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 1.19-3.50,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.

Health Status and Access to Health Services in Indian Slums

This paper analyzes the state of health and access to health services among the urban poor in India. Analysis is based on data from a primary survey conducted among 2000 households, covering 10,929 individuals from four cities of India. Summary statistics and regressions (using STATA) are used for data analysis. Results show lack of government facilities and services, a very high preference for private health facilities, high expenses especially in private but also in public facilities, and a perception that private facilities are offering high quality services as important concerns. An econometric analysis of the determinants of acute illness indicates the insufficiency of basic amenities like sanitation, garbage disposal and potable water. Together with the lack of availability of government health facilities in the vicinity, these results indicate continued vulnerability of the urban poor, and the need for urgent government action.

Financing of sanitation services in the slums of Kampala and Dar es Salaam

This paper presents an assessment of the extent and conditions under which private financing can be a realistic approach for sanitation in slums. It is based on a cross-sectional study comparing two slum communities in East Africa, where 250 households from Bwaise III in Kampala, Uganda and 379 households from Temeke in Dar es Salaam, Tanzania were interviewed in 2010. Also, 10 key-informant interviews and 8 focus group discussions were conducted in addition to field observations. Findings show that majority (85%) of households used unimproved, private-shared pit latrines. These privately owned latrines had many structural shortfalls besides poor operation and maintenance while the public latrines provided by third-party were structurally sound but were under-utilized in residential slum neighorhoods. This is attributed to the presence free or at least cheaper alternatives which the community members preferred instead of paying per-visit user-fees. For the few who were willing to pay, willingness to pay was positively associated with the presence of a facility User committee and having been sensitized. In this context, a combination of these factors made cost recovery as well as operation and maintenance very minimal. The poor status of privately owned shared pit latrines matched the limited income levels of households. Similarly, cost recovery for public facilities was dependent on the number of users who were willing to pay: the more the users, the more the cost recovery. A combination of private and public financing is thus necessary to fund different but complementary aspects of sanitation in slums.

Pre-lacteal feeding practices among newborn in urban slums of Lucknow city UP, India

Aim: To study the Practices of Pre-lacteal feeding among Newborns in Urban slums of Lucknow city. Setting and Design: A cross-sectional study in Urban slums of Lucknow city, UP. Methods and Material: A cross-sectional study in Urban slums of Lucknow city, UP included 524 women who had a live birth during last one year preceding data collection. A pre-desined and pretested questionnaire was used for data collection. Statistical analysis used: The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 10.0 for Windows and Discrete data were analyzed using the chisquare test. Results: Study findings showed that Half (50.6%) of the mothers had given pre-lacteal feedings to their newborn. Out of those who had given pre-lacteal feed, 55.1 percent had given mugli ghutti/griipe water and 49.4 percent had given boiled water as pre-lacteal feed Only mother’s education (p < 0.01), father’s education (p < 0.001) and socioeconomic status (p < 0.05) were statistically associated with the practice of giving prelecteal feeding. Conclusion: It was concluded that maternal knowledge and awareness of correct feeding practices is essential for the normal growth, health and well being of the children. We therefore suggested that the primary focus of various nutrition related national programs in India for children should aim at imparting nutrition and health education to the mothers.

Detecting Slums from SPOT Data in Casablanca Morocco Using an Object Based Approach

Casablanca, Morocco's economic capital continues today to fight against the proliferation of informal settle- ments affecting its urban fabric illustrated especially by the slums. Actually Casablanca represents 25% of the total slums of Morocco [1]. These are the habitats of all deprived of healthy sanitary conditions and judged precarious from the perspective humanitarian and below the acceptable. The majority of the inhabi- tants of these slums are from the rural exodus with insufficient income to meet the basic needs of daily life. Faced with this situation and to eradicate these habitats, the Moroccan government has launched since 2004 an entire program to create cities without slums (C.W.S.) to resettle or relocate families. Indeed the process control and monitoring of this program requires first identifying and detecting spatial habitats. To achieve these tasks, conventional methods such as information gathering, mapping, use of databases and statistics often have shown their limits and are sometimes outdated. It is within this framework and that of the great German Morocco project “Urban agriculture as an integrative factor of development that fits our project de- tection of slums in Casablanca. The use of satellite imagery, particulary the HSR, has the advantage of providing the physical coverage of urban land but it raises the difficulty of choosing the appropriate method to apply.This paper is actually to develop new approaches based mainly on object-oriented classification of high spatial resolution satellite images for the detection of slums.This approach has been developed for mapping the urban land through by integration of several types of information (spectral, spatial, contextual ...) (Hofmann, P ., 2001, Herold et al. 2002b;Van Der Sande et al., 2003, Benz et al., 2004, Nobrega et al., 2006). In order to refine the result of classification, we applied mathematical morphology and in particular the closing filter. The data from this classification (binary image), which then will be used in a spatial data- base (ArcGIS).

Cairo＇s Slums： A Ticking Time Bomb

Despite being one of the symbols of civilization throughout human history, Greater Cairo has many slum areas, hosting a population of three million people living in deteriorating conditions and lacking the basic human necessities. These slums represent a fertile environment for diseases caused by pollution in all its forms and are subject to crimes, rape and theft. There is a huge difference in the state of conditions when comparing the formally planned areas to the informally planned ones. People living in the formally planned settlements, like Nasr City, and in informal ones, like Ezbet El-Haggana, are similar to the kings and queens and slaves of legends. This paper tries to find solutions to the problem of slums and random areas.

Sanitation in Urban Slums： Perception, Attitude and Behavior： The Case of Kibera, Nairobi-Kenya

Over 60 percent of Kenya＇s urban dwellers live in slum settlements. Here, people live under life-threatening conditions characterized with poverty, inadequate food and shelter, physical overcrowding, unsafe drinking water and poor sanitation. The flimsiness of these dwellers is not always due to low incomes. It is often the result of insecurity of tenure and other deprivations： the lack of entitlement inhibits their investment in better health. In Kibera Slum, Africa＇s second largest and Kenya＇s oldest and largest slum, poor sanitation and inadequate water supply is a daily challenge for the residents. Over 150 persons share one shallow pit latrine while 75 percent of the population uses sanitation practices that involve direct handling of human waste increasing in spread of infectious diseases. Insecurity of tenure; low levels of education; inadequate socio-economic, infrastructural and physical entitlements all affect the Kibera＇s residents＇ perception and attitude towards investing in better sanitation behavior.

Should China Develop Small Cities and Towns?

Given its national conditions,China cannot simply copy the European and American model of modernization, which was driven by industrialization. The Communist Party of China adopted a "small city and town" strategy in 1998 in recognition of the success of towns that thrived even without state investment.However,this development strategy also faces a series of challenges.China should draw on international experiences and prevent the emergence of social malaises such as slums,mafia groups and crimes that occurred in some other large developing countries with a population of above 100 million.The key to developing small cities and towns in China is to reform the ownership of rural community land and township enterprises,reform local governance structure,and balance the relationship between statutory towns and village self-governance.

Correlates of age at first birth among the slum dwellers in Sylhet,Bangladesh

The first birth marks a transition of a woman into motherhood.It contributes substantially to overall fertility of each individual woman.The age at which childbearing begins influences the number of children a woman bears throughout her whole reproductive life span.Thus,the mother's age at first birth influences the total number of births that she might have in her life,which impacts the size,composition,and future growth of the population.Child-bearing at very young ages is common among the poor in Bangladesh.The objective of the present study is to examine the factors associated with age at first birth among slum dwellers of five selected slums(locally,colony) in Sylhet city corporation area,Bangladesh.The data of this study was collected from 520 women aged 14-50 years.The study found that almost 93%of women were married by the ages of 18 years and about 56%of the women have had their first child by the age of 18 years.The Ordinary Least Squares(OLS) regression model was used to analyze the factors correlated with women's age at first birth.The regression model is significant with an F-value of 49.48 and can explain 40.4%of the variation in the dependent variable as it is indicated by the R-square.

Prevalence of <i>Helicobacter pylori</i>and hygiene practices among public secondary school students in Ikeja local government area, Lagos, Nigeria

This study determined prevalence of Helicobacter pylori and hygiene practices among public secondary school students in Ikeja Local Government Area (LGA), Lagos state, Nigeria. An institutional-based, cross-sectional study was conducted among two randomly selected secondary schools. One hundred (100) consented students participated in the study and interviews were conducted using a semi-structured questionnaire while blood samples were collected by venipuncture. Respondents’ ages were 16.1 ± 2.8 years and 54.0% were females. Mean number of persons living in a room was 7.0 ± 3.5, and however, 39.0% of the respondents lived in a room with 4 - 6 persons. The prevalence of H. pylori was 59.0% (59/100). Majority, 64.4% of those infected with H. pylori were 15 years and above while 62.7% females were tested positive to H. pylori. Some, 38.9% of the participants infected with H. pylori drink tap water while 84.7% did hand washing after visiting toilets with water and soap. Mostly, 64.0% of those tested positive to H. pylori did not experience abdominal pain in the last 4 weeks. No significant association existed between drinking water source, hand washing practice after defecation and H. pylori positivity. Routine examination of school students is required to detect Helicobacter pylori in order to commence treatment immediately and awareness about the H. pylori infection should be increased throughout secondary school to prevent further infection.

Post-displacement status of climate migrants in Rajshahi City, Bangladesh

Some big cities in Bangladesh have been experiencing a massive and rapid influx of rural people due to the impacts of climate change,and therefore the urban administration encounters enormous challenges.This study aims to investigate the drivers of climate-induced migration and the post-displacement status of the migrants living in the urban slum of Rajshahi City.Using a semi-structured questionnaire survey,this study conducted interviews with 50 migrants residing in two slums in Rajshahi City.An interpretive phenomenological analysis(IPA)approach was implemented to evaluate the survey data.This study finds that food insecurity and flood are the two significant climate drivers of migration.Among the non-climate drivers,lack of alternative livelihood is the major reason.It should be noticed that the climate migrants in many cases do not get the opportunity to improve their living standards;they are usually occupied with low-pay professions like maid,van and rickshaw puller,and scrap collector.The study also reveals that migrants,especially females and children,need several basic physiological,economic,social,and health services.Most children have no chance to attend school.Compared to males,females have more opportunities for some support and allowances.Overall,an inadequate level of change has taken place in the lives of migrants,which raises the concern if migration is ever a way to resolve a problem or the beginning of many other problems.Further research may concentrate on the impact of migration on the dynamics of social capital among slum dwellers.

Perceptions on Public Health Facilities by Slum Dwellers in the Metropolitan Cities of India

Rapid urbanisation and quest for better livelihood, push-pull factor of occupations education, policy changes attract large scale rural population to urban areas. It is well documented that in spite of better public health facilities including tertiary care hospitals which are available in the urban areas but the services are underutilised by the urban poor. Aim: Hence, in this paper, it is attempted to comprehend the reasons for underutilisation of available public health facilities and to compare the difference with non-slum areas of the major metropolitan cities of India. Methods: A secondary data from National Family Health Survey-III for five major metropolitan cities namely, Delhi, Hyderabad, Mumbai, Kolkata and Chennai is used for the analysis. Slum data which are classified by both the agencies, that is census of India and NFHS-III as slum households only considered for analysis. Results: In Mumbai slums about 90% of the households are having water sources from public tap or piped to yard followed by Hyderabad having better water supply and Chennai slum dwellers having minimum access to good water sources. About 11.4% of the households do not know where their toilet drainage is connected. There is a significant (P 0.05) 75% to 79%, Kolkata and Chennai have parallel high proportion, that is more than 95% (P > 0.05) and Mumbai stands as median percent age as 89.6. Apart from Delhi, about 40% to 45% of the slum population is in the opinion of “long waiting time” in the government hospitals, and the same trend of proportions is observed for “poor quality of service”.

Development of a cervical cancer screening program in a slum setting using visual inspection with acetic acid: Analysis of feasibility and cost

Objective: In Bangladesh, cervical cancer is the second most common cause of cancer deaths in women. Annually, over 50 million women are at risk for cervical cancer, with 17,686 cases diagnosed and 10,362 deaths each year. Visual inspection with acetic acid (VIA) is a well validated tool in low resource areas for identifying cervical lesions. In this pilot study, AK Khan Health Care Trust (AKKHCT), in collaboration with oncologists at Massachusetts General Hospital (LB, BD, AG), launched a VIA cervical cancer-screening program. Methods: A clinic was established in the Korail Slum of Dhaka, a 90-acre slum with over 70,000 inhabitants, in the summer of 2011. From September 17, 2011 to November 1, 2011, ten women living in the Korail Slum were recruited and completed the three-month training program to learn how to do a pelvic examination and to evaluate the cervix using VIA. Three of the ten women performed VIA screening during the study period. Results: 44 patients were recruited and 8 women were identified to have VIA-positive results for a screen-positive rate of 18.2%. Two of the eight women underwent treatment. One woman underwent an excisional procedure for pre-invasive disease in the slum clinic. The other woman had an early invasive cervical cancer and was successfully treated in a local hospital. Conclusion: Our pilot project demonstrates some important factors in developing and implementing a successful screening program. Involving laywomen as healthcare workers provides a strong tie to community, as well as education, economic independence, and empowerment for women who would otherwise occupy a lower social standing in their community. VIA is feasible in the complicated environment of an inner city slum. It was feasible to perform minor excisional procedures to treat pre-invasive cervical disease in the slum clinic.

Direct and Indirect Effects of Socioeconomic Factors on Age at First Marriage in Slum Areas,Bangladesh

This article attempts to examine the influence of some selected predictor variables on female age at first marriage in slum areas of Bangladesh.A path and multiple classification analysis(MCA) approach have been adopted.Authors thought that respondent's educational level and the mass media such as watching television have a significant direct impact on age at marriage,while the types of family and occupational status have an indirect effect on age at marriage.

Sustainable Urban Restructuring of Khartoum： A Revolutionary Measure for Rapid Growth Absorption and Urban Changes

Rapidly developing cities are under continuous physical and social changes which make sustainable urban growth concept a matured line of thinking. They are therefore, in need of restructuring to contain these changes. Likewise, Khartoum is growing rapidly and is subjected to continual transformation. It started in Independence Day （1/1/1956） by 〈3% of Sudan population and reached 16.8% in 2010 while its physical block grew beyond imagination. The objective of this paper is to throw light on Khartoum rapid growth change effects which necessitated implementation of a revolutionary restructuring programme. At first, huge rural influxes were absorbed and later physical distortions were corrected. This included squatter settlements＇ treatment to strengthen urban fabric, reallocation of incompatible urban functions, revitalization of the CBD （central business district） and other urban renewal schemes. Transportation lines were extended to ease people mobility and higher population concentrations were diluted, particularly the filthy slums. Old neighbourhoods, traditional villages, etc. were re-planned and popular physical development was encouraged. The restructuring programme appropriated population distribution, administrative districts, new local markets＇ locations and urban activities＇ distribution. The programme attained social benefits, particularly availing shelter and essential social services. Difficulties from relocation processes were encountered but settlements＇ regularization achieved social justice and sustained urban growth.

Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh

Background: Until recently, the experience on implementing community based management of acute malnutrition (CMAM) among children has been largely based in African settings. While the government in Bangladesh is yet to scale up CMAM approach, there is still paucity of knowledge on the experience of CMAM within the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka, Bangladesh, this paper describes a CMAM programme performance and outcomes run by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme data of children admitted with severe acute malnutrition between May 2010 and November 2011. Kamrangirchar is an urban slum of a large migrant population in Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of whom 333 (52%) were males. The median age was 18 months (Inter-quartile range (IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of 69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5% reported to the programme that they will leave the slum and go back to their villages. These performance indicators did not meet the threshold level indicators set by MSF and Sphere standards. Conclusions: Our experience highlights the need for developing more adapted and contextualised indicators for assessing the performance of CMAM programmes in settings such as urban slums. Community engagement in the process of developing relevant standards is crucial. Nutrition humanitarian actors have a vital role to collaborate with local authorities to contextualize and refine these standards.

Health Risk Assessment on Selected Essential and Non-Essential Elements in Food Crops Grown in Kibera Slum, Nairobi-Kenya

Peri-urban agriculture of food crops is practiced in many slum areas in developing countries. This often uses waste water whose levels of essential and non-essential elements are largely unknown but would be feared to contaminate soils, consequently exposing man to associated health risks. Inhabitants in Kibera slum, Nairobi City practice these growing kales, amaranthus, arrowroots, and spinach. Health risk assessment was done using daily intake of metals (DIM), target hazard quotient (THQ) and incremental lifetime cancer risk (ILCR). Atomic absorption spectroscopy was employed for elemental analysis. The levels of essential elements ranged as follows;Mn 91.04 - 374.44, Mg 261.28 - 532.96, Fe 350.74 - 1273.68, and Zn 1.18 - 6.3 μg/g per dry weight were found to be below the recommended limits by FAO/WHO. Non-essential elements ranged as follows;Cr 1.15 - 4.32 and Pb 0.14 - 0.91 μg/g above the EU recommendation. DIM of Fe 5.81 - 27.61 and Mn 1.97 - 8.12 μg/g is above the recommended daily intake amounts. THQ values for Mn and Fe were more than unit. THQ values for non-essential elements were generally below unit. ILCR showed that from lead alone 73 people (0.043% of 0.17M residents) are likely to develop cancer. There are foreseen health risks associated with consumption of food crops grown in Kibera slum that requires immediate address.

Public-Private Partnership Arrangement in <i>In-Situ</i>Housing for Slum Rehabilitation in Yenagoa, Bayelsa State, Nigeria

The provision of decent accommodation is a major challenge to government in the developing nations. It is a common phenomenon in the urban centres of the developing nations where most houses are in deplorable conditions. The houses are overcrowded with little or no air space between them. There is no basic sanitation in the urban centres as they lack flush toilet, some of the few available flush toilets are piped into seasonal streams, most houses lack defined kitchen areas and healthy sewage disposal method. The cities lack good access roads and functional drainage system with a common practice of environmentally-unfriendly solid waste management methods that create various health challenges to urban dwellers. The aim of the study is to show how in-situ Housing method of slum rehabilitation can be applied through Public/Private Partnership to upgrade houses within a major slum area in Yenagoa. This shall be done with an agreement between the property owners, Real Estate investors and the state government. Basic Research Methodology was applied using questionnaire, direct observation and personal interview techniques to collect data. Both qualitative and quantitative techniques were applied to analyse data through the use of tables and charts. The findings in the study showed that poor housing condition seriously degrade the environmental quality of the study area. The standard of living in the area is very poor as the people lack access to decent accommodation, basic sanitation and social amenities.

An Assessment of Comprehensive Knowledge of HIV/AIDS among Slum and Non-Slum Populations in Delhi, India

In order to design appropriate HIV prevention programs, it is important to examine the perception and knowledge of HIV/AIDS and methods of preventive. This article explores comprehensive knowledge of HIV/AIDS prevention methods among women and men in slum and non-slum areas in the National Capital Territory of Delhi, India. Data were drawn from the National Family Health Survey, 2005-06 (NFHS-3). The sample included 3096 women aged 15 - 49 years and 1321 men aged 15 - 54 years. Pearson Chi-square test and logistic regression analyses were conducted to examine the association between the study variables and the background characteristics of the slum and non-slum populations. Comprehensive knowledge of HIV/AIDS prevention methods was significantly lower among women and men in slum areas as compared with non-slum areas. Compared to men, women had less comprehensive knowledge of HIV/AIDS prevention methods in slum and non-slum areas, even after controlling for various demographic and socio-economic and exposure variables. Findings indicate that comprehensive knowledge of HIV prevention methods is low among women in slum areas. Interventions are needed to build knowledge of HIV transmission and prevention methods in this vulnerable group. Strategies to build awareness of HIV/AIDS could include mass media campaigns HIV/AIDS, and information, education and communication programs (IEC) on HIV/AIDS in slum areas.

Multiple Sexual Partners and Vulnerability to HIV: A Study of Patterns of Sexual Behaviour in the Slum Population of India

Globally, research indicates that monogamous married women living in slums are at heightened risk of HIV men’s risky sexual behaviour. Hence, to reduce the risk of HIV transmission, there is need to understand the number, nature and variation in transition of sexual partners of men in living in slums. This paper uses India’s National Family Health Survey-3 data to estimate the variation in the type of sexual partners among sexually active men age 15 - 54 with more than one sexual partner in last 12 months prior to the survey in eight slums?of India. Among sexually active men, 1.3 percent reported having more than one sexual partner in the last 12 months prior to the survey. Men who are more likely to have two or more partners are those who are young, especially below age 25 years, never married, educated up to 5 years, and from middle class. There is a higher increase in the probability of sex with spouse from second last to the last sexual partner in non-slum areas than slum areas. However, in case of transition from other friends/relatives and female sex workers to spousal partners, there is a major decline in probability among non-slum men than slum men. These transitions are extremely important from the perspective of curbing the spread of HIV epidemic, especially in situations where women lack control over their own sexuality and seldom use condom in marital sex. Therefore, strategies focused in slums should either consider reducing men’s risky sexual behaviour or build capacities of women to negotiate safe sex in marital relationships or consider a combination of both.