Urban Slum Of Delhi Research Articles

Abstract: Singh Arvind Kumar, Mani Kalaivani, Krishnan Anand, Aggarwal Praveen and Gupta Sanjeev Kumar. Prevalence, Awareness, Treatment and Control of Diabetes among Elderly Persons in an Urban Slum of Delhi. Indian Journal of Community Medicine, 2012; 37

Abstract: <b>Singh Arvind Kumar, Mani Kalaivani, Krishnan Anand, Aggarwal Praveen and Gupta Sanjeev Kumar</b>. Prevalence, Awareness, Treatment and Control of Diabetes among Elderly Persons in an Urban Slum of Delhi. <i>Indian Journal of Community Medicine</i>, 2012; <i>37</i>

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

Role of Inter Personal Communication in Infant and Young Child Feeding Practices in an Urban Slum: An Overview Based on Case Studies

In India, child malnutrition is prevalent, especially among the poor and vulnerable. It is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding and caring practices, and it sets in mostly during the first 2 to 3y of life. Therefore, the present study was done to assess the role of inter personal communication in influencing the infant and young child feeding practices of mothers in an urban slum of Delhi. Case study method was used to document the practices of mothers residing in an urban slum of Delhi, for infant and young child feeding. In most of the cases, it was observed that full potential of health system contact of beneficiary was not utilized for providing appropriate Inter Personal Communication (IPC). It was not able to make proper use of the opportunity to create awareness on nutrition issues, change norms and practices, and persuade mothers/families to make positive behavior change. IPC was not effective, as it was not personalized as per patient's educational level and ability to understand technical information. Though IPC component was better for immunization services, it was weakest for nutrition in case of children younger than 2y. ICDS program implementation lays more emphasis on food supplementation than on nutrition and health education interventions. Thus, role of IPC should be increased manifold to inculcate appropriate feeding practices among mothers to improve nutrition in these children. Health and nutrition messages need to reach every household repeatedly through multiple complementary sources to bring desired behavior-change in the community.

Type-Specific Incidence and Persistence of HPV Infection among Young Women: A Prospective Study in North India

Infections with human papillomavirus (HPV) are highly prevalent among sexually active young women in India. However, not much is known about the incidence of type-specific human papillomavirus (HPV) infections and their patterns of persistence, especially in the Indian context. The objective of this study was to evaluate the rate of acquisition and persistence of HPV types in young women. Women residing in an urban slum in Delhi (n=1300) were followed for 24 months at 6 monthly intervals. Exfoliated cervical cells collected at each visit were tested for the presence of HPV DNA. Genotyping was performed using the reverse line blot assay. The incidence rate for any HPV type was calculated to be 5 per 1000 women-months. Among high risk HPV types, HPV16 had the highest incidence rate followed by HPV59, HPV52 and HPV18, i.e., 3.0, 0.58, 0.41 and 0.35 women per 1000 women-months respectively. The persistence rate was higher for high-risk than low-risk HPV types. Among low-risk types, HPV42, HPV62, HPV84 and HPV89 were found to persist. Whereas almost all high risk types showed persistence, the highest rate was found in women with HPV types 16, 45, 67, 31, 51 and 59. The persistence rate for HPV16 infection was 45 per 1000 women-months. Incident HPV infections and high risk HPV type-specific persistence were found to be high in our study population of young married women. Understanding the patterns of HPV infection may help plan appropriate strategies for prevention programs including vaccination and screening.

Women’s perception about sex selection in an urban slum in Delhi

Background: A strong son preference has been the norm in most of Asian countries. Modern sex-selection1 technology (although illegal in India) along with traditional methods have led to a skewed sex ratio. Methods: This study attempts to explore slum-dwelling women’s perception regarding the use of sex-selection techniques, both traditional and modern. Forty-two women from three different groups (adolescent, adult and elderly) participated in seven focus group discussions. Thematic analysis using interpretive framework identified five themes; that is, ‘Preference for male child’, ‘Acceptance of female foeticide’, ‘Awareness and impact of declining sex ratio’, ‘Awareness of methods of sex detection and selection’ and ‘Awareness of the law’ related to sex selection. Results: One-third of the participants expressed a preference for sons compared to daughters and only half perceived female foeticide as undesirable. The majority were aware of one or more method for sex detection and selection; however, less than half of the participants were aware that sex detection and selection is illegal. Five adolescent girls admitted to sex selection in their families. Conclusion: There is a continued use of sex selection and detection methods including the use of traditional medicines in slums.

Prevalence, Awareness, Treatment and Control of Diabetes Among Elderly Persons in an Urban Slum of Delhi

Background:The increasing proportion of elderly persons is contributing to an increase in the prevalence of diabetes. The residents of urban slums are more vulnerable due to poverty and lack of access to health care.Objective:To estimate the prevalence of diabetes in elderly persons in an urban slum and to assess their awareness, treatment and control of this condition.Materials and Methods:All persons aged 60 years and above, residing in an urban slum of Delhi, were included in this cross-sectional community- based study. Data were collected on sociodemographic variables. The participants’ awareness and treatment of diabetes was recorded. Their fasting blood sugar was estimated using an automated glucometer. Diabetes was diagnosed if fasting blood glucose was ≥126 mg/dL, or if the participant was taking treatment for diabetes. Impaired fasting blood glucose was diagnosed if fasting blood glucose was 110–125 mg/dL.Results:Among the 474 participants studied, the prevalence of diabetes was estimated to be 18.8% (95% CI 15.3–21.5). It decreased with increasing age, and was higher among women. The prevalence of impaired fasting blood glucose was 19.8% (95% CI 16.3–23.7). It was higher among women. One-third of the diabetic participants were aware of their condition; two-thirds of these were on treatment and three-fourths of those on treatment had controlled fasting blood sugar level. The awareness, treatment and control were better among women.Conclusions:Diabetes is common among elderly persons in urban slums. Its magnitude and low awareness warrant effective public health interventions for their treatment and control.

Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India

Tobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of Indian adolescents, especially those from low socio-economic communities. Research in two phases was undertaken among economically disadvantaged adolescents in two urban slums of Delhi. In phase I, qualitative research methods such as focus group discussions and in-depth interviews were used to explore and understand the determinants influencing tobacco use among these adolescents. Prevalence of tobacco use was higher among boys than girls. Adolescents reported using tobacco in multiple forms, chewing tobacco being the most popular. Peer pressure, easy availability and affordability were important reasons associated with tobacco initiation and continued use. Though they had some knowledge about the harmful effects of tobacco, this was not sufficient to motivate them to abstain or quit. The community-based intervention model developed on the basis of the results of phase I was evaluated in phase II in a demonstration study with two slum communities. One was treated as the intervention and the other as control. A significant difference in current use of tobacco was observed between the study groups (p = 0.048), with the intervention group showing a reduction in use, compared with an increase in use among the control group. Post-intervention, the intervention group reported significantly lower fresh uptake (0.3%) of tobacco use compared with the control group (1.7%). No significant change was found for quit rate (p = 0.282) in the two groups. Community-based interventions can be effective in preventing adolescents from initiating tobacco use in a low-resource setting such as India.

Prevalence of human papillomavirus infection among young women in North India

Background: The number of women infected with human papillomavirus (HPV) and the distribution of the HPV genotypes vary across populations and with age. Objective: To determine the prevalence and genotype distribution of HPV in young married women aged 16–24 years. Methods: 1300 women residing in an urban slum in Delhi donated samples of exfoliated cervical cells that were collected by the Digene ® kit and tested for the presence of HPV DNA by two techniques in parallel, i.e., PCR using PGMY consensus primers for all HPV types and the Digene HPV test (Hybrid Capture 2 (HC2) Probe B for high-risk (hr) types. Genotyping was done on all HPV positive samples using the Roche reverse line blot assay. Results: HPV infection was detected in 91/1300 (7%) samples by PCR and 110/1300 (8.4%) samples by HC2. Genotyping identified 20 high-risk and 11 low-risk types. HPV16 was the commonest high-risk type (3%) followed by HPV52 (1.2%) and HPV51 (0.8%). Among low-risk types, HPV62 was the commonest (0.8%), followed by HPV84 and HPV89 (0.5% each). Multiple infections were found in 3% of the HPV positive samples. Conclusion: A wide spectrum of HPV genotypes is seen in this young population. Knowledge about HPV types prevalent in communities in different regions of India would be useful in devising the optimum strategy for cervical cancer prevention.

Seasonal Variation of Blood Pressure in Normotensive Females Aged 18 to 40 Years in an Urban Slum of Delhi, India

Season is one of the factors affecting blood pressure. The objectives of this study are to quantify the magnitude of seasonal changes in blood pressure among normotensive women aged 18 to 40 years and to find out the association of blood pressure variation between winter and summer with body mass index, temperature, humidity, day length, and salt intake. The study was carried out on 132 women, included 4 home visits during the seasons of spring, summer, autumn, and winter. Mean increase in systolic blood pressure (SBP)/diastolic blood pressure (DBP) in winter was 11.07/6.79 mm Hg during summer (P < .001). No significant relationship in blood pressure variation with change in environmental variables was observed. Mean increase in SBP/DBP in winter was more among underweight than individuals who were normal/overweight/obese (P < .05). There was significant increase in SBP/DBP during winter compared with summer. This seasonal factor should be considered while evaluating individual blood pressure and comparing community studies.

Awareness about birth registration in a resettlement colony of Delhi

The UN Convention on the Rights of the Child is more than a decade old, but even today more than a third of all children are denied the right to an identity. Birth registration is the first legal document in which the name of the child gets entered along with the name of the parents. Globally, every year about 40 million children are born without being registered. Six out of ten unregistered newborns are in South and South-east Asia.(1) The registration of births and deaths in India was made compulsory under the Registration of Births and Deaths (RBD) Act, 1969. However, the current level of birth registration in India is 63.8% as per the latest 2005 provisional national estimates, which means that out of the estimated 26 million births taking place each year, approximately 9.4 million children (36.2%) go unregistered every year.(2) Taking these facts into consideration, this study was planned to assess the awareness about birth registration in an urban slum of Delhi.

Indoor air quality assessment in and around urban slums of Delhi city, India

The present study aims at investigating the indoor air quality (IAQ) in selected households in one of the urban slums i.e. the Nizamuddin slums in Delhi, the capital city of India. The study includes investigations and assessments on associated health effects on the occupants living in inefficiently designed houses having poor ventilation. The monitoring of indoor air pollutants e.g. the respirable suspended particulate matter (RSPM), the carbon dioxide (CO2), the carbon monoxide (CO), the sulphur dioxide (SO2) and the nitrogen dioxide (NO2) for all three seasons i.e. summer (April-June 2004), rainy (July-September 2004) and winter (December 2004-February 2005) have been conducted. In addition, the spirometry tests on the occupants, particularly the womenfolk and children have been performed to determine the incidence of acute respiratory infections (ARI). Questionnaire survey has also been conducted in the households during the study period to investigate the sick building syndrome (SBS). The study reveals maximum concentration of indoor air pollutants in households during winters (December 2004-February 2005) associated with aggravated respiratory problems like cough, phlegm, wheezing, and breathlessness among occupants particularly the women occupants. Besides, decrement in lung function indices (i.e. FVC and/or FEV1) due to increased concentrations of RSPM and CO2 indoors during winter period has also been observed in the women respondents. The study concludes that women and children indoors are most vulnerable to respiratory problems compared to other sexes. A high SBS score is observed in these 'urban poor' households because of inadequate ventilation. 'High indoor airborne pollutants during winter are associated with respiratory problems for women and children in houses in urban slum in Delhi. The work demonstrated the need of further studies of indoor air quality for the 'urban poor' in developing countries.'

Role of reorientation training in enhancement of the knowledge regarding growth monitoring activities by Anganwadi workers in urban slums of Delhi

Early childhood developments constitute the foundation of the human development. Early years of the life are the most crucial period for the physical, mental, social, emotional, language development and lifelong learning. In a malnourished child, development of the milestones is delayed. Developmental delays are mainly observed in the areas like vision and fine motors, language and comprehension and personal social development. The delay was noticed to the extent of 7-11 months in these areas in different age groups.(1) In urban areas, nutritional status of the slum children is poorer than their counterparts in the rural areas.(2) Two-third of the preschool children in the urban slum are underweight. According to NFHS-2 of Delhi, 35% of children under 3 years of age are underweight and 37% are stunted.(3) Anaemia is the most frequent malnutrition among the children from the slum community.(4) ICDS scheme, in such scenario of health, occupies a significant place as an intervention in the socially and economically disadvantaged class of the society. The effective outcome of the nutrition services rendered through the Anganwadi centers (AWCs) depends on the knowledge of the anganwadi workers (AWWs) regarding growth monitoring (GM). A sound knowledge of the AWWs strengthens their skills and raises their capabilities to identify the children earliest moving towards malnutrition with the help of regular GM so as to take appropriate and early corrective action for further departure from good health. It also helps them as a teaching tool for empowering the mothers for preventive actions and better nutrition care of their children. Therefore, attempt has been made to discuss knowledge of AWWs about GM activities and the influence of reorientation training on their correct knowledge.

Correlates of the immunization status of children in an urban slum of Delhi

Background: This was a community-based, observational, cross-sectional study to determine the immunization status of children living in slums in the 26 blocks of Sangam Vihar and 4 blocks of Tigri extension area of South Delhi, India. Study Population: A total of 210 children between 12 and 23 months old. Sampling Technique: 30 cluster technique approved by the World Health Organization. Primary Outcome Measures: Immunization coverage by sex, religion, type of family, occupational status of the head of the family, stated average monthly family income, and education status of the mothers. Data collection procedure: Interview technique; principal investigator Dr. Imteyaz Ahmad collected the data using a standardized structured interview schedule with the mother/caregivers of children 12 to 23 months old after permission to conduct the study was taken from the civic authority of the local government. Record analysis of antenatal care for tetanus immunization by antenatal cards and BCG scar survey by observation of scar arm in the deltoid region for scar was also done by him. Results: One hundred and six (50.4%) children in our sample were found to be fully immunized, 88(41.9%) partially immunized and 16 (7.6%) were not immunized. Amongst these associations the difference of coverage by occupation groups and mothers education were found to be statistically significant. Conclusion: There was a discernable bias in favour of male children, Hindu children, children of nuclear family, children of non manual labour occupation parents, children from higher income family and children with mothers having high school or higher level education.

Screening for psychosocial development among infants in an urban slum of Delhi

Psychosocial developmental screening of the infants in an urban slum of Delhi and studying the factors influencing the development. In this cross-sectional study 202 infants and their mothers were included. Psychosocial Development Screening Test developed by Indian Council of Medical Research was used to asses the development status of infants, and the mothers were interviewed for socio-demographic details Infants who achieved milestones in time were 92.5% for personal skills, 91.8% for hearing language and concept development and 90.6% for gross motor milestones, respectively. These percentages were lower for Vision and fine motor (88.6) and social skills (81.4). Sex of the infant and socioeconomic status of their families significantly influences the few domains of development. Other factors like age of the infant, literacy of their mothers were not significantly influencing the development of infants. The objective evaluation and screening for psychosocial development of infants living tin urban slums is necessary for early detection and intervention.

Prevalence of reproductive morbidity amongst males in an urban slum of north India

Studies assessing the prevalence of reproductive morbidity among males in India have chiefly focused on prevalence of Reproductive Tract Infections/Sexually Transmitted Infections (RTIs/STIs) among males attending Sexually Transmitted Disease clinics blood donors and other selected population groups with only few focused on the magnitude and the type of reproductive morbidity amongst Indian males at community level. The objective was to estimate prevalence of reproductive morbidity including (RTIs/STIs) among males in the age group of 20-50 years residing in an urban slum of Delhi. Out of 268 males in the targeted age group selected by systematic random sampling residing in an urban sum of Delhi 260 males were subjected to clinical examination and laboratory investigations for diagnosis of reproductive morbidity. Laboratory investigations were done for diagnosis of Hepatitis B and C Syphilis Gonorrhoea Non gonococcal urethritis and urinary tract infection. A total of 90 (33.6%) of 268 study subjects reported one or more perceived symptoms of reproductive tract / sexual morbidity in last six months. Overall reproductive morbidity based on clinical and laboratory diagnosis was present in 76 (29.2%) study subjects and of this sexually acquired morbidity accounted for 21.2% cases. Hepatitis B was most common (10.3%) reproductive morbidity followed by Urinary Tract Infection (5.0%) scabies (3.5%) and congenital anomalies (3.5%). High prevalence of reproductive morbidity (29.2%) amongst males in an urban slum highlights the need for more studies in different settings. There is a need for developing interventions in terms of early diagnosis and treatment and prevention. (authors)

Maternal health-care utilization among women in an urban slum in Delhi

Maternal mortality and morbidity continue to be high despite the existence of national programs for improving maternal and child health in India. This could be related to several factors an important one being non-utilization or under-utilization of maternal health-care services especially amongst the rural poor and urban slum population due to either lack of awareness or access to health-care services. Understanding of the knowledge and practices of the community regarding maternity care during pregnancy delivery and postnatal period is required for program implementation. Therefore the present study was carried out to evaluate the sociodemographic correlates and barriers of maternal healthcare utilization amongst married women aged 15-45 years living in a slum in Delhi. (excerpt)

A cross-sectional study of the association of postnatal growth and psychosocial development of the infants in an urban slum of Delhi

Rapid growth of urban slums due to alarmingly increasing urbanization is adversely affecting the growth and development of infants residing in such deprived areas. The objectives were to study the association of postnatal growth and psychosocial development of urban slum infants. 202 infants and their mothers were included in a cross-sectional study conducted in Raja bazaar in 2002. Growth was assessed using anthropometric measurements: weight and length for age and development by psychosocial developmental scale developed by ICMR. Development was delayed in significantly higher percentage of underweight (W/A<-2 S.D) than normal infants (p value <0.05): gross motor (15.3% & 4.5%) Vision &fine motor (21.1% 4.6%) and social skills (27.6% 12.1%). Development of gross motor milestones was also delayed in significantly high percentage of stunted infants with L/A<-2S.D (22.2%) compared to normal L/A (5.6% p value=0.003). Difference in the percentages of infants was significantly very high (p value0.000) for vision & fine motor (27.5% & 6.9 ) hearing language and concept development (22.5 & 4.2%) and social skills (42.5% & 11.9%). Interventions to improve the postnatal growth will be helpful in facilitating the psychosocial development of infants living in urban slums. (authors)

Prevalence and awareness about sexually transmitted infections among males in urban slums of Delhi

India is at present facing an emergence of sexually transmitted infections (STIs) and human immunodeficiency virus. Community-based studies on the prevalence of STIs among males are scanty. (i) To study the prevalence of STIs and (ii) to assess the level of awareness about STIs among males belonging to the reproductive age group residing in an urban slum. This is a cross-sectional study conducted in selected areas of Delhi, using a camp approach. One hundred ninety-six males in the reproductive age group were interviewed regarding their awareness about STIs, past history and present complaints of any symptoms suggestive of an STI. This was followed by a clinical examination. Required samples were also collected for microbiological tests. Simple proportions and Chi-square test. As many as 70% of the study participants were unable to mention even one symptom of an STI. About 73.4% of the study participants stated that staying in a monogamous relationship could help prevent STI, while only 39.2% were aware that condoms could afford protection against an STI. As many as 8.7% complained of urethral discharge, while 5.6% complained of itching, 2.5% reported presence of genital ulcer and 1.0% complained of groin swelling. We found a seroprevalence rate of 1.5% for trichomoniasis and 3.6% for syphilis. Thus the overall awareness level about STIs and their prevention was rather low. Poor treatment-seeking behavior was also observed. The actual prevalence rate in the general population might be higher due to the likelihood of presence of an asymptomatic infection. The present study calls for a multipronged approach which also includes targeted interventions and strategies to be adopted in the reproductive health programs for males who have been neglected by the program managers so far.

Newborn care practices in an urban slum of Delhi

Despite efforts by government and other agencies, neonatal morbidity and mortality continues to be high in India. Among other reasons, newborn care practices are major contributors for such high rates. To find out the newborn care practices including delivery practices, immediate care given after birth and breast-feeding practices in an urban slum of Delhi. Community based, cross-sectional survey in a resettlement colony (a type of urban slum). Semi-structured, pre-tested schedule was used to interview 82 mothers of newborns in the study area. Data was analyzed using Epi - info version 6.04. Fischer exact test and chi2 test were applied. A P value of less than 0.05 was considered significant. More than half i.e. 26 (56.1%) of home deliveries, which were mostly conducted by dais (24, 91.3%) or relatives in 4 (8.7%) of home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6%) of home deliveries. Finger was used to clean the air passage in most of the home deliveries (29, 63%). About 61% (28) of home delivered newborns were not weighed at birth. Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were given injection tetanus toxoid by unqualified practitioners. Use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care.

Determinants of Reasons of School Drop-outs Amongst Dwellers of an Urban Slum of Delhi

Determinants of Reasons of School Drop-outs Amongst Dwellers of an Urban Slum of Delhi