Urban Slum Community Research Articles

EVALUATING THE EFFECTS OF HEALTH EDUCATION ON ADOLESCENTS' KNOWLEDGE AND PERCEPTION OF RISK TO HIV/AIDS IN SOUTHWESTERN NIGERIA

Adolescents constitute a sizeable proportion of new HIV infections. Their reported poor risk perception to HIV/AIDs calls for a more formidable way of reaching them with HIV prevention messages. This study evaluated the effects of peer-led health education on secondary school adolescents' perception and knowledge of risk to HIV/AIDs in urban slum communities of Osun state. Descriptive cross-sectional study of the pre and post-test type was carried out among intervention and control groups of 700 secondary students each, selected using multi-staged sampling method. The intervention group had a six months’ peer-led health education sessions. Research instruments were semi- structured self-administered pre-tested questionnaires. Data was analysed using the SPSS software version 17.0 Two hundred and ninety-six (84.6%) and 283(80.9%) of respondents were aware of HIV/AIDs in the pretest of intervention and control groups respectively. An increase of 12.0% and 1.7% in awareness was recorded among intervention and control group respectively during post-test. With a high-risk knowledge but poor risk perception scores reported among both groups during pretest, there was an increase of 7.4% in risk perception scores among intervention and 3.2% among control group during post-test. Higher education classes and male gender were predictors of good risk knowledge and good risk perception respectively. Adolescents under study had high awareness, high-risk knowledge but poor self-risk perception towards HIV/AIDs. Peer-led health education significantly increased risk knowledge and perception among study group than the control group.

Rotavirus and other Diarrheal Disease in a Birth Cohort from Southern Indian Community.

To describe the incidence, severity and etiology of diarrheal disease in infants and young children residing in an urban slum community in Southern India. Three contiguous urban slums in Vellore, Tamil Nadu. 452 children participating in a birth cohort study on diarrheal disease; 373 completed three years of follow-up. Diarrheal incidence (obtained by twice-weekly home visits) and severity (assessed by the Vesikari scoring system), and etiological agents associated with diarrhea (through examination of stool specimens by bacteriologic culture, rotavirus enzyme immunoassay, PCR for norovirus and microscopy for parasites). A total of 1856 diarrheal episodes were reported in 373 children. The overall incidence rate of diarrhea was 1.66 episodes per child year for three years, with 2.76 episodes per child year in infancy. The incidence peaked during the months of July and August. Severe diarrhea formed 8% of the total episodes. Rotavirus was the most common pathogen detected, being identified in 18% of episodes. Good hygiene status resulted in 33% protection against moderate-to-severe diarrhea. This study highlights the burden of diarrheal disease and the important etiological agents of childhood diarrhea in Southern India. Promotion of hygienic behavior through health education may help reduce diarrheal incidence in this and similar communities.

Seroepidemiology of toxoplasmosis in rural and urban communities from Los Rios Region, Chile

BackgroundToxoplasmosis is a prevalent protozoan infection with a complex lifecycle and wide profile of risk factors. The impact of congenital infection is well documented; however, there is increasing evidence of a much broader range of potential health outcomes and the need to improve our understanding of the transmission patterns and infection sources in the overall population. This study examined the epidemiology of toxoplasmosis in distinct community types from a highly endemic area of Chile.MethodsA cross-sectional serosurvey was carried out in households from urban slums, rural villages, and farms which included collection of blood samples, as well as data on sociodemographic, behavioral, and spatial variables. Blood samples were analyzed for the presence of T. gondii-specific IgG antibodies. Avidity index was obtained for IgG-positive samples. Mixed-effects regression modeling was used to identify associations with relevant risk factors.ResultsCrude seroprevalence was 55.9% (95% CI: 52.6–59.1%) with no difference by community type. Results are indicative of early exposure to the parasite, including 40% of 13- to 17-year olds who were already seropositive. Sociodemographic factors associated with seropositivity included age, occupations, and income. However, sex modified the effect of occupation as well as of income. Practices associated with increased seropositivity were consumption of sheep and locally produced vegetables as well as cleaning household barns or sheds. Boiling water for household use was a protective factor. Living on a sloped terrain without vegetation was a protective factor, while living in an area with high flow accumulation index was a risk factor.ConclusionsSeroprevalence of infection was high in both rural and urban slum communities with unique risk factor profiles for each community type. Findings highlight the role of the household and the community environment as influential factors in the epidemiology of the infection. Increasing awareness is needed at the health care and public health levels to establish disease burden and options for suitable control programs.

A longitudinal study to assess the cost incurred by patients undergoing treatment for tuberculosis in an urban slum community

Objectives: The objective of the study was to estimate direct medical/nonmedical and indirect costs incurred by patients diagnosed with tuberculosis (TB) residing in an urban slum of Mumbai. Subjects and Methods: A longitudinal study of 16 months duration (June 2013-September 2014) was undertaken in a directly observed treatment short-course (DOTS) center of an urban slum area. The method of sampling was universal sampling and thus all the patients who were registered in the period June 2013 to December 2013 were enrolled as study participants. These subjects were then followed for their completion of treatment. All the subjects were interviewed using a semistructured questionnaire to obtain the desired information. Permission from the Institutional Ethics Committee was obtained. Statistical analysis was performed using SPSS software version 19. Results: Of the 232 patients enrolled in the study, 176 (75.9%) completed the entire course of treatment. The median direct, indirect, and total costs for 176 patients were: pretreatment direct medical cost, direct nonmedical cost, and pretreatment indirect cost was Rs. 1200 ($20), Rs. 800 ($13.3), and Rs. 1250 ($20.8), respectively. However, during the course of treatment direct medical cost, direct nonmedical cost, and indirect cost were nil, Rs. 360 ($6) and Rs. 400 ($6.6), respectively. Conclusion: Despite the free availability of diagnostic and treatment component of TB in India, the majority of the tuberculosis patients still have to spend a significant amount of money.

Screening of individuals of age group 25 years and above for hypertension and diabetes in urban slum community, Sion, Mumbai

Background: The prevalence of hypertension and diabetes is showing an increasing trend. In India, majority of individuals are not aware of presence of these conditions in self, as they do not undergo regular health checkups. Majority are diagnosed when they undergo routine investigations for surgical procedures or medical examination for some other health problem. These conditions can be detected early, by simple screening techniques such as measuring blood pressure and blood sugar level which can be carried out by trained individuals, leading to reduction in the morbidity and mortality. Hence an initiative was taken to identify and train adolescent volunteers from the community to educate and screen the individuals of urban slum area Pratikshanagar, Sion, Mumbai. Objectives of the study were to screen individuals ≥25 years of age for hypertension and diabetes; to find the level of risk factors like alcohol, tobacco consumption, obesity. Methods: It is a cross – sectional type of study. Results: Out of 1119 individuals, 113 (10.09%) were aware of their hypertensive status, thus from the rest 1006 individuals screened, 147 (14.61%) were detected with raised blood pressure. Out of these 147, 86 (8.54%) were confirmed as hypertensive. With regards to diabetes, out of 1119 individuals, 82 (7.32%) were aware of their diabetic status. On screening the rest 1037, 23 (2.21%) were detected with raised blood sugar. Out of these 23, 13 (1.25%) were confirmed as diabetics. Conclusions: Volunteers from community can be trained for screening individuals in their locality thus ensuring early detection of hypertension and diabetes.

Sanitation Practice of Slum Communities in Addis Ababa, Ethiopia

Globally, an estimated 2.5 billion people lack access to improved sanitation which is more than 35% of the world’s population and about 1billion people, 15% of the world population do not have access to any kind of sanitation facility and exercise open defecation. A total of 16% of population living in urban Ethiopia do not have access to any kind of sanitation facility and exercise open defecation, of which the huge proportion lives in the slum areas. Objectives: To assess the level of practice and associated factors towards sanitation in the urban slum communities of Addis Ababa, Ethiopia. Methods: A community based cross-sectional study design was conducted on January 2015 in Addis Ketema, Lideta, Kirkos, and Gulelle sub cities of Addis Ababa. Using stratified sampling 636 sample households was selected and data was collected from 624 household, which is 98.1% of estimated sample size. Results: Practice of sanitation was 43.89% and it gets higher in households found in Lideta [AOR=3.37, 95% CI=1.12-10.15, p<0.031], Kirkos [AOR= 4.97, 95% CI=1.76-14.04, p<0.002], and Gullele [AOR= 10.16, 95% CI=3.61-28.58, p<0.000] sub cities; and who own previous latrines [AOR= 6.26, 95% CI=3.01-13.01, p<0.000]. It gets lower in households who share latrine with other neighboring households [AOR= 0.08, 95% CI=0.03-0.17, p<0.000], those who own simple pit latrines [AOR= 0.02, 95% CI=0.05-0.74, p<0.016], those who didn’t receive support during the construction of their latrine, [AOR=0.004, 95% CI=0.001– 0.014, p<0.000], and those whose annual income is between 55,001 ETB and 65,000 ETB [AOR=0.15, 95% CI= 0.02– 0.88, p<0.036]. The level of practice of sanitation in the study population is low. Latrine sharing habit, not hiring sanitation facility builder/ skilled mason, and need for subsidy and support during latrine construction were found to be the main factors contributing for this low practice. Establishing well organized and responsible body at each level of administration that will incept and execute awareness and promotion activities to improve the practice of sanitation should be done using different promotion approaches.

Effect of smoking on PEFR: a comparative study among smokers and non smokers in an urban slum community of Hyderabad, India

Background: Smoking is hazardous for health. The first impact of smoking is on lungs where it starts decreasing the lung capacity of the smokers. Hence if we can identify this decrease in lung capacity, at an early stage among the smokers, we can try to prevent the further effects of smoking on all body systems. The objective of the study was to study the effect of smoking on PEFR among smokers and compare with age, sex and other facts matched controls (non smokers) in an urban slum community of Hyderabad, India. Methods: A community based cross sectional comparative study was carried out among 50 smokers and 50 age, sex and other factor matched non smokers. Detailed history was taken. Lung capacity was measured by Wright’s peak flow meter as per the standard guidelines. Statistical tests like odds ratio and chi square were used wherever applicable. Results: The mean age and BMI of smokers and non smokers were comparable. PEFR in smokers was significantly low compared to non smokers. Smoking is strongly associated with the abnormal PEFR. The prevalence of abnormal PEFR was 84% among smokers as compared to 60% among non smokers. The smokers were found to be 3.33 times more at risk of having abnormal PEFR than non smokers. This association was statistically significant. (p < 0.05). Conclusions: The smokers were found to have reduced lung capacity compared to non smokers. Smoking is known to reduce the lung capacity. This study has proved that smoking adversely affects the normal functioning of lungs which leads to increased morbidity and mortality among smokers. Thus smoking was found to be directly related to reduced lung capacity measured in terms PEFR.

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.

Catastrophic health expenditure and its determinants in Kenya slum communities.

BackgroundIn Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya.MethodsWe use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis.ResultsThe results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE.ConclusionThis study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.

Serological evidence of hantavirus infection in apparently healthy people from rural and slum communities in southern Chile.

Hantavirus disease in America has been recognizable because of its rapid progression in clinical cases, occurrence in previously healthy young adults, and high case fatality rate. Hantavirus disease has been proposed now to define the diversity of clinical manifestations. Since 1995, a total of 902 cases of hantavirus pulmonary syndrome have been reported in Chile, caused by Andes virus (ANDV), with overall fatality of 32%. This report describes the sero-epidemiology of hantavirus in apparently healthy people in rural and urban slum communities from southern Chile. Ten of 934 samples yielded a positive result resulting in a seroprevalence of 1.07% (95% confidence intervals: 0.05%–2.0%). A higher proportion of positive samples was found among individuals from rural villages (1.3%) and slums (1.5%) compared with farms (0.5%). Seropositivity was associated with age (p = 0.011), low education level (p = 0.006) and occupations linked to the household (homemaker, retired, or student) (p = 0.016). No evidence of infection was found in 38 sigmodontinae rodents trapped in the peri-domestic environment. Our findings highlight that exposure risk was associated with less documented risk factors, such as women in slum and rural villages, and the occurrence of infection that may have presented as flu-like illness that did not require medical attention or was misdiagnosed.

Seroprevalence, disease awareness, and risk factors for Toxocara canis infection among primary schoolchildren in Makoko, an urban slum community in Nigeria

In this study, we investigated the seroprevalence of Toxocara canis infection in southern Nigeria, which previously was unknown, in addition to evaluating disease awareness and potential risk factors for schoolchildren in an urban slum community. In total, 366 primary schoolchildren were investigated for the presence of anti-Toxocara IgG antibodies. Blood was collected and screened by a Western blot analysis based on the excretory–secretory antigens of larval T. canis (TcES), targeting low molecular weight bands of 24–35kDa specific for T. canis. Children were considered seropositive if their serum reacted with TcES when diluted to a titer of 1:32. Questionnaires concerning possible risk factors were given to the schoolchildren to acquire data on this infection. The overall seroprevalence of Toxocara infection was 86.1% (315/366). The logistic regression analysis of risk factors showed that children's age (odds ratio (OR)=2.88, 95% confidence interval (CI)=1.08–7.66, p=0.03), contact with dogs (OR=0.51, 95% CI=0.28–0.94, p=0.03), the age of the dog (OR=0.34, 95% CI=0.18–0.68, p=0.002), the feeding location of the dog (OR=0.31, 95% CI=0.12–0.79, p=0.01), the consumption of raw vegetables (OR=0.89, 95% CI=0.54–1.48, p=0.004), and the drinking of unboiled water (OR=0.48, 95% CI=0.26–0.90, p=0.02) were risk factors associated with Toxocara infection. Although there was a high awareness of dogs being hosts of some parasites in this study, not much was known about T. canis. This is the first serological investigation of T. canis infection among primary schoolchildren in southern Nigeria. The high seroprevalence recorded is an indication of high transmission with the consequent risk of visceral or ocular larval migrans and neurologic toxocariasis in these children. Our findings suggest the need for prompt interventional measures, particularly health education on personal hygiene.

A Study of Epidemiology of Hypertension in an Urban Slum Community of Mumbai

Background: Hypertension is often asymptomatic disease and can lead to lethal complications. So the present study was done with the objective of studying the prevalence and determinants of hypertension and to assess the applicability of the rule of halves in hypertension in the urban slum community. Methods: It was a community based cross-sectional study conducted from April 2010 to March 2012, among people above 18 years of age residing in an urban slum of Mumbai, from Malwani slum. Multistage sampling procedure was employed and total sample size was 1089. Statistical analysis was done by using SPSS 16 software. Frequency distribution was calculated for all the socio-demographic variables and chi-square test was also employed to study the association between risk factors and presence of hypertension. Results: The prevalence of hypertension in the study group was 23.59%. The prevalence of hypertension in males and females was 23.15% and 24.04%, respectively (using blood pressure ≥ 140/90 as Hypertension). Prevalence of hypertension showed a significant positive association with age, family history of hypertension, body mass index, absence of physical activity, smokeless tobacco, tobacco smoking, alcohol, mixed diet. The hypertensives aware of suffering from hypertension were 41.6%. Out of the hypertensives who were aware of suffering from hypertension 55.5% were taking treatment. While only 47.4% of hypertensives who were taking treatment had controlled blood pressure. Conclusion: The prevalence of hypertension in the current study was 23.59% and thus it still remains a major public health concern in urban slum settings. The rule of halves was still prevalent and the awareness about hypertension and its regular treatment should be given to the community.

Assessment of morbidity profile in urban slum community of Udaipur (Rajasthan)

Background:The urban slums has diversity, but the universal characteristics refer to overcrowding and congestion, lack of hygiene, extremely poor sanitation, lack of garbage disposal facilities, high density of insects and rodents, makes the dwellers more prone to morbidity. Objectives: To study morbidity profile in urban slum dwellers. Methods:Cross sectional study had been carried out between January 2014 to July 2014 on slum dwellers of Udaipur. Information obtained by interviewing the head and/or other family members of about 76 households. Results:The morbidity rate for both sexes was 33.0%. About 31.2% males and 34.6% females were either suffering from or have a history of one or more illness within previous two weeks. Anemia was found in 11.2% of females. Respiratory tract infections and diarrhea were present in 8.8% and 2.1% of studied population respectively. Among five years above age slum dwellers, 18.9%, 38.3% and 31.2% had a habit of smoking, tobacco chewing and alcohol intake respectively.Conclusions:Slum dwellers were unaware of the effective information on hygiene, health and substance use, education, communication activities along with effective health care delivery measures needed.

Assessment of visual problems in elderly in an urban slum community of Mumbai

Background: Visual problems in the elderly share a major portion of the disability in the elderly. Visual impairment in the elderly can interfere with daily activities tremendously leading to dependence in many things. It can also lead to accidents and falls. Hence a study was carried out in an urban slum community at Mumbai to assess the various visual problems in the elderly, its causes and the prevalence. Methodology: Community based cross-sectional study of the elderly persons residing in an urban slum of Mumbai. Results: 65.54% (426) people had visual disability. Of 426 people with visual impairment 405(95.07%) people had low vision and 21 (4.93%) were blind. It was observed that errors of refraction (63.85%) and cataract (18.31%) were the most common cause of visual impairment. Conclusion: Visual impairment and disability is a major problem of the elderly. Errors of refraction and Cataract are the major causes for this disability which can be treated, thus preventing visual handicap and dependency.

Prevalence of hypertension and associated cardiovascular risk factors in an urban slum in Nairobi, Kenya: A population-based survey

BackgroundUrbanisation has been described as a key driver of the evolving non-communicable disease (NCD) epidemic. In Africa, hypertension is the commonest cardiovascular problem. We determined the prevalence and risk factor correlates of hypertension in the largest Nairobi slum.MethodsIn 2010 we conducted a population-based household survey in Kibera, a large informal settlement in Nairobi City; utilising cluster sampling with probability proportional to size. Households were selected using a random walk method. The WHO instrument for stepwise surveillance (STEPS) of chronic disease risk factors was administered by trained medical assistants, who also recorded blood pressure (BP) and anthropometric measures. BP was recorded using a mercury sphygmomanometer utilising the American Heart Association guidelines. Hypertension was defined as per the 7th Report of the Joint National Committee or use of prescribed antihypertensive medication. Those with hypertension or with random capillary blood sugar (RCBS) >11.1 mmol/l had an 8 hours fasting venous blood sugar sample drawn. Age standardised prevalence was computed and multivariate analysis to assess associations.ResultsWe screened 2200 and enrolled 2061 adults; 50.9% were males; mean age was 33.4 years and 87% had primary level education. The age-standardised prevalence of hypertension (95% CI) was 22.8% (20.7, 24.9). 20% (53/258) were aware of their hypertensive status; 59.3% had pre-hypertension; 80% reported high levels of physical activity and 52% were classified as harmful alcohol drinkers; 10% were current smokers and 5% had diabetes. Majority of males had normal BMI and waist circumference, whereas a third of females were obese or overweight and 40% had central obesity. Older age, higher general and central obesity were independently associated with hypertension and higher SBP and DBP readings.ConclusionsOur findings of high prevalence of hypertension, in association with excess body weight in this poor urban slum community, point to the need for greater awareness and implementation of primary preventive strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1177) contains supplementary material, which is available to authorized users.

Community based case-control study of rotavirus gastroenteritis among young children during 2008-2010 reveals vast genetic diversity and increased prevalence of G9 strains in Kolkata.

BackgroundGroup A Rotaviruses are a major etiologic agent of gastroenteritis in infants and young children (<5 years) worldwide. Although rotavirus vaccines have been successfully administered in many countries, in India the introduction of rotavirus vaccine in national immunization program was approved in 2014. Since high disease burden and large number of genetic variants have been reported from low income countries including India, monitoring of rotavirus was initiated prior to implementation of the vaccine in the region.MethodsA total number of 3,582 stool samples were collected from an urban slum community in Kolkata, among which 1,568 samples were obtained from children of ≤5 years of age, with moderate to severe diarrhoea and 2,014 samples were collected from age-sex matched healthy neighbourhood controls. Rotavirus positive samples were typed by multiplex semi-nested PCR and nucleotide sequencing. Circulating strains were phylogenetically analyzed.ResultsAmong 1,568 children with diarrhoea, 395 (25.2%), and among 2,014 asymptomatic children, 42 (2%) were rotavirus positive. G1P[8] was identified as the most common strain (32%) followed by G9P[8] (16.9%), G2P[4] (13.5%) and G9P[4] (10.75%). G12 strains with combinations of P[4], P[6] and P[8] comprised 11.9% of total positive strains. The rest (<10%) were rare and uncommon strains like G1P[4], G1P[6], G2P[8] and animal-like strains G4P[6], G6P[14] and G11P[25]. The 42 rotavirus positive samples from asymptomatic children revealed common genotypes like G1, G2 and G9.ConclusionThis community based case-control study showed increased predominance of genotype G9 in Kolkata. It also confirmed co-circulation of a large number of genetic variants in the community. Asymptomatic rotavirus positive children though low in number can also be a source of dispersal of infection in the community. This study provides background information to the policy makers for implementation of rotavirus vaccines in this region.

Prospective study of leptospirosis transmission in an urban slum community: role of poor environment in repeated exposures to the Leptospira agent.

BackgroundLeptospirosis has emerged as an urban health problem as slum settlements have rapidly spread worldwide and created conditions for rat-borne transmission. Prospective studies have not been performed to determine the disease burden, identify risk factors for infection and provide information needed to guide interventions in these marginalized communities.Methodology/Principal FindingsWe enrolled and followed a cohort of 2,003 residents from a slum community in the city of Salvador, Brazil. Baseline and one-year serosurveys were performed to identify primary and secondary Leptospira infections, defined as respectively, seroconversion and four-fold rise in microscopic agglutination titers. We used multinomial logistic regression models to evaluate risk exposures for acquiring primary and secondary infection. A total of 51 Leptospira infections were identified among 1,585 (79%) participants who completed the one-year follow-up protocol. The crude infection rate was 37.8 per 1,000 person-years. The secondary infection rate was 2.3 times higher than that of primary infection rate (71.7 and 31.1 infections per 1,000 person-years, respectively). Male gender (OR 2.88; 95% CI 1.40–5.91) and lower per capita household income (OR 0.54; 95% CI, 0.30–0.98 for an increase of $1 per person per day) were independent risk factors for primary infection. In contrast, the 15–34 year age group (OR 10.82, 95% CI 1.38–85.08), and proximity of residence to an open sewer (OR 0.95; 0.91–0.99 for an increase of 1 m distance) were significant risk factors for secondary infection.Conclusions/SignificanceThis study found that slum residents had high risk (>3% per year) for acquiring a Leptospira infection. Re-infection is a frequent event and occurs in regions of slum settlements that are in proximity to open sewers. Effective prevention of leptospirosis will therefore require interventions that address the infrastructure deficiencies that contribute to repeated exposures among slum inhabitants.

Malnutrition in under five children in Turbhe stores urban slums in Navi Mumbai

Background: Malnutrition is a problem not only in rural area but also among the urban poor. Also, the urban poor are a neglected segment of population in terms of basic services and amenities. Nutrition in children is affected by various determinants including mother’s level of knowledge, attitudes and practices. Hence, this study was conducted in an urban slum setting to understand the extent and determinants of malnutrition in children below five years of age. Aims & Objectives: The study objectives were to understand the knowledge, attitude and practices of mothers with respect to nutrition of their under five children and to measure the extent of malnutrition in the sample population of under five children. Materials and Methods: This was a cross sectional study and data was collected on a sample of 300 children under five years and their mothers selected through cluster sampling technique in Turbhe stores urban slum community of Navi Mumbai. Using a semi-structured interview schedule, Knowledge, Attitude and Practice (KAP) on nutrition among mothers of these children were assessed and anthropometric measurements were taken. The study used the World Health Organization (WHO) guidelines for measuring malnutrition. Data was entered and analyzed using SPSS, version 20. z score analysis for malnutrition assessment was done using the appropriate WHO software. Results: The knowledge levels of mothers regarding breast-feeding were mixed. Majority (88%) of the mothers were aware that only breast-feeding is required post-delivery, and duration of breast-feeding could be more than six months. there was a gap in knowledge about breast-feeding practice during infant illness. Only 9% of mothers had the correct knowledge to increase breast feeding if the infant was ill and 20% felt breast feeding should be decreased during illness of child. Mothers had very poor knowledge about nutritious food. The attitude score was created using the Likert scale with a minimum score of 16 and maximum score of 64. The mean attitude score was 54.29 with a standard deviation of 5.24. In terms of breast-feeding practices, 74 (24.6%) mothers did not initiate breast-feeding within one hour of birth, and only 21 (7%) mothers increased breast feed frequency during illness of child. Conclusion: The study found gaps in knowledge about breast-feeding practices among mothers and very poor practices related to adequate nutrition for children. Stunting was seen in more than 50 % of children. However, the mothers had a very positive overall attitude about improving nutrition of their children and were willing to learn about it. This provides an opportunity for a targeted intervention among the mothers of these children in the community

An epidemiological study to find out the prevalence of RTI/STI and various factors associated with it among ever married women of reproductive age group in an urban slum community of Mumbai

Background and objectives : Reproductive tract infection presents a huge burden of disease and adversely impacts reproductive health. A broad based study conducted in different part of the country revealed a prevalence of reproductive tract infections varying from 19 to 71%. Marked variations have been found in terms of pattern and level of morbidity. The present study was undertaken with the following Objectives: (1) To assess the prevalence of various reproductive tract infections among ever-married women aged 15- 49 years based on laboratory diagnosis. (2) To understand the influence of various factors on reproductive tract infections in women. Material and methods: A Community based epidemiological study was undertaken over a period of 6 months from September 2007 to February 2008 in an urban slum, field practice area of Urban Health Centre (UHC), Total 500 ever married women of reproductive age group (15-49 years), residing in study area for more than 1 year, were selected by systematic sampling technique. Information was collected on preformed, pre tested interview schedule by investigator. At the end of the interviews, each woman was given an appointment card to visit at the clinic (Urban Health Centre) were Per speculum examination was carried out and Samples (vaginal and cervical swab) were collected for laboratory investigation of RTI/STI Result: 50% of women in the study reported one or more RTI related symptoms, the various symptoms reported by women were Vaginal discharge (44.2%) Lower abdominal pain (13.6%) Lesion over genital area (1.0%) Inguinal swelling (0.8) . Total 466 women had undergone gynaecological examination and laboratory investigations. The prevalence of women with at least one RTI, based on laboratory diagnosis, was found to be 67.81% (316/466). The total number of positive tests being 505. Thus, the number of RTIs per woman was 1.59 (505/316). On Logistic regression analysis, Among different variables, prevalence of RTI was influenced by gravida status, place of delivery, IUD use and with history of RTI/STI in last three months.

Association between Child Diarrhea and Maternal Depression

CORRECTION: The following authors were added to this paper on 11/10/2013: Grace Milad; Saria Izzeldin; Tahmeed Ahmed; William A. Petri.The author Mohammad Ibrahim Khalil was changed to Ibrahim KhalilBackground: Maternal depression has been found to be associated with increased diarrheal incidence and childhood malnutrition. Objective: The purpose of the present study was to observe whether the Self- Reporting Qustinative (SRQ-20) questionnaire was sensitive enough to pick-up the depressive symptoms of mothers in the urban slum community. Methodology: This was a pilot study in a Dhaka Shantytown and women were interviewed to examine the relationship between maternal depression and their children's diarrheal morbidity. In addition to other socio-demographic information, the Self-Reporting Questionnaire (SRQ-20) was used to screen for maternal depression. Result: A total number of 55 women were interviewed to examine fifty-one percent of mothers scored within the high-risk psycho-morbidity group, suggesting depression. High SRQ scores significantly correlated with poor marital relationships (Regression coefficient ± standard error =-0.624+0.225, p=0.008; 95%CI:-1.076, -0.172). High-risk mothers breastfed for a shorter duration than low-risk mothers (3.4 vs. 4.4 months, p=0.35) and their children had more diarrheal episodes (2 episodes vs. 1, p=0.18), although these differences did not show statistical significance. Conclusion: Depression is common among mothers in urban slums and that a well-designed large study is required to further explore the provocative relationship between maternal depression and child diarrhea with subsequent malnutrition to improve the quality of life of those at risk. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16199 J Shaheed Suhrawardy Med Coll, 2013;5(1):14-20