Urban Slum Population Research Articles

Underestimated urban slum populations

Underestimated urban slum populations

Assessment of self-care practices & associated factors among hypertensives in urban slum areas of Mysuru city: A community-based cross-sectional study.

Background & objectives Hypertension is a significant modifiable risk factor for cardiovascular diseases (CVDs) and premature mortality worldwide, particularly affecting low- and middle- income countries (LMICs). This study focused on evaluating self-care practices among hypertensive affected individuals in urban slum areas of Mysuru city, India, and explore associated factors and their relationship with hypertension control levels. Methods A community based cross-sectional study was carried out from March 2022 to August 2023, enrolling 650 hypertensive affected individuals from 63 urban slums of Mysuru city. Data on sociodemographic characteristics, self-care practices, and hypertension control were collected using structured questionnaires and standardized scales. Descriptive statistics and chi-square tests were used for data presentation and analyses. Results Among the participants, 62.9 per cent reported poor self-care awareness, and only 37.1 per cent had good self-care awareness. Factors such as age group, education, occupation, type of family, marital status, socioeconomic status, and hypertension control showed significant associations with self-care scores (P≤0.001). However, no significant association was found between gender and self-care scores. Interpretation & conclusions This study highlights the critical need for comprehensive interventions integrating self-care awareness into existing health programmes to address the growing burden of hypertension, particularly in urban slum populations. By prioritizing self-care education and empowerment, healthcare stakeholders can equip individuals with the necessary knowledge and skills for effective hypertension management, thus improving health outcomes at individual level and also reducing public health impact of hypertension.

A Community based Non Communicable disease Prevention Intervention among Urban Slum population in Surat city

A Community based Non Communicable disease Prevention Intervention among Urban Slum population in Surat city

Effectiveness of Multifaceted Lifestyle Interventions in Prediabetic Adults: A Field Study in an Urban Slum Population of Pune, India.

Introduction Adults with diabetes have an increased risk of hypertension, heart attack, and stroke than those without diabetes. Diagnosing prediabetes at an early stage can significantly reduce the risk of diabetes through simple interventions such as lifestyle modifications. Lifestyle modifications such as weight loss combined with regular physical exercise and a healthy diet can help delay or prevent the progression of diabetes. This study aims to estimate the prevalence of prediabetesamong the urban slum population and to assess the effect of lifestyle modifications on blood sugar levels, glycated hemoglobin (HbA1c), and lipid profile among the participants. Methods A quasi-experimental field study was conducted among the urban slum population. Participants were randomly selected from previous health screening data. Pre-intervention blood evaluations were performed, and those who fulfilled the criteria were enrolled for interventions. The follow-up period lasted three months and included telephonic and in-person meetings for support and motivation. All variables were reevaluated at the end of the follow-up period. Results Out of 34 participants included in the study, 20 completed the three-month follow-up. Statistically significant changes were observed after three months of intervention in weight, fasting blood sugar, HbA1c, BMI, triglycerides, and high-density lipoprotein (HDL) cholesterol levels. However, decreases in systolic blood pressure (BP), diastolic BP, total cholesterol, and low-density lipoprotein (LDL) cholesterol were not statistically significant. Conclusion The study revealed that lifestyle intervention programs promoting healthy diets, physical activity, and body weight reduction can prevent or delay the onset of diabetes among high-risk populations. The effectiveness of interventions across community settings depends on delivery formats, implementers, and the level of motivation of participants.

Contraceptive behaviors and awareness in an urban slum community of south India

Objective: To assess the factors associated with knowledge, attitude and behavior of contraception use among urban slum population in Chennai. Methods: A cross-sectional study was conducted in the urban slum of Anakaputhur, Chennai. Married couples between ages of 19-49 years and living in slum areas were taken up for the study by simple random sampling. Pregnant women, postnatal and postmenopausal women were excluded from the study. Data collection was done using a pretested structured questionnaire focusing on details regarding contraception knowledge, attitude, and practices. Data analysis was done using IBM SPSS version 22. Analytical test like Chi square and odds ratio (OR) were used to identify association between knowledge, attitude, and behavior of contraception with the associated variables and enter method of logistic regression analysis was done. Results: Out of the 360 respondents, 228 were females, with a mean age of (34±5) years. Approximately 43% demonstrated adequate knowledge of contraception use, and 91% were aware of at least one contraceptive method. Notably, 72% exhibited a positive attitude towards contraceptive use. Nevertheless, 43% (155 individuals) did not utilize any contraceptive method. Among contraceptive users, intrauterine devices were the most commonly adopted, followed by barrier methods and female sterilization. There was significant association between knowledge of contraception and education (aOR 7.29, 95% CI 2.93-18.10, P<0.05), age (aOR 2.04, 95% CI 1.193.50, P<0.05) and socioeconomic class (aOR 3.66, 95% CI 1.71-7.85, P<0.05; aOR 3.97, 95% CI 2.12-7.49, P<0.05). Regarding attitude towards contraception use, education (aOR 8.54, 95% CI 2.35-31.03, P<0.05), sex (aOR 0.15, 95% CI 0.06-0.37, P<0.05), age (aOR 0.53, 95% CI 0.28-0.99, P<0.05), socio-economic class (aOR 4.42, 95% CI 1.97-9.92, P<0.05; aOR 9.83, 95% CI 3.63-26.58, P<0.05) and number of children (aOR 10.04, 95% CI 4.26-23.66, P<0.05) were the variables that had a significant association. Conclusions: These findings underscore the imperative for enhanced dissemination of health education pertaining to contraception use within the slum population. The health sectors of the area and other stakeholders need to make sure to extend penetration of family planning related services to the urban slum population.

Coronary artery disease, its’ socio-demographic and behavioral correlates in urban slum population of Bhubaneswar, India

BackgroundCoronary artery disease (CAD) causes 15.5 % of all fatalities worldwide and has increased to epidemic proportions. There is dearth of data pertaining to CAD especially among slum inhabitants in India. The present study aimed to assess the prevalence of CAD and its’ socio-demographic and behavioral correlates among slum population of Bhubaneswar. MethodsIn a community-based cross-sectional study, we selected 625 adults as study participants using a stratified multistage cluster sampling method and gathered relevant information using a structured interview schedule. Standard protocols were followed while measuring anthropometry, blood pressure, electrocardiograms, fasting blood sugar levels, and serum lipid levels. ResultsThe overall prevalence of definite CAD and probable CAD was 5.1 % and 7.5 % respectively. Multivariable logistic regression analysis revealed that after adjusting for other variables, currently smoking tobacco (aOR: 3.45; CI: 1.68–7.12), moderate intensity activity (aOR: 3.19; 95 % CI: 1.45–6.79), presence of hypertension (aOR: 1.99; 95 % CI: 1.10–3.59), presence of diabetes (aOR: 2.29; 95 % CI: 1.22–4.33), and body mass index ≥25 (aOR: 2.27; 95 % CI: 1.24–4.15) were significantly associated with coronary artery disease among slum population. Individuals with CAD had significantly higher serum total cholesterol, triglyceride, low density lipoprotein levels and lower high density lipoprotein levels than the control group. ConclusionThe prevalence of any CAD in slum areas of Bhubaneswar was high, as were the majority of the associated factors for CAD. Targeted interventions both at individual and community level are needed to address the risk factors of CAD thereby reducing the burden of CAD in this population.

IJCM_158A: Usage and disposal of plastic waste among general population in urban slums of Field practice area, Gandhi medical college, Telangana.

Background: Plastics, owing to their ease of use and affordability, have taken over every aspect of our modern world. It has become an essential aspect of our everyday lives, permeating every sector from food packaging to toys and electronics, to the degree that it is unimaginable to picture a world without it. Plastic takes around 15 to 1000 years to biodegrade. The consumption of plastic by individuals and the ineffective reuse or recycling of it has detrimental effects on the ecosysystem. Overusing plastic and neglecting disposal solutions for plastic over a long time led not only India but many other nations to adopt laws to limit plastic because of its increasing environmental damage. Objectives: 1. To determine the utilization and disposal of plastic waste among general population in urban slums. 2. To study association between sociodemographic factors and plastic usage and disposal. Methodology: Study Design: A cross sectional analytical study Study Population: General population residing in urban slum Sampling Technique: Simple random sampling Sample Size:216 (p= 50%, l= 7, NR=10%) Study Tools: Self-designed, semi structured, pilot-tested questionnaire will be used for the data collection which will be entered in Microsoft Excel and analysed using SPSS statistical software version 20. Results: Usage of plastic was seen in all the study participants and more than 96% of them were reusing the plastics more than once. Most common method was disposing plastic in municipal dust bins (60.2%) followed by open dumping (20.9%), whereas 16.4% were reusing them for other purposes. Level of education and religion has no association with proper disposal of plastic waste. Present study observed that there was a significantly high percentage (96.1%) of three generation families were following proper plastic waste disposal methods followed by nuclear and Joint families with 56.9% and 48.8% respectively. with P≤0.05. Conclusion: Most common method was disposing plastic in municipal dust bins followed by open dumping. Level of education and religion has no association with proper disposal of plastic waste.

IJCM_202A: Catastrophic health expenditure (CHE) due to diabetes mellitus among urban slum population of Agra city- An Observational study

Background: People with diabetes need extensive self-management support, medications, regular screening for and treatment of possible complications and comorbidities, all of which can increase out-of-pocket (OOP) costs in patients and their families. There is a very strong correlation between the level of OOPs and an indicator that is used to monitor how well a health system is performing in terms of financial protection namely, incidence of catastrophic health expenditure. Objectives: 1. To assess the catastrophic health expenditure on treatment of diabetes mellitus and its complications in the study population. 2. To find out the association of CHE with sociodemographic profile, diabetic profile, and treatment compliance among the study population. Methodology: After applying the inclusion criteria 360 known diabetics were included from the four randomly selected slum areas of Agra city. A cross- sectional study through face-to-face interview using predesigned, pretested, and semi-structured questionnaire was conducted from September 2020 to March 2022. Data was entered on MS excel and appropriate statistical analysis was done. Results: Males and females were 59% and 41% respectively. Nearly 66% participants were of age group 35-60 years, 28% were illiterates, 54% were unemployed & 44% belong to upper lower socioeconomic class. Almost 96% were having type 2 diabetes, 74% were on oral hypoglycaemic agents and 70% were compliant to treatment. Monthly median direct out-of-pocket expenses were INR 1500 and indirect expenses were INR 505. Type of diabetes, and treatment regimen were the factors found to be associated with Catastrophic health expenditure. Conclusion: A significant proportion of 39.4% of the study participants were found to have catastrophic health expenditure.

Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India.

Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India. This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels. Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40y) but not sex. A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.

Visualizing urban slum population across the globe

Monitoring the percentage of urban residents dwelling in slums (referred to as the urban slum population percentage) is crucial for enhancing living conditions in cities. Despite its importance, there is a notable lack of research that maps this indicator on a global scale. Addressing this gap, our study aims to graphically represent the urban slum population percentage alongside the absolute numbers of the urban slum population worldwide. This analysis was conducted by synthesizing statistical data from a variety of sources. Our findings indicate that countries with a high urban slum population percentage are predominantly situated in Africa, with India having the most substantial absolute slum-dwelling population. Our research offers a comprehensive global viewpoint, underscoring the imperative to improve urban living conditions.

Serosurveillance among urban slum and non-slum populations immunized with COVID-19 vaccines in Bangladesh.

Using two rounds of serosurveillance, we aimed to observe the COVID-19 vaccination status and the dynamics of antibody responses to different vaccines among urban slum and non-slum populations of Bangladesh. Adults (>18years) and children (10-17years) were enrolled in March and October 2022. Data including COVID-19 vaccine types and dosage uptake were collected. SARS-CoV-2 spike (S)-specific antibodies were measured in blood. The proportion of vaccinated children was significantly lower among slum than non-slum populations. Two doses of vaccines showed an increase in the level of anti-S-antibodies up to 2months, followed by reduced levels at 2-6months and a resurgence at 6-12months. Children showed significantly higher anti-S-antibodies after two doses of the Pfizer-BioNTech vaccine than adults; however, after 6months, the level of antibodies declined in younger children (10- <12years). In a mixed vaccine approach, mRNA vaccines contributed to the highest antibody response whether given as the first two doses or as the third dose. Our findings emphasized the need for increasing the coverage of COVID-19 vaccination among slum children and booster dosing among all children. The use of mRNA vaccines in the mixed vaccination approach was found to be useful in boosting the antibody response to SARS-CoV-2.

Impact of community health workers on improving identification and primary care of hypertension among the urban poor – findings from Chhattisgarh state of India

BackgroundHypertension is a major health problem globally and in India. Around 60% of people with hypertension in India are not aware that they have the condition. Less than 30% of individuals with hypertension are on treatment. Existing studies have indicated that community health workers (CHWs) can play a useful role in expanding the care for hypertension. Evaluations are needed to study the impact when an intervention is implemented by the government in its existing large-scale CHW programme to improve the identification, regular follow-up and medication adherence for hypertension.MethodsChhattisgarh state implemented a pilot intervention to improve screening and follow-up for hypertension by equipping Mitanin-CHWs to measure blood pressure (BP). The study design involved an intervention-group and a comparison-group of urban slum population. The survey covered 5974 individuals (30–79 years age) in intervention-group and 5131 in comparison-group. Multivariate analysis was conducted to find out the effect of intervention on the desired outcomes.ResultsIn intervention-group, 80.2% of the individuals (30–79 years age) had been screened for hypertension whereas the proportion was 37.9% in comparison-group. For 47.0% of individuals in intervention-group, Mitanin CHW was the provider who measured BP for the first time. Around 16.3% of individuals in intervention-group and 9.5% in comparison-group had been diagnosed with hypertension. Around 85.9% of hypertension cases in intervention-group and 77.0% in comparison-group were on treatment. BP had been measured in preceding 30 days for 81.8% of hypertension-cases in intervention-group and 64.3% in comparison-group. Around 70.3% of hypertension-cases in intervention-group and 55.1% in comparison-group had taken their complete medication for last seven days. Multivariate analysis showed that CHW intervention was associated significantly with improvements in all the desired outcomes.ConclusionEquipping the CHWs to measure BP was effective in increasing the screening and identification of hypertension, regular measurement of BP of individuals with hypertension and the adherence to medication. This shows the potential if the one-million strong work-force of Accredited-Social-Health-Activists (ASHA) CHWs in India gets equipped for this role. Governments need to provide a stronger policy push to get this materialised.

A case series of substance abuse among urban slum population during the COVID 19 pandemic.

The COVID 19 pandemic stuck the world already burdened with numerous diseases. The approach toward controlling the pandemic disturbed the healthcare delivery system and also aggravated the already existing problems of malnutrition, unemployment, economic inequalities, decreased routine immunization services, and substance abuse. Six individuals with multiple substance use histories were identified and in depth interviews were conducted in an urban slum under the field practice area of a medical college. Common features were identified and reported. The age of initiation of alcohol and tobacco use was found to be in the early adolescence period (10-14 years). Chronic substance abuse causes poor health, an economic burden on families, and domestic violence. Lack of self esteem due to unemployment, decreased social interaction, and multiple failed attempts at abstinence were the shared features among dependents. Measures employed during the COVID 19 pandemic to contain the virus have caused unanticipated adverse effects on health, finance, and social life. A holistic approach would play a pivotal role rather than reactionary and momentary interventions.

A study to assess the knowledge and practice regarding sanitation and hygiene among women in parts of Delhi, India

Background: Poor hygienic practices, inadequate water supply, and poor sanitary conditions play a major role in the spread of infectious diseases. So, safe drinking water and basic sanitation is of crucial importance to the prevention of health problems.&#x0D; Objects: To study the knowledge, attitude, and practices related to drinking water and sanitation facilities among the urban slum population of different areas of Delhi.&#x0D; Design: Open label, observational, non-randomized, community-based study.&#x0D; Methodology: A cross-sectional study was designed to evaluate the knowledge of 297 females of different slum areas of Delhi regarding sanitation and hygiene, their attitude, and practices were collected using a previously validated questionnaire. The data obtained was analyzed on MS Office (Excel).&#x0D; Major Outcome: Major Outcome: Findings of the study showed that 42% of the subjects had average knowledge and 75 % of the subjects followed unsafe practices on water, sanitation and hygiene.&#x0D; Result: The study was conducted on 297 housewives having mean age as 34.14 years living mostly in joint family with 6000- 12000 monthly family income. 76.4% had toilet in their household but lack proper water disposal system.&#x0D; Conclusion: Conclusion: The knowledge and practice on hygiene and sanitation among the households of slum areas of Delhi was found to be satisfactory. This study found significant association between knowledge, practice, age, education, occupation, family income per month. It was observed that young women had good knowledge however financial constrains rule the roast.&#x0D; Keywords: Sanitation and hygiene; Knowledge; Attitude; Practices, WASH.

What is missing in our understanding of urban slum environments and maternal, infant and young child nutrition from publicly available data in Asia and the Pacific?

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large-scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum-dwellers in large-scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN.

Epidemiological Determinants of Depression among the Geriatric Population Residing in a Slum of Urban India: A Cross-sectional Study

Background: Mental health is important at every stage of life, from childhood and adolescence through adulthood. Worldwide interest in geriatric depression has increased but studies to assess the depression among the elderly population in urban slums has hardly been done. So this study would shed light on the risk factors of depression among geriatrics in urban slums. Aim &amp; Objective: To study the epidemiological determinants such as age, marital status, education, financial dependency, economic status and chronic illness in relation to of depression among the geriatric population (60–80 years). Settings and Design: Community-based, cross-sectional study for 24 months with a samplesize of 209. Methods &amp; Material: Urban slum area represented by one health post was selectedas the study area which caters to around 96,630 slum residents. Pre-tested semi-structuredinterviews were conducted after selecting households by systematic random sampling. Statistical analysis: Data was analyzed using SPSS version 21. A chi-square test was applied. Result: The present study shows overall prevalence of depression among the elderly above 60 years of age to be 48.6%. Depression is found to been significantly associated with an increase in age, living alone (72.7%), lower class economic status (100%), financial dependency (54%), history of chronic family illness (54.7%) and with no formal education (62.1%) among elderly dwelling in slums. Conclusions: There is a high prevalence of depression in the community and hence, a need to sensitize Primary level Health Care Services to institute screening tests considering the association of these determinants with depression and link them to specialized services for further management.

COVID-19 Booster Dose Coverage and Hesitancy among Older Adults in an Urban Slum and Resettlement Colony in Delhi, India.

The high prevalence of vaccine booster hesitancy, with the concomitant waning of humoral vaccine or hybrid immunity, and the emergence of SARS-CoV-2 variants of concern can accentuate COVID-19 morbidity and mortality. The study objective was to ascertain the COVID-19 vaccination coverage, including the administration of precaution (booster) dose vaccination, among the older population in an urban slum and resettlement colony population in Delhi, India. We conducted a cross-sectional survey in an urban resettlement colony, slum, and village cluster in the Northeast district of Delhi among residents aged ≥50 years. A total of 2217 adults (58.28%) had obtained a COVID-19 booster (precaution) dose vaccine, 1404 (36.91%) had received two doses of a COVID-19 vaccine without booster dose, 121 (3.18%) were unvaccinated, while 62 (1.63%) participants received a single dose. Based on adjusted analysis, older adults (>65 years), higher education, and higher per-capita income were statistically significant predictors of booster dose vaccination. More than four in ten adults in an urban slum and resettlement colony in Delhi lacked COVID-19 booster dose vaccination despite high rates of double-dose vaccination (~95%). Public health programming should provide an enhanced focus on reducing complacency with renewed prioritization for improving ease of access to COVID-19 vaccination services, particularly in underserved areas.

Health system impact of COVID-19 on selected urban slum population of Bangladesh: A rapid assessment study to support pandemic preparedness

Health system impact of COVID-19 on selected urban slum population of Bangladesh: A rapid assessment study to support pandemic preparedness

Social and micro-economic consequences of COVID-19 pandemic among urban slum population in Chandigarh- an analytical cross-sectional study

Background: Corona virus disease-2019 (COVID-19) pandemic has disproportionately affected marginalized communities because of the loss of livelihood and lack of food, shelter, health, and basic necessities. This study assessed the socio-demographic characteristics, social and micro-economic aspect of health determinants during COVID-19 pandemic among patients attending urban health training centre (UHTC) in Indira Colony, Chandigarh. Methods: An analytical cross-sectional study conducted in urban health training centre, Indira colony. All patients aged ≥18 years attended UHTC OPD were recruited till the sample size (n=110) was achieved. By considering 95% level of significance, Kruskal Wallis test and McNemar test were applied to determine the association between different variables. Results: The mean age of the participants were 40 years and nearly 40% belong to the age category less than 30 years. In pre-COVID-19, only 5% of the participants were found to have weaker relationship with family members, however, during COVID-19 pandemic this had increased to nearly 19%. The unemployment status in pre-COVID-19 and during COVID-19 pandemic was found to be 8% and 65% respectively, which is statistically significant. Conclusions: The unprecedented COVID-19 pandemic significantly affected the social and micro-economic status of the people living in the slum area due to closure of major economic activities.

Awareness about COVID-19 vaccine, its acceptance and hesitancy among the urban slum & non-slum population of Dharavi in Mumbai, India

Awareness about COVID-19 vaccine, its acceptance and hesitancy among the urban slum & non-slum population of Dharavi in Mumbai, India