Socioeconomic inequalities in self-reported chronic non-communicable diseases in urban Hanoi,Vietnam

This study measures and decomposes socioeconomic inequalities in the prevalence of self-reported chronic non-communicable diseases (NCDs) in urban Hanoi, Vietnam. A cross-sectional survey of 1211 selected households was carried out in four urban districts in both slum and non-slum areas of Hanoi city in 2013. The respondents were asked if a doctor or health worker had diagnosed any household members with an NCD, such as cardiovascular diseases, chronic respiratory, diabetes or cancer, during last 12 months. Information from 3736 individuals, aged 15 years and over, was used for the analysis. The concentration index (CI) was used to measure inequalities in self-reported NCD prevalence, and it was also decomposed into contributing factors. The prevalence of chronic NCDs in the slum and non-slum areas was 7.9% and 11.6%, respectively. The CIs show gradients disadvantageous to both the slum (CI?=??0.103) and non-slum (CI?=??0.165) areas. Lower socioeconomic status and aging significantly contributed to inequalities in the self-reported NCDs, particularly for those living in the slum areas. The findings confirm the existence of substantial socioeconomic inequalities linked to NCDs in urban Vietnam. Future policies should target these vulnerable areas.     

HIV risk perception and constraints to protective behaviour among young slum dwellers in Ibadan, Nigeria

This study examined the relationship between HIV/AIDS risk perception and protective behaviour among sexually-active urban young slum dwellers in Ibadan, Nigeria. The multistage sampling techniques were used for selecting 1,600 respondents aged 15-24 years. Of these, 1,042 (65%) respondents who reported unprotected sex in the last three months were selected for analysis. Although the sexually-active respondents demonstrated basic knowledge of HIV/AIDS and high risk perception, risky behaviour was common and protective behaviour was poor. About 48% of 505 males and 12% of 537 females had multiple partners. Similarly, 29% of males and 38% of females were engaged in transactional sex. Only 14% of males and 5% of females used any form of protection, resulting in the high rates of sexually transmitted infections reported by 27% of males and 10% of females. Structural and environmental constraints were identified as barriers to adopting protective behaviour. Therefore, programme and policy interventions should be designed to address the peculiar circumstances of urban young slum dwellers to curtail the HIV epidemic.     

Prevalence,care-seeking,and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon

Background

Given the large burden of non-communicable diseases (NCDs) among both Syrian refugees and the host communities within which they are settled, humanitarian actors and the government of Lebanon face immense challenges in addressing health needs. This study assessed health status, unmet needs, and utilization of health services among Syrian refugees and host communities in Lebanon.

Methods

A cross-sectional survey of Syrian refugees and host communities in Lebanon was conducted using a two-stage cluster survey design with probability proportional to size sampling. To obtain information on chronic NCDs, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences in household characteristics by care-seeking for these conditions were examined using chi-square, t-test, and adjusted logistic regression methods.

Results

Over half (50.4 %) of refugee and host community households (60.2 %) reported a member with one of the five NCDs. Host community prevalence rates were significantly higher than refugees for all conditions except chronic respiratory diseases (p?=?0.08). Care-seeking for NCDs among refugees and host community households was high across all conditions with 82.9 and 97.8 %, respectively, having sought care in Lebanon for their condition. Refugees utilized primary health care centers (PHCC) (57.7 %) most often while host communities sought care most in private clinics (62.4 %). Overall, 69.7 % of refugees and 82.7 % of host community members reported an out-of-pocket consultation payment (p?=?0.041) with an average payment of US$15 among refugees and US$42 for the host community (p <0.001).

Conclusions

Given the protracted nature of the Syrian crisis and the burden on the Lebanese health system, implications for both individuals with NCDs and Lebanon’s health system are immense. The burden of out of pocket expenses on persons with NCDs are also substantial, especially given the tenuous economic status of many refugees and the less affluent segments of the Lebanese population. Greater investment in the public sector health system could benefit all parties. Efforts to improve quality of care for NCDs at the primary care level are also a critical component of preventing adverse outcomes and lowering the overall cost of care for NCDs.

     

Cigarette smoking among Southern Nigerian youth and what geopolitical zones got to do with it

Cigarette smoking is a known public health challenge given the number of tobacco-related diseases. Research is needed to constantly evaluate smoking prevalence in particular settings like Nigeria with projections of increasing smoking uptake. This study examined the smoking behaviour of the young people in Southern Nigeria in relation to their demographic and socio-economic attributes like gender, age, employment status and educational attainment. Intentions to quit and quit attempts of current smokers were also explored. A cross-sectional survey was conducted with 550 respondents aged 18–24 years in three categories: students, skilled and unskilled workers using a modified version of the global youth tobacco survey questionnaire. Chi-square tests were used to explore associations between relevant variables. Participants were recruited using a multi-stage non-probability sampling technique. The software Statistical Package for the Social Sciences (SPSS) version 19 was used in the analysis of the data. Prevalence of active smokers was 29.7% (n = 160) while 40% (n = 224) of the respondents had experimented with smoking. Nearly half of the smokers (43.8%, n = 70) smoke between two and five cigarettes per day. Smokers were more likely to be males, unskilled workers and reside in or come from the South-East geopolitical zone of Nigeria. About a third of current smokers (34.4%, n = 55) indicated an intention to quit while 39.4% (n = 63) attempted to quit in the year prior to the study. There is an urgent need to implement the National Tobacco Control Act 2015 in Nigeria. This will reduce youth access and stop the targeted marketing of young people by Tobacco multinationals in Nigeria.     

Prevalence and determinants of the cleanliness of shared toilets in Kampala slums, Uganda

Aim

Keeping shared toilets clean is a key public health challenge household users face in urban slum settlements of most developing countries. This paper provides insights on the cleanliness of households’ shared toilets and the factors that influence their cleanliness, as well as influencing the inclination of the users to keep them clean.

Subjects and methods

This analysis is part of a cross-sectional study conducted in 50 randomly selected slums in Kampala, Uganda between October and November 2010. A total of 1,500 respondents were interviewed, using a semi-structured questionnaire.

Results

Out of 1,019 respondents using shared toilets, less than 12 % reported having very clean toilets. Some of the significant factors influencing the cleanliness of shared toilets are: the ease or difficulty in keeping shared toilets clean, the number of households sharing a toilet room, effortful cleaning behaviour and cleaning intention on the part of the users.

Conclusion

The findings show that most slum dwellers use toilets that are not hygienic.     

Geographical variation in prevalence of non-communicable diseases (NCDs) and its correlates in India: evidence from recent NSSO survey

Aim

This study examines the geographical variation in prevalence of non-communicable diseases (NCDs) and its correlates in India.

Subjects and methods

The study has used data from recent NSSO (71st Round, 2014) survey. Simple bivariate analyses are used to calculate the prevalence rate of NCDs per thousand persons. Binary logistics regression is applied to examine the effects of demographic and socioeconomic variables on the prevalence of NCDs.

Results

The overall prevalence of NCDs, reported by the respondent, is 55/1,000 people in India, and it varies across all geographical regions. The southern region shows highest prevalence of NCDs (107/1,000) and the north east region is the lowest prevalence of NCDs (11/1,000). The prevalence of NCDs varies with the socio-demographic characteristics of respondents, where the prevalence of NCDs is much higher among people above 60+ years (i.e. 419/1,000 for the southern region and also for other regions) than corresponding categories. The prevalence of NCDs is high among urban residency, female, ever married women, other ethnicities, other religions, and affluent groups excluding level of education. Similarly, the logistic regression result shows that age, sex, place of residence, ethnicity, religion, and income status of respondent have statistically significant impact on NCDs and is more susceptible to having NCDs across the geographical regions of the country.

Conclusion

The study highlights the need to develop proper surveillance and monitoring programmes to focus on highly affected geographical regions to arrest the growing burden of NCDs.

     

Are there geographic and socio-economic differences in incidence, burden and prevention of malaria? A study in southeast Nigeria

Rationale

It is not clearly evident whether malaria affects the poor more although it has been argued that the poor bear a very high burden of the disease. This study explored the socioeconomic and geographic differences in incidence and burden of malaria as well as ownership of mosquito nets.

Methods

Structured questionnaires were used to collect information from 1657 respondents from rural and urban communities in southeast Nigeria on: incidence of malaria, number of days lost to malaria; actions to treat malaria and household ownership of insecticide treated and untreated mosquito nets. Data was compared across socio-economic status (SES) quartiles and between urban and rural dwellers.

Results

There was statistically significant urban-rural difference in malaria occurrence with malaria occurring more amongst urban dwellers. There was more reported occurrence of malaria amongst children and other adult household members in better-off SES groups compared to worse-off SES groups, but not amongst respondents. The average number of days that people delayed before seeking treatment was two days, and both adults and children were ill with malaria for about six days. Better-off SES quartile and urban dwellers owned more mosquito nets (p < 0.05) (treated and untreated).

Conclusion

Malaria occurs more amongst better-off SES groups and urban dwellers in southeast Nigeria. Deployment of malaria control interventions should ensure universal access since targeting the poor and other supposedly vulnerable groups may exclude people that really require malaria control services.     

Burden of Healthcare Utilization and Out-of-Pocket Costs Among Individuals with NCDs in an Indian Setting

Non communicable diseases (NCDs) are now the major cause of death and disability worldwide. It increasingly affects people from developing as well as developed countries. Over the coming decades the burden from NCDs is projected to rise particularly fast in the developing world. There is a lack of optimal data collection about the burden of risk factors related to NCDs especially in the developing countries. To assess the burden of healthcare utilization and out-of-pocket costs associated with NCDs in an Indian setting. A cross sectional study was performed to enroll a convenient sample of 166 participants aged 18 years and above from a tertiary hospital in Punjab, a Northern state of India. The data was gathered during the period of Feb 2010–April 2010. A mixed methods approach was used to assess the burden of diabetes, hypertension, high cholesterol, and their associated risk factors. Further we evaluated the burden of healthcare utilization and out-of-pocket costs associated with these conditions using self-reported assessments. Results showed the average age of the participants was 50 years, 63 % (n = 104) were females, 32 % (n = 53) had education less than high school and 20 % (n = 33) had no formal education. About 96 % of the study participants were living with a partner. Majority of the study participants were non-smokers and 17 % (n = 27) of them reported to have history of alcohol consumption. The majority of the participants had access to cell phones (94 %; n = 156) and about 40 % (n = 66) had computers at home. About 33 % (n = 55) of the study participants had some form of previous knowledge of computers. Majority of the study participants went to the private hospital (47.5 %) for seeking healthcare. About 32 % (n = 53) also sought healthcare from some kind of healthcare professional including a primary care doctor or a nurse or even a pharmacist in a village setting. Doctor visits related to diabetes were higher as compared to the individuals either with hypertension or high cholesterol. However; the out-of-pocket costs of the visit to the healthcare professional were much higher for hypertension than for diabetes or high cholesterol. A strengthened surveillance system, effective inter-sectoral action, and improved access to basic healthcare are pivotal to prevent NCDs. A multifaceted NCDs surveillance system could help us measure the burden of risk factors, its associated health care utilization and out of pocket costs, and further facilitate interventions that can guide evidence based decision making.     

Nutritional status of pavement dweller children of Calcutta City

Pavement dwelling is likely to aggravate malnutrition among its residents due to extreme poverty, lack of dwelling and access to food and their exposure to polluted environment. Paucity of information about nutritional status of street children compared to that among urban slum dwellers, squatters or rural/tribal population is quite evident. The present study revealed the magnitude of Protein Energy Malnutrition (PEM) and few associated factors among a sample of 435 underfives belonging to pavement dweller families and selected randomly from clusters of such families, from each of the five geographical sectors of Calcutta city. Overall prevalence of PEM was found almost similar (about 70%) to that among other 'urban poor' children viz. slum dwellers etc., but about 16% of them were found severely undernourished (Grade III & V of IAP classification of PEM). About 35% and 70% of street dweller children had wasting and stunting respectively. Severe PEM (Grade III & IV) was more prevalent among 12-23 months old, girl child, those belonged to illiterate parents and housewife mothers rather than wage earners. It also did increase with increase of birth rate of decrease of birth interval.     

High Prevalence of Chronic Non-Communicable Conditions Among Adult Refugees: Implications for Practice and Policy

The global rise in non-communicable disease (NCD) suggests that US-based refugees are increasingly affected by chronic conditions. However, health services have focused on the detection of infectious disease, with relatively limited data on chronic NCDs. Using data from a retrospective medical record review of a refugee health program in the urban Northeast (n = 180), we examined the prevalence of chronic NCDs and NCD risk factors among adult refugees who had recently arrived in the US, with attention to region of origin and family composition. Family composition was included because low-income adults without dependent children are at high risk of becoming uninsured. We found that half of the adult refugees in this sample had at least one chronic NCD (51.1%), and 9.5% had three or more NCDs. Behavioral health diagnoses were most common (15.0%), followed by hypertension (13.3%). Half of adults were overweight or obese (54.6%). Chronic NCDs were somewhat more common among adults from Iraq, but this difference was not significant (56.8 vs. 44.6%). Chronic NCDs were common among adults with and without dependent children (61.4 vs. 44.6%, respectively), and these two groups did not significantly differ in their likelihood of having a chronic NCD after adjustment for age and gender (AOR = 0.78, 95% CI = 0.39, 1.55). This study suggests that chronic NCDs are common among adult refugees in the US, including refugees at high risk for uninsurance. We propose that refugee health services accommodate screening and treatment for chronic NCDs and NCD risk factors, and that insurance outreach and enrollment programs target recently arrived refugees.     

Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi

Background

The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed.

Results

Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors.

Conclusions

It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.

     

Overview of migration,poverty and health dynamics in Nairobi City's slum settlements

The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents.     

Nutritional status of nursery school children: a comparison between Lagos State (Southern Nigeria) and Jos, Plateau State (Northern Nigeria)

This comparative study was carried out to assess the nutritional status of preschool children in the Southern part of Nigeria (Lagos) and Jos, Plateau State in the Northern part of Nigeria. A total of 393 nursery school children aged 24-77 months in 5 schools (3 in Jos, 2 in Lagos) were randomly selected by multistage sampling. Anthropometric data (height, weight and age) were taken from the subjects and dietary information, weaning and breastfeeding history and general socio economic data were obtained from the parents by administering questionnaires. Weight/Height Z-score (WHZ) differed significantly between Jos (3.0%) and Lagos (11.6%), while weight/age (WAZ) was found to have the same prevalence rate in both locations (2.5%) each. This WAZ score is the normal expected prevalence in a standard population of children. Height/Age Z-scores (HAZ) were not statistically different in both South and North, 2.5% HAZ < -2.0 SD in Jos and 0.0% HAZ < -2.0 SD in Lagos. The intestinal parasitosis rates in this study were as follows: in Jos, a 13.5% infection rate was found, and in Lagos, the infection rate was 8.8%.     

Bwamba virus infection: a sero-survey of veterbrates in five ecological zones in Nigeria

Sera of humans, birds, domestic and wild animals from 28 localities in 5 ecological zones of Nigeria were tested for neutralizing antibody to Bwamba virus.A total of 984 human sera were tested, of which 516 (52·4%) were positive for Bwamba antibody. The highest prevalence (68·2%) was found in the southern guinea savannah zone. The prevalence in other zones were: 62·3% in derived savannah, 40·6% in swamp forest, and 32·1% in rain forest. The small number of samples tested from the Jos Plateau (northern guinea savannah zone) renders uninterpretable the high prevalence (74%) in this area. Significant differences in antibody prevalence were found between the relatively dry savannah areas (southern guinea and derived savannah) and the wet forested areas (swamp forest and rain forest). Except for a significantly lower prevalence of Bwamba antibody in urban dwellers in the wet forested zone as compared with rural dwellers, antibody prevalence was not significantly different for sites within each major ecologic zone. None of the 502 animal and bird sera tested was positive for Bwamba virus antibody.It is suggested that man is an important host in the transmission cycle of Bwamba virus and that Aedes (N.) circumluteolus is the major vector.     

Are slum dwellers at heightened risk of HIV infection than other urban residents? Evidence from population-based HIV prevalence surveys in Kenya

In 2008, the global urban population surpassed the rural population and by 2050 more than 6 billion will be living in urban centres. A growing body of research has reported on poor health outcomes among the urban poor but not much is known about HIV prevalence among this group. A survey of nearly 3000 men and women was conducted in two Nairobi slums in Kenya between 2006 and 2007, where respondents were tested for HIV status. In addition, data from the 2008/2009 Kenya Demographic and Health Survey were used to compare HIV prevalence between slum residents and those living in other urban and rural areas. The results showed strong intra-urban differences. HIV was 12% among slum residents compared with 5% and 6% among non-slum urban and rural residents, respectively. Generally, men had lower HIV prevalence than women although in the slums the gap was narrower. Among women, sexual experience before the age of 15 compared with after 19 years was associated with 62% higher odds of being HIV positive. There was ethnic variation in patterns of HIV infection although the effect depended on the current place of residence.     

Urban health: people living below the poverty line

Available data indicate that levels of urban poverty in India are increasing, while rural poverty is decreasing. Given the difficulty of accurately estimating the size of the poor and slum populations residing in urban areas, it is also difficult to assess the health and nutritional status of such populations. In 1991, 28% of the estimated 20 million people living in 23 major metropolitan areas lived in slums. 39-43% of India's slum population is distributed between Calcutta, Mumbai, Delhi, and Chennai. India must rise to the challenge of providing primary health care to millions of slum dwellers. Based upon the current urban growth rate, the Task Force of the National Institute of Urban Affairs has projected that by 2000, 62-78 million people will reside in India's slums, of an estimated 310 million person urban population. The health status of the urban poor is influenced by urban economies, urbanization, and urban environments. These factors are discussed, followed by consideration of the major health problems among the urban poor, the urban health care delivery system, and recommendations for a better urban health.     

2006年绵阳市涪城区农民主要慢性非传染性疾病患病情况调查

[目的]了解农村居民主要慢性非传染性疾病(慢性病)患病现况,为慢性病干预工作提供科学依据。[方法]2006年,对绵阳市涪城区15个乡镇的农村居民进行调查。[结果]调查137674人,其中男性71821人,女性65853人。主要慢性病患病率为6.03%,其中男性与女性分别为6.77%、5.22%,患病率随着年龄的增长而增高(P<0.01);高血压、慢性支气管炎、肺气肿、糖尿病、肺心病的患病率分别为2.45%、1.74%、0.92%、0.55%、0.37%。男性、女性前5种主要慢性病均依次为高血压、慢性支气管炎、肺气肿、糖尿病、肺心病。[结论]农村居民主要慢性病患病情况不容忽视,应积极开展农村居民健康知识教育及慢性病健康行为干预。     

General Morbidity Prevalence in the Delhi Slums

Research Question:

What is the sickness prevalence in the slums of a metropolitan city?

Objectives:

To estimate the morbidity prevalence with reference to a socio-economic and demographic perspective of the slum population of Delhi.

Study Design:

A cross-sectional study was conducted and data were collected by a two-stage random sampling method. In the first stage, slum locations were selected and in the second stage households were selected.

Participants:

Data were collected from 1049 households consisting of 5358 individuals'' information.

Results:

The overall morbidity prevalence is 15.4%. It is 14.7 and 16.3% for males and females, respectively but the differences are not statistically significant. The reported higher morbidity prevalence and the illiteracy status are significantly associated. Diseases of the respiratory system appear to be very high among slum dwellers.

Conclusion:

From this study, it can be concluded that the number of years of staying in the slum area, presence of a separate kitchen, type of house, it being Pucca or Kuccha, types of toilet pits or open defecation are the important environmental factors for the reports of higher morbidity patterns from the slum area.     

我国中老年人群主要慢性病及危险因素分析

目的 了解我国中老年人群主要慢性病的患病情况及危险因素。方法 利用世界卫生组织\