the gender bias prevalent in the slum areas of Allahabad city of Uttar Pradesh. The sample consisted of 120 children aged five to ten years (60 of higher caste 60 lower caste; with 30 boys and 30 girls in each category). The data was collected through interview schedules administered on the mothers. To study the gender gap a Gender Disparity Index (GDI) was calculated. Results indicate the existence of strong gender bias in both the higher caste and the lower caste slum dwellers regarding the fulfillment of the demands of the children the type of work assigned to them the mode of punishment etc. The GDI values revealed slightly better position of girls in lower caste in comparison to the higher caste girls. (authors)

Immunization status in children.

Recent studies and surveys are observing a declining trend of routine immunization coverage and fully immunized children in India are reported to be 38%. A rapid assessment technique was used on National Immunization Day (PPI) to assess the immunization status among children in the age group of 12-23 months covering urban, rural and slum areas in UT, Chandigarh. The study covered 796 children in proportion of their distribution in urban, rural and slum areas. Evaluation recorded fully immunized children as 72.23%, partially immunized as 22.99% and unimmunized as 4.64%. Only 58.66% children in urban slums were fully immunized. The overall coverage for various vaccines was BCG: 93.09%, DPT1/OPV1: 93.97%, DPT2/OPV2: 90.57%, DPT3/OPV3: 85.92% and measles: 76%. No sex-wise difference was noticed in the study. Efforts must be made to strengthen routine immunization programme especially in the underprivileged groups and areas such as slum in cities so that target of universal coverage can be achieved as envisaged at national level.

Characteristics of young foster children in the urban slums of Bangladesh

Characteristics of young foster children in the urban slums of Bangladesh

Urban children's work during and after the 1998 floods in Bangladesh

The 1998 floods, which inundated much of Bangladesh, had a major effect on the lives and work of urban slum children. Lack of work opportunities, and beliefs about appropriate roles for young children, meant that the floods did not lead to great increases in workforce entry and in some cases led to a reduction in the opportunities available. Children's domestic work was also affected. Children's paid and domestic work had an important impact on how well households survived during and after the floods. The findings highlight the simultaneously beneficial and harmful nature of much child labour, and are therefore relevant to the dilemmas that face policy makers in this area. The research reported on in this article also has implications for those involved in disaster relief policy making.