Vulnerability To Health in A Ward of Bengaluru: Insights from A Mobile-Based Survey

Context/Background: Rapid urbanization has resulted in a growing number of people living in under-served areas with inadequate and overburdened infrastructure and services, worsening of environmen-tal factors. Sustainable Development Goal 11: “sustainable cities and communities”, highlights, there is an urgent need to re-orient the community development strategies by adopting economically & techno-logically sustainable models. Aims/Objectives: An application-based household survey to assess the vulnerability and Health condi-tions among the urban poor of slums in Bengaluru. Methodology: The tool for Vulnerability Assessment by Government of India was modified to develop a user-friendly tool for Community Health Workers in an Android–based smartphone application (Namma Samudaya). Data was collected through house-to-house survey. Results: A total of 3165 households (HHs) were surveyed. Among these, 54.2% of the HHs belong to vulnerable category and 45.8% to highly vulnerable group. Conclusions: Domain-wise analysis showed, Residential -25.2% of HHs were located besides polluted water Social - “No social support” and “disability” was reported by 3% of households each; Health-Related - Catastrophic Health expenditure in the past 1 year was reported by 40.4% HHs. The baseline information of slums & their geographic mapping obtained during the survey can be used as foundation for effective planning of health care services.

Caring and witnessing in an urban poor community through engaged ethnography amidst the COVID19 pandemic

@#In this paper, I reflect on caring and witnessing through engaged ethnography of an urban poor community during the onset of the COVID19 pandemic. The urban poor are individuals and families who live below the poverty line in metropolitan areas, many of whom have little or no political voice and are insufficiently protected by social networks and other institutions. In March 2020, the government placed Metro Manila under Enhanced Community Quarantine to control the spread of COVID19. This left many an urban poor community in Metro Manila to struggle even more against an already precarious existence. By standard, nurses render different levels of care for urban poor clients in almost all health care settings. In public health nursing, we come in close contact to the realities of our clients when we see them in health centers, in the community, or whenever we do our home visits. Now, caring for vulnerable and marginalized groups such as the urban poor has changed due to minimum public health standards of wearing masks, physical distancing, handwashing, and enforcement of lockdowns. As a nurse, an academic, and as a student of anthropology, I came up for self-review while doing an article for a popular social news network derived from a virtually engaged ethnography. While this novel method requires you to see the world through the eyes of the “other,” and generates bioethical dialogue and awareness of personal biases in addressing ethical considerations and challenges, it gives voice and fulfills our roles as client advocates. In May 2020, the article was published with the urban poor organization and its partners as my coauthors. I borrowed from anthropology to arrive at a greater understanding of the socio-cultural effects and political implications of COVID19 to one of the most vulnerable nursing clientele – the urban poor.

The Effect of Health Education on Blood Pressure in an Urban Poor Community

@#The objective of the study was to evaluate the effect of cardiovascular health education on change in blood pressure at 3, 6, 12, and 18 months follow-up. This was a prospective cohort study. Participants were from an urban poor community in Metro Manila. Included were the 98 adults at least 40 years of age with hypertension, without cardiovascular disease. Among those previously diagnosed with hypertension, 20.3% had controlled blood pressures at the time of screening. There were 29.6% newly diagnosed cases of hypertension in the study. During the 18-month intervention phase, cardiovascular disease health education and counseling on risk factor control were given along with medical check-ups. Systolic and diastolic blood pressures were measured at 3, 6, 12, and 18 months. The decreases in mean systolic blood pressures from the baseline at 3, 6, 12 and 18 months were 11.9, 15.2, 9.1, and 14.1-mm Hg, respectively. The diastolic blood pressures decreased by 6.9, 9.3,.4.6, and 4.4 mm Hg. These differences were statistically significant. For the urban poor, health education on risk factor modification and cardiovascular diseases can be an important tool in improving blood pressure.

Personal hygiene practices and related skin diseases among primary school children of urban poor locality

Background: Government of India has launched ‘Swachh Bharat Swachh Vidyalaya’ initiative in 2014, with emphasis on promoting safe and hygiene practices among school children. Providing easy access to hygiene and health education regarding personal hygiene is a simple and cost effective tool for prevention and control of hygiene related health problems including skin diseases. Objectives of the study were to assess the personal hygiene practices of primary school children and to find out the skin diseases related to personal hygiene practices.Methods: The study was conducted among 12 primary schools in an urban poor locality. The availability of hygiene facilities in all the schools was noted. The hygiene practices among the children were collected using pre-designed, semi-structured proforma and clinical examination was done to find out skin diseases among them. Subsequently, all school children were given health education regarding correct hygiene practices. The data was analysed using mean, percentages and Chi-square test.Results: The study included 1404 students. Among them 40.7% took bath daily, 53.7% wore washed undergarments, uniform and socks daily, 56.5% had trimmed nails and 76.7% washed hands with soap and water before eating and after using toilet. On examination, 475 (33.8%) had skin diseases like pityriasis alba (13.2%), pediculosis capitis (12.3%), pyoderma (4.6%) and others. There was significant association between skin diseases and hygiene practices (p<0.001).Conclusions: Improper hygiene practices were associated with skin diseases. Therefore, regular social and behavioural change communication activities on hygiene practices has to be imparted for school children to prevent related skin diseases.

Urban health: Needs urgent attention

Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.

The Infant Feeding Practices Among The Lactating Mothers Of Mansa Devi Area Located In Panchkula, Haryana.

Background: Malnutrition has been responsible for 60% of the 10.9 million deaths annually among children under five. 2/3 of these deaths are associated with inappropriate infant feeding practices. The nutritional status of slum children is even poorer than the rural average. Objective:To assess the infant feeding practices among the lactating mothers of Mansa Devi area located in Panchkula, Haryana. Methodology: Cross-sectional study among mothers of child up to one year of age was carried in Mansa Devi area located in Panchkula, Haryana. 76 mothers between 18 to 40 years were interviewed by predesigned and pretested questionnaire. Results and Conclusion: 92.1% infants were breast fed. 61.8% were exclusively breast fed. 10.5% infants had birth ghutti. Knowledge of breastfeeding (78.9%) , Colostrum (59.2%) and Complementary feeding (72.4%) was good due to Urban ASHA Worker (84.2%) awareness in area.

Nutritional Disparities among Women in Urban India.

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/ severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days.

Prevalence of Urban Poor and Its Health Related Factors in the State of Selangor, Malaysia

The objectives of this study were to determine the prevalence of the urban poor and its health related factors in Selangor. This cross-sectional study was conducted in the community of Selangor. Data was collected from January 2006 to June 2006. Three out of nine districts were selected to be involved in the study, which were Klang, Kuala Langat and Petaling. A Multistage Stratified Proportionate Systematic Random Sampling was used for this study. The sampling was carried out by the Statistics Department of Malaysia. The survey frame was based on the information gathered from the Population and Housing Census in year 2000. The respondents were interviewed by trained research assistants using a structured pre-tested standardized questionnaire prepared in Malay and English languages. A monthly income of RM706 and less was used to define urban poor based on the guidelines given by the Economy Planning Unit of Malaysia (2004). SPSS 16.0 version was used to analyze the data. Out of 2535 respondents interviewed in this study, 2491 respondents answered the questionnaire completely (response rate 98.3%). Out of 2491 respondents, 202 (8.1%) had a monthly income of RM706 and less. Analysis of the urban poor respondents found that majority were aged between 18 to 40 years old (55.9%), and 29.7% had diagnosed medical illnesses, where hypertension, diabetes and asthma were the most common illnesses at 12.4%, 10.9% and 5.0% respectively. About 10% of the urban poor respondents had physical disabilities such as blurring of vision (7.9%), hearing problems (1.0%) and other disabilities (1.0%).

Human touch to detect hypothermia in neonates in indian slum dwellings.

Objective. To assess the validity of human touch (HT) method to measure hypothermia compared against axillary digital thermometry (ADT) and study association of hypothermia with poor suckle and underweight status in newborns and environmental temperature in 11 slums of Indore city, India. Methods. Field supervisors of slum-based health volunteers measured body temperature of 152 newborns by HT and ADT, observed suckling and weighed newborns. Underweight status was determined using WHO growth standards. Results. Hypothermia prevalence (axillary temperature <36.5oC) was 30.9%. Prevalence varied by season but insignificantly. Hypothermia was insignificantly associated with poor suckle (31% vs 19.7%, p=0.21) and undernutrition (33.3% vs 25.3%, p=0.4). HT had moderate diagnostic accuracy when compared with ADT (kappa: 0.38, sensitivity: 74.5%, specificity: 68.5%). Conclusions. HT emerged simpler and programmatically feasible. There is a need to examine whether trained and supervised community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple signs of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked to the program to ensure prompt management of illness.

Medical care expenditure of residents in urban poor area / 영남의대학술지

This study was carried out to assess medical care expenditure of residents in urban poor area. The study population included 377 family members of 85 households in the poor area of Daemyung 8-Dong, Nam-Gu, Taegu and 442 family members of 96 households in a control area. The data was collected through self-administered q'iestionnaires completed by housewives. The survey was conducted. from , March 1 to May 31; 1992. The mean age was 31. 1 years in the poor area and 37. 1 years in the control area. The average number of households per house was 4.5 in the poor area and 4.5 in the control area. The frequency of medical care utilization per household in a one month period was 4.6 in the poor area and 4.3 in the control area. The average number of days of utilization was 12.9 in the poor area and 12.5 in the control area. The averge monthly income of a househlod in the poor area was 848,600 Won compared to the control area's 1,752,300 Won. The average monthly consumption expenditure of a household in the poor area was 568,800 Won and that in the control area 1,238,400 Won. The average medical care monthly expenditure per household was 34,500 Won in the poor area and 58,400 Won in the control area. The proportion of the medical care expenditure to monthly income and to monthly consumption expenditure was 4.1% and 6.1% respectively in the poor area, and 3.3% and 4.7%, respectively in the control area. The premium of medical insurance was 1.5% in both areas. The proportion of cost for drug was 57.4%, for medical appliance was 1.2%, and for medical treatment was 41.1% in the poor area and in the control area 52.4%, 1.9%, 45.7%, respectively. The highest proportion of medical care expenditures in the poor area was herb clinic utilization (36.9%). while hospital and clinic (37.8%) was the highest proportion in the control area. Mean medical care expenditure per visit was 7,400 Won in the poor area and 12,600 Won in the control area. Mean medical care expinditure per day was 2,800 Won in the poor area and 6.300 Won in the control area.

Morbidity pattern of residents in urban poor area by health screening / 영남의대학술지

The purpose of this study was to assess the morbidity pattern of urban residents in the poor area by health screening for the community diagnosis. The items of health screening were history taking and physical examination by medical doctor and hearing test, check blood pressure, test for hematocrit, liver function (sGOT, sGPT), urine sugar and protein, and chest X-ray. The examinee in health screening were 437 persons and they occupied 16.9% of total residents in the poor area. Male examinee were 129 persons (9.9% of total residents) and female examinee were 308 persons (23.9% of total residents). Age group of above sixty years old, 42.0% of total residents in the poor area were participated, but only 5.9% were participated in age group of 10 to 19 years old. Among the 437 examinee, 191 persons (43.7%) had one or more abnormal findings in health screening. In male 38.7% had abnormal findings, and somewhat lower than that of female (45.8%). Age group of above sixty years had most high rate of abnormal findings (69.8%), in contrast to age group of 10 to 19 years old (10.9%). Diseases of the digestive system was the most common and which occupies 23.7% of total abnormal findings. And diseases of the circulatory system occupied 19.7%. Low hematocrit (14.6% of total participants of 437 persons) occupies the most common abnormal findings for screening test (hematocrit, blood pressure, hearing test, sGOT/sGPT, urine protein and urine sugar, chest X-ray) and high blood pressure (10.1%) occupied second, third; hearing impairment (5.5%), fourth; abnormal liver function (4.1%), fifth; sugar in urine (2.3%), sixth; protein in urine (1.4%) and lastly abnormal chest X-ray (0.9%). The positive rate of abnormal findings in health screening was very high compared with morbidity rate by health interview. It is supposed that some portion of this high rate is by selection bias in examinee in health screening specially high participating rate in older age, and the other portion is due to the low socioeconomic status and bad environment of the residents of the poor area. These findings will be good information for the research and development of health care system in the urban poor area.