Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda.

BACKGROUND: Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with illicit drug and high-risk alcohol consumption. METHODS: We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25 March 2019 to 30 March 2020. Data was collected on social demographics, sexual behavior, and reproductive health using interviewer-administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. RESULTS: We enrolled 490 participants (60.6% female) with a median age of 18 (IQR 17-18) years, 84.9% had less than secondary education, 48.4% had their sexual debut before 15 years, 47.1% reported paid sex in the past 3 months and 22.8% had a sexually transmitted infection (chlamydia, gonorrhea, and active syphilis) baseline characteristics associated with illicit drug use in the past 3 months were male gender (aOR 12.45; 95% CI 7.21-21.50) being married (aOR 2.26; 95%CI 1.03-4.94) 10 or more paying sexual partners (aOR 2.45; 95%CI 1.05-5.69) and high-risk alcohol use (aOR 3.94; 95%CI 2.10-7.40), baseline characteristics associated with high-risk alcohol use were male gender (aOR 0.29; 95% CI 0.13-0.63) emotional violence from sexual partners (aOR 2.35; 95%CI 1.32-418) illicit drug users com (aOR 3.94; 95% CI 2.10-7.40). CONCLUSION: Illicit drug and high-risk alcohol use are prevalent among male adolescents and adolescents involved in high-risk sexual behavior living in the urban slums of Kampala.

Access inequalities to WASH and housing in slums in low- and middle-income countries (LMICs): A scoping review.

Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity amongst the slum population lead to differential experiences in Water, Sanitation, and Hygiene (WASH) and housing access. This scoping review provides evidence of the interconnection of WASH and housing and presents barriers to access and the consequences thereof for slum dwellers. It does so while considering the social stratification amongst urban slum dwellers and their lived experiences. A systematic search of journal articles was conducted in November 2022 in PubMed, Scopus, and Web of Science. A total of 33 papers were identified which were full text reviewed and data extracted. Infrastructure, social and cultural, socio-economic, governance and policy and environmental barriers emerged as general themes. Barriers to WASH and housing were more frequently described concerning women and girls due to gender norms within WASH and the home. Barriers to WASH lead to compromised health, socio-economic burdens, and adverse social impacts, thus causing residents of slums to navigate their WASH mobility spatially and over time. Insights from this review underscore the need for an intersectional approach to understanding access inequalities to WASH and housing.

Understanding challenges related to menstrual hygiene management: Knowledge and practices among the adolescent girls in urban slums of Jaipur, India.

Objective: This study aimed to determine the factors associated with knowledge and practices related to menstrual hygiene management among adolescent girls in urban slums in Jaipur, India. Material and Methods: A cross-sectional study among 417 adolescent girls was conducted. Descriptive statistics, Chi-square, and bivariate and multivariate logistic regression methods were used to analyze the data and determine the associated factors. Findings: Only 48.7% of girls had a correct understanding of menstruation. In addition, 55.1% of the menstruating girls had faced health problems related to mensuration in the last 6 months; however, only 47.6% visited a health facility for treatment. Educational status of the girl (AOR = 1.89, 95% CI = 0.88-4.06), mother's education (AOR = 2.19, 95% CI = 1.30-3.67) and income (AOR = 1.89, 95% CI = 0.67-3.95), father's income (AOR = 1.42, 95% CI = 0.76-2.95), and counseling by field health workers (AOR = 2.08, 95% CI = 1.23-3.51) were found to be associated with knowledge about menstruation. Girl's education (AOR = 1.49, 95% CI = 0.74-2.95), mother's education (AOR = 1.46, 95% CI = 0.7-2.84) and income (AOR = 1.314, 95% CI = 0.44-2.02), father's education (AOR = 1.64, 95% CI = 0.55-3.08) and income (AOR = 2.0, 95% CI = 0.86-3.28), and counseling by field health workers (AOR = 1.48, 95% CI = 0.76-2.64) were found to be associated with the type of absorbents used. Conclusion: The findings from the study show that the awareness about mensuration and utilization of health services among adolescent girls is low. There is a need to create an enabling environment for girls to access knowledge and health services related to menstruation by creating awareness at the community level, strengthening outreach by field health workers, and ensuring privacy in healthcare facilities.

Social determinants of low uptake of childhood vaccination in high-risk squatter settlements in Karachi, Pakistan - A step towards addressing vaccine inequity in urban slums.

Background: Routine vaccination has remained historically low in major urban pockets of Pakistan, and now lags behind rural vaccination rates. Grossly insufficient publicly funded primary healthcare infrastructure, heterogeneous mix of providers and multi-ethnicity of populations pose challenges in the delivery of essential health services. This paper ascertains factors associated with uptake of routine childhood vaccination, using Pentavalent-3 vaccine, as a proxy indicator for completion of age-appropriate vaccines in urban slums of Karachi, at high risk of Polio and vaccine preventable disease outbreaks. Methods: Data was drawn from baseline assessment of an urban immunization delivery pilot project in urban slums of Karachi, Pakistan. The study sample comprised of 2,097 households with children aged 4-12 months, sampled through a cross-sectional cluster survey, applying a structured questionnaire. Multivariable logistic regression was used to determine the association between Penta-3 vaccination, as the outcome variable, and predictor variables including socio-demographic characteristics and healthcare access factors. Results: The findings showed that the likelihood of being immunized with Penta-3 was higher for non-Pashtun ethnicity [adjusted odds ratio (aOR) 1.69; 95% CI 1.33-2.14], children of educated mothers, secondary or higher [aOR 2.95, 95% CI 2.34-3.71], and those whose fathers were formally employed (aOR 1.53; 95% CI 1.19-1.97). No association was seen by gender of child [aOR 0.89; 95% CI 0.73-1.08], and place of new born delivery [aOR 1.01; 95% CI 0.83-1.24]. Conclusion: Pockets of critically low under-vaccinations within the urban slums of Karachi are associated with Pashtun ethnicity, distance to the vaccination centre, lack of mothers' education and lack of stable family income as in the case of unemployed and daily wage-earning fathers. Recognition of these factors is required in designing contextually appropriate strategies to address vaccine inequity in urban settings.

A qualitative study of mental health problems among children living in New Delhi slums.

Children living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., "madness or anger," "pain in the heart and mind") not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.

Reproductive health service access and utilisation among migrant women in Dhaka's urban slums: a qualitative study.

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18-49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.

Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda.

Background; Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption. Methods; We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. Results; We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners. Conclusion: Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.

Cardiovascular Risk Assessment Among People With Type 2 Diabetes Mellitus in Urban Slums of Central Karnataka, India.

BACKGROUND: The intricate interplay between type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) necessitates a comprehensive investigation into the cardiovascular risk landscape among individuals with T2DM. The burgeoning global burden of both conditions underscores the urgency of targeted research in this area, with the potential to inform preventive strategies and mitigate adverse cardiovascular outcomes. By unravelling the risk of CVD among T2DM patients and identifying key risk factors, the current research could pave the way for tailored interventions that could have the potential to substantially alleviate the cardiovascular burden associated with T2DM. AIMS AND OBJECTIVES: To assess the cardiovascular risk and its determinants among T2DM patients. METHODS: A cross sectional study was conducted among known diabetes patients accessing urban outreach clinic serving approximately 20,000 population across 18 urban slums in central Karnataka from September 2022 to June 2023. A pre-tested semi-structured questionnaire was used to collect information on socio-demographic details and CVD risk was assessed using QRISK3 score. Data were entered in Excel 2019 (Microsoft, Redmond, WA, USA) and analysed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA) and are presented in the tables and figures. RESULTS: A total of 483 adults above 30 years participated in the study. Among them, the majority were men (67.9%). Cardiovascular risk factors were found more among males and the 10-year cardiovascular risk assessment prediction through QRISK3 score was higher among males compared to females and it was found to be statistically significant (13.5±8.6% vs. 19.5±10.1%, p<0.001). CONCLUSION:  According to a comparison of cardiovascular risk variables by gender among diabetic patients using the QRISK3's 10-year risk assessment, males, smokers/tobacco users, obese, and known hypertensives had significantly greater risk.

Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda.

Background: Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption. Methods: We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. Results: We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners. Conclusion: Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.

A cross-sectional survey of climate and COVID-19 crises in young people in Indian slums: context, psychological responses, and agency.

Background: COVID-19 and the climate crisis have caused unprecedented disruptions across the world. Climate change has affected the mental health and wellbeing of children and adolescent. Young people with a mental illness and without social support are at an increased risk of climate change induced mental ill-health. COVID-19 resulted in a marked increase of psychological distress. Increase in depression, anxiety and insomnia have increased due to the upheavals that people were experiencing including loss of livelihood and breaking of social bonds. Methods: This exploratory study adopted a cross sectional survey design using quantitative methods to understand the perceptions, thoughts, and feelings of young people on both the climate and COVID-19 crises, their concerns, and desires for the future and to understand their sense of agency to contribute to the changes that they want to see. Findings: The findings show that most of the respondents from the sample studied reported nearly similar interference of climate change and COVID-19 on their mental wellbeing. Their climate concern and COVID-19 concern scores were comparable. Tangible experiences of extreme weather events, that were personally experienced or that impacted their family members had a negative impact on their lives, while action around improving the environment had a positive impact.Loss of income, loss of mobility and loss of social contact due to COVID-19 had negative impacts on the respondents, while indulging in leisure activities and bonding with the family had positive impacts. Although the majority of the participants reported having both climate and COVID agency, it did not translate into action to improve the environment. Interpretation: Young people's activism on climate change and COVID-19 has a positive impact on their mental wellbeing hence more opportunities and platforms must be provided to enable young people to take action on both these crises. Funding: None.

Pandemic within a pandemic! Policy Implications of community-based Interventions to mitigate violence against women during COVID-19 in Urban Slums of Lucknow, India.

Background: The COVID-19 pandemic has brought an unprecedented adverse impact on women's health. Evidence from the literature suggests that violence against women has increased multifold. Gender-based violence in urban slums has worsened due to a lack of water and sanitation services, overcrowding, deteriorating conditions and a lack of institutional frameworks to address gender inequities. Methods: The SAMBHAV (Synchronized Action for Marginalized to Improve Behaviors and Vulnerabilities) initiative was launched between June 2020 to December 2020 by collaborating with the Uttar Pradesh state government, UNICEF and UNDP. The program intended to reach 6000 families in 30 UPS (Urban Poor settlements) of 13 city wards. These 30 UPS were divided into 5 clusters. The survey was conducted in 760 households, 397 taken from randomly selected 15 interventions and 363 households from 15 control UPS. This paper utilized data from a baseline assessment of gender and decision-making from a household survey conducted in the selected UPS during July 03-15, 2020. A sample size of 360 completed interviews was calculated for intervention and control areas to measure changes attributable to the SAMBHAV intervention in the behaviours and service utilization (pre- and post-intervention). Results: The data analysis showed a significant difference (p-value < 0.001) between respondents regarding women's freedom to move alone in the control and intervention area. It also reflected a significant difference between control and intervention areas as the respondents in the intervention area chose to work for the cause of gender-based violence. Conclusion: The SAMBHAV initiative brought an intersectional lens to gender issues. The community volunteers were trained to approach issues based on gender-based violence with the local public, and various conferences and meetings were organized to sensitize the community. The initiative's overall impact was that it built momentum around the issue of applying the concept of intersectionality for gender issues and building resilience in the community. There is still a need to bring multi-layered and more aggressive approaches to reduce the prevalence of gender-based violence in the community.

Assessment of sanitation and drinking water facilities among slum households in Bhubaneswar, Odisha - A cross-sectional study.

Aim: The study aims to assess the practice of using unsafe drinking water and sanitary practices among the population dwelling in slum settings of Bhubaneswar city, Odisha, India. Subjects and Methods: A cross-sectional study was conducted among 288 households in the Bhubaneswar slums of Chandrasekharpur, Neeladri Vihar, and Trinatha basti. A questionnaire was administered face to face. Descriptive statistics were used to define the participants' sociodemographic characteristics, household information, drinking water, latrine characteristics, and waste disposal. Results: The majority (59.7%) resided in kutcha households in notified slum areas, and 89.6% were reportedly illiterate. About 92.7% resided in a deplorable condition, relying on piped water (79.5%) from the community sources and 20.5% used it for drinking and household purposes. Around 83% of the respondents stated they did not treat water before consumption. Bathroom facilities were found to be inadequate, and 74.3% used pit latrines. The majority of household wastes (83%) were managed by directly letting them to the drainage system untreated. As a consequence, 91% reported breeding of flies and mosquitoes near their household premises and 70.5% stated having fever in the past 6 months. Conclusion: Despite the government's initiatives to improve water, sanitation, and hygiene (WASH) strategies, an extensive gap in practice was observed. As a result, Bhubaneswar municipality must strictly enforce policy and regulatory guidelines concerning WASH to improve the sanitation practices, particularly in the areas of drinking water and household waste management.

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers.

BACKGROUND: It is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda. METHODS: A qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software. RESULTS: The main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care. CONCLUSIONS: Despite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021.

Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.

Enablers and barriers to COVID-19 vaccine uptake in an urban slum in Lagos, Nigeria: informing vaccine engagement strategies for the marginalized.

BACKGROUND: Vaccination against coronavirus disease 2019 (COVID-19) is a cost-effective mitigation strategy against the pandemic. As the COVID-19 vaccine becomes more available, low uptake is now a global threat and understanding the underpinnings in local contexts is a priority for intervention development. We aimed to evaluate behavioural determinants of COVID-19 vaccine acceptance that could inform engagement strategies to improve vaccine uptake in Makoko, an urban slum in Lagos, Nigeria. METHODS: A population-based case-control study utilized the barrier analysis (BA) approach to evaluate the beliefs and behaviours of 45 'doers' and 45 'non-doers'. The standardized BA tabulation sheet was used to assess differences in the proportions between the two groups to identify significant factors that could be addressed through a behaviour change strategy. RESULTS: Perceived social norms (family, friend, healthcare workers) that approve the vaccine and expected vaccine protection against diseases among doers were determinants of behaviour. Perceived poor accessibility, safety concerns, lack of trust, low vaccine efficacy and low susceptibility to the infection were the most important determinants of behaviour among non-doers. CONCLUSIONS: Measures to improve COVID-19 vaccine acceptance in Makoko should include improvement in accessibility and exposing myths and misinformation through clear, concise and evidence-based community education delivered by trusted persons such as healthcare workers and religious leaders.

Carriage prevalence, serotype distribution, antimicrobial resistance, pspA typing and pilus islets of Streptococcus pneumoniae isolated from adults living in a Brazilian urban slum.

INTRODUCTION: For Brazilian adults, pneumococcal vaccines have been usually taken only by those who are at higher risk for development of pneumococcal diseases. Since populations from lower socioeconomic status are at high risk of acquiring pneumococcal infections, we investigated the carriage prevalence, colonization risk factors, capsular and surface protein types, and antimicrobial resistance among pneumococcal isolates recovered from adults living in a Brazilian urban slum. METHODS: Between September-December 2016, we conducted a cross-sectional study among individuals aged ≥ 18 years who attended a public primary clinic in Niterói/RJ, Brazil. Pneumococci were isolated by culture on sheep blood agar plates with and without gentamicin. Antimicrobial susceptibility was determined for all isolates. We used PCR to determine capsular types, PspA families (Fam) and pilus islets (PI). RESULTS: Of 385 adults, 32 (8.3 %) were pneumococcal carriers. Three carriers had two different pneumococci, totaling 35 isolates. After multivariate analysis, smoking, previous hospitalization, alcohol consumption and co-habitation with children aged < 6 years increased the odds of pneumococcal carriage, but antibiotic use in the previous 2 weeks was found to be a protective factor. Fourteen different serogroups/serotypes were detected and the prevalent ones were 9 N/L, 10A, 15B/C and 35F/47F (n = 3; 8.6 % each). Non-typeable (NT) isolates made up 31.4 %. All isolates were susceptible to chloramphenicol, levofloxacin and vancomycin. We found eight (22.9 %) penicillin non-susceptible pneumococci (PNSP) with minimum inhibitory concentrations (MICs) of 0.38-1.5 µg/mL. The two (5.7 %) erythromycin-resistant isolates had MIC > 256 µg/mL, cMLSB phenotype and the erm(B) gene. Twelve (34.3 %) and 17 (48.6 %) isolates had PspA Fam1 and Fam2, respectively. Three (8.6 %) isolates had genes for pilitwo PI-1 and one PI-2. CONCLUSION: We detected a low frequency of pneumococcal carriage among the adult population, but a high diversity of serotypes. Frequencies of PNSP and NT isolates resistant to antimicrobial agents are concerning.

Determinants of complementary feeding practices among children aged 6-24 months in urban slums of Pune, Maharashtra, in India.

BACKGROUND: Inequalities in child feeding practices are evident in urban slums in developing nations. Our study identified the determinants of complementary feeding (CF) practices in the informal settings of Pune, India, a district close to the business capital of India. METHODS: Employing a cross-sectional study design, 1066 mother-children dyads were surveyed. Five indicators defined by the WHO were used to study complementary feeding practices. Determinants of complementary feeding practices were identified using multivariate analyses. RESULTS: Timely initiation of CF was reported by 42%. Minimum acceptable diet (MAD), minimum meal frequency (MMF), and Diet Diversity Score > 4 were achieved by 14.9%, 76.5%, and 16.4%, respectively. Continued breastfeeding (CBF) at 2 years, and feeding processed foods were practiced by 94% and 50%, respectively. Among the maternal characteristics, a mother's age > 30 years at pregnancy was less likely to achieve DD [AOR: 0.195 (CI 0.047-0.809)] and MAD [AOR: 0.231 (CI 0.056-0.960)]. Mothers with lower education were less likely to meet MMF [AOR: 0.302 (0.113-0.807)], MAD [AOR: 0.505 (CI 0.295-0.867)] and to introduce formula feeds (FF) [AOR: 0.417 (0.193- 0.899)]. Among obstetric characteristics, birth spacing < 33 months was less likely to achieve DD [AOR: 0.594 (CI 0.365-0.965)] and CBF [AOR: 0.562 (CI: 0.322-0.982)]. Receiving IYCF counseling only during postnatal care hindered the timely initiation of CF [AOR: 0.638 (0.415-0.981)]. Very Low Birth Weight increased the odds of achieving DD [AOR: 2.384 (1.007-5.644)] and MAD [AOR: 2.588(CI: 1.054-6.352)], while low birth weight increased the odds of children being introduced to processed foods [AOR: 1.370 (CI: 1.056-1.776)]. Concerning socio-economic status, being above the poverty line increased the odds of achieving MMF, [AOR: 1.851 (1.005-3.407)]. Other backward castes showed higher odds of achieving MAD [AOR: 2.191 (1.208-3.973)] and undisclosed caste in our study setting decreased the odds of FF [AOR: 0.339 (0.170-0.677)]. Bottle feeding interfered with MMF [AOR: 0.440 (0.317-0.611)] and CBF [AOR: 0.153 (0.105-0.224)]. CONCLUSION: Investing in maternal education and IYCF counseling during both ANC and PNC to provide nutritious complementary foods alongside addressing poverty should be a national priority to prevent the double burden of undernutrition at an early age in informal settings.

Many hops, many stops: care-seeking "loops" for diabetes and hypertension in three urban informal settlements in the Mumbai Metropolitan Region.

Background: The burden of Non-Communicable Diseases (NCDs) in urban informal settlements across Lower and Middle Income Countries is increasing. In recognition, there has been interest in fine-tuning policies on NCDs to meet the unique needs of people living in these settlements. To inform such policy efforts, we studied the care-seeking journeys of people living in urban informal settlements for two NCDs-diabetes and hypertension. The study was done in the Mumbai Metropolitan Region, India. Methods: This qualitative study was based on interviews with patients having diabetes and hypertension, supplemented by interactions with the general community, private doctors, and public sector staff. We conducted a total of 47 interviews and 6 Focus Group Discussions. We synthesized data thematically and used the qualitative software NVivo Version 10.3 to aid the process. In this paper, we report on themes that we, as a team, interpreted as striking and policy-relevant features of peoples' journeys. Results: People recounted having long and convoluted care-seeking journeys for the two NCDs we studied. There were several delays in diagnosis and treatment initiation. Most people's first point of contact for medical care were local physicians with a non-allopathic degree, who were not always able to diagnose the two NCDs. People reported seeking care from a multitude of healthcare providers (public and private), and repeatedly switched providers. Their stories often comprised multiple points of diagnosis, re-diagnosis, treatment initiation, and treatment adjustments. Advice from neighbors, friends, and family played an essential role in shaping the care-seeking process. Trade-offs between saving costs and obtaining relief from symptoms were made constantly. Conclusion: Our paper attempts to bring the voices of people to the forefront of policies on NCDs. People's convoluted journeys with numerous switches between providers indicate the need for trusted "first-contact" points for NCD care. Integrating care across providers-public and private-in urban informal settlements-can go a long way in streamlining the NCD care-seeking process and making care more affordable for people. Educating the community on NCD prevention, screening, and treatment adherence; and establishing local support mechanisms (such as patient groups) may also help optimize people's care-seeking pathways.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey.

BACKGROUND: Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan. METHODS: The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake. RESULTS: Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities. CONCLUSIONS: We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Tobacco chewing and associated factors among a vulnerable youth population in Sri Lanka.

BACKGROUND: Tobacco in any form kills millions of people every year. Tobacco addiction among youth shows an increasing trend while smokeless type is becoming more common. This study aimed to describe the lifestyle of chewing smokeless tobacco among a group of high-risk youth population in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among a sample of 1431 youths aged between 15 to 24 years residing in urban slums in Colombo Sri Lanka, using a cluster sampling technique combined with probability proportionate to size technique. Data were collected using an interviewer-administered questionnaire. Chewing smokeless tobacco was assessed using betel quid chewing and commercially prepared tobacco and areca nut packet chewing. Current chewer was defined as who had the practice of chewing during past 30 days. RESULTS: The mean age of the study sample was 17.53 (95% CI: 17.40-17.65). Of the 1431 respondents, 57% were males and 43% were females. The prevalence of current smokeless tobacco chewers was 44.9% and among them 90.8% were males and 9.8% were females. Around 31.3% did not have smokeless tobacco chewing practice (Male-5.9%, Female-64.9%). Among the current smokeless tobacco chewers 21.5% chew both types of smokeless tobacco products and all of them were males. Male gender (OR 17.9; 11.4 -27.9) and ever smoking lifestyle (OR 4.4; 2.9-6.6) were significant determinants of current smokeless tobacco chewing lifestyle. CONCLUSION AND RECOMMENDATIONS: The study shows a high prevalence of smokeless tobacco use by youth aged between 15 to 24 years who were residing in urban slum areas in the district of Colombo, in Sri Lanka, highlighting this target group for early intervention to reduce the uptake and promote the quitting of this practice.