Child health in urban areas

Health care can be expensive for the un-insured, often constituting a potential poverty trap. Urban India is particularly vulnerable to this possibility given the greater demand for health, absence of a structured health care system, overburdened public institutions, ubiquitous and unregulated private health care market and the generic paucity of public funds. Using nationally representative household level data at two time points, this paper computes the degree and depth of impoverishment from out of pocket medical expenses, and its variation across states and select socio-economic characteristics. Roughly 6 percent of the urban population or about 18 million people were impoverished entirely due to out of pocket medical expenses in India. There were substantial inter-state variation in incidence of this burden and all but one states display an increase in the degree of impoverishment between 1995-96 and 2004. The depth of poverty also registered a threefold increase between the two periods. Urban Muslims, scheduled caste, casual labour and lower middle income households were easily the most vulnerable to the financial implications of ill-health.

This paper uses data from a maternal health study carried out in 2006 in two slums of Nairobi, Kenya, to: describe perceptions of access to and quality of care among women living in informal settlements of Nairobi, Kenya; quantify the effects of women’s perceived quality of, and access to, care on the utilization of delivery services; and draw policy implications regarding the delivery of maternal health services to the urban poor. Results show a pattern of women’s good perceptions in terms of access to, and quality of, health care provided by the privately owned, sub-standard and often unlicensed clinics and maternity homes located within their communities.In the multivariate model, the association between women’s perceptions of access to and quality of care, and delivery at these ‘inappropriate’ facilities remained strong, graded and in the expected direction. Women from the study area are seldom able to reach not-for-profit private providers of maternal health care services like missionary and non-governmental organization (NGO) clinics and hospitals. Against the backdrop of challenges faced by the public sector in health care provision, we recommend that the government should harness the potential of private clinics operating in urban, resource-deprived settings.

A comparison between public and private healthcare provider sector has been carried out in Panchkula district of urban Haryana, northern state of India, for services measured against operational and quality indicators to estimate the best of both the worlds and suggest those changes that will make a difference for the welfare of the society.
The study has been carried out in two phases – in the first phase of study- important quality and operational indicators were identified on the basis, which could elaborate on the health status of the existing population in the district and determining efficiency of the services provided to them by public and private sector individually.
Results: It was found that in private hospital bed occupancy rate was only 55 percent whereas nearby public hospital served with a bed occupancy rate of 128 percent. The existing lag in bed occupancy rate (BOR) in private sector and over burden of public hospital could both be overcomed if healthcare was dealt as a unit rather then differentiating on the basis of economies of the population. This could not just help in coping up for improving health scenario but also improving quality of services as a whole in both the sector.

Health issues in urban areas of developing countries, which are experiencing a rapid growth but are characterized with lack of infrastructure, have been subject to researches in recent times under the massive rate of urbanization and rural to urban migration. The main objective of this study is to examine the health inequality in urban India and the health status of urban poor as compared to rural average in India. We have used the data from National Family Health Survey-3. To show the inequalities we have calculated Kuznet’s Index, Dissimilarity Index and Human Opportunity Index (HOI) values. We have carried out bivariate and multi-variate analysis over the indicators like, home and institutional deliveries, assisted deliveries, immunization, undernourishment, breastfeeding, anaemia, birthweight and also child health. We have found that though the urban people seem to be much healthier as compared to rural, the inequality indices show that urban health is no better than the average health of rural people, as depicted by Kuznet’s index for complete immunization, institutional deliveries, breastfeeding or child health. The result urges policymakers to focus urgently on urban health especially among poor, besides their rural concern, since urban health being further aggravated with poor infrastructure and environmental condition.

There is a long standing debate on whether measures of subjective wellbeing are an adequate reflection of objectively assessed health states among a population. This question has not previously been empirically examined in Ghana. Using a representative sample of women aged 20 through 85 years from the second wave of the Women’s Health Study of Accra (WHSA II) conducted in 2008/2009, the study seeks to address this issue by investigating the strengths of a woman assessing her own subjective health as poor compared with her objectively assessed health outcomes after controlling for other covariates. The study employs descriptive, bivariate and multivariate analysis to describe the general health situation among urban women in Accra. The results show that 31.7% and nearly one-fifth of women in Accra are living with a chronic condition or hypertensive. The bivariate analysis also showed that a higher proportion who assessed their subjective health as poor were having a medical condition.
Although, subjective health measures can be employed to supplement objectively assessed health outcomes as surveys cover a wider population; its influence is mixed. Subjective health measures are not substitute for medical examination; they provide simple and inexpensive ways of identifying people at risk of chronic morbidity and mortality.

In Kenya, diarrhea is among the leading causes of childhood mortality, despite being easy to prevent and treat, it causes about 1.5 million under-five deaths annually. Adverse health outcomes due to diarrheal diseases are worse in slums, however they are preventable with appropriate and prompt healthcare-seeking.The study aims at exploring the healthcare-seeking practices of caregivers with under-five children in two slum settlements in Nairobi, Kenya. Specifically to identify care-seeking practices of caregivers of under-five children with diarrhea; determine the prevalence of appropriate healthcare-seeking practices and identify socio-demographic factors associated with care-seeking practices of caregivers.The study uses data from a project nested into the Nairobi Urban Health and Demographic Surveillance System, which collected information on morbidity for children reported to be ill over the last 2 weeks preceding the survey. Results show that healthcare-seeking practices for diarrhea remains a great challenge among the urban poor with more than half (55%) of the caregivers seeking inappropriate healthcare. Use of ORS and Zinc supplements which are widely recommended for management of diarrhea is very low. The critical predictors of healthcare-seeking identified are duration of illness, place of residence and the child’s age

Indonesia is a large multi cultural country. Development of transportation infrastructure, social, education and economic opportunities encourage people to move not only in the same sub district or regency or province but also moves across provinces.Hence intermarriage between individual with different ethnic background is bound to happen. Using the Indonesia Family Live Survey (IFLS), this paper explore the level of matching of the ethnic, religion, education and age of spouses and family background of three cohorts: born before 1962, born 1962-1976 and born after 1976. The paper also examines the correlation of the matching of the characteristic of the spouse with mental health condition of the person. The descriptive statistics and multivariate regression used to explore matching characteristic and family background of the spouse and its correlation with mental health controlling for social condition of the individual, household and community. Different Ethnic group of spouse significatly increase felt bothered by things that usually don’t bother, felt depressed, felt fearful and felt lonely. Living in urban and outside Java worsen mental health condition of couple with unmatched characteristics

This study examines the prevalence rates and social determinants of two mental impairment outcomes, self-reported depressive symptoms and perceived stress, among rural-to-urban migrants in Shenzhen and Shanghai, two popular destinations of rural-to-urban migration in China. Two cross-sectional surveys were separately conducted, one in Shanghai in 2008, the other in Shenzhen in 2010. The two questionnaires were designed similarly with the purpose of making meaningful comparisons between the two samples of rural-to-urban migrants located in the two cities. The rationale of this comparison was based on the distinct socioeconomic and cultural features of the two cities with Shenzhen arguably a culturally more welcoming receiving community for migrants. Social factors examined in this study as covariates of mental health were selected based on theories of mental health of migrants including perspectives on migrants’ socioeconomic achievements, social resources, and goal-striving stress. Preliminary results show that rural-to-urban migrants in Shenzhen compared to those in Shanghai on average report higher numbers of depressive symptoms but are less stressed. Many social factors hypothesized and examined as covariates of mental health and explainers of the location differences turned out to be significant in expected directions.

Au Gabon, selon l’EDSG 2012, il existe des différences significatives entre le milieu urbain et milieu rural au niveau de la prévalence des IRA, de la fièvre et des maladies diarrhéiques des enfants de moins de 5 ans. C’est également le cas pour le recours aux soins lors des épisodes de ces maladies.
Les enfants du milieu urbain sont proportionnellement plus nombreux que ceux du milieu rural à souffrir des IRA (10.3 % contre 9.5 %). Ils sont également, proportionnellement plus nombreux à souffrir de fièvre (30.2 % contre 27.4 %). Par contre, ils sont proportionnellement moins nombreux à souffrir de diarrhées (19.8 % contre 20.2 %).
Quel que soit la maladie, la propension à rechercher un traitement auprès d'un personnel qualifié est plus élevée en milieu urbain qu’en milieu rural.
Pourquoi les différences observées au niveau de la prévalence et du recours aux soins entre ces deux milieux ?
Les différences entre les deux environnements sont nombreuses. En effet, alors que la ville se caractérise des quartiers dépourvus des services d’hygiène adéquats (ordures non ramassées, eaux usées non canalisées etc.) et un air pollué par les véhicules, La campagne est confrontée à une triple barrière à l’accès aux soins : géographique, économique et culturelle.
Comment ces différences expliquent la prévalence et le recours aux soins?

Indian government has initiated the world’s largest Integrated Child Development Services (ICDS) in 1975 through community level anganwari centres (AWC). However, nearly half of the children under five years of age are still under nourished and merely one- third of babies are weighed immediately after birth. The present paper seeks the utilization of ICDS programme in India and examines the unmet need of the service to the children and their mothers and uses information from 51887 children (0-71 months), 55550 pregnant women, and 51837 lactating mothers from NFHS-3. The results show that only 32.9 percent children had received any services from AWC, which means two third of children did not received any services from AWC in the country. The unmet need is high in urban areas, with OBC membership and among Muslim. To reduce this unmet need one should focus up on why not people with high education and belong to upper strata of society utilized the ICDS services? The purpose of programme is to reach to every sections of the society with well acceptance and provide proper services to the target population. There must be some gap in the programme implementation which might make it not acceptable to all and create a cavity of unmet need.