Child health in urban areas

This paper contributes to the analysis of the relation between child malnutrition and morbidity by providing a comprehensive assessment of the mutual impacts of the two phenomena. We investigate the synergistic relationship between malnutrition and morbidity among infants in Nairobi's poor urban settlements using data from 3,459 children enrolled in an ongoing Maternal and Child Health Longitudinal study. For our analysis we use a joint dynamic framework to account for persistence in a given nutritional or morbidity status, and also for dynamic cross-effects between the two phenomena. We address the econometric challenges associated to our analytical framework using a bivariate random effects dynamic probit model, a bivariate extension of Wooldridge approach. This paper contributes to the literature in two ways. First, we propose an analytical framework that examines both dynamics of malnutrition and morbidity and analyze the contamination process between them, which permits to investigate the interactions existing across the two problems. Second, we contribute to shed light on a very important empirical question: does malnutrition interact identically with all common forms of morbidity, or is its effects stronger for some types of morbidity than others? Answer to this question may have important policy implications.

Aim- To understand and explain the temporal process and dynamics of decision-making on intrapartum care for first births among the urban poor in India.
Methods- The study uses a qualitative longitudinal research design. Two stages of semi-structured in-depth interviews were conducted in January-July 2012 with primiparous women, as well as their husbands, mothers-in-law and/or mothers (depending on the composition of their household around the time of the birth). The first interview was conducted in the third trimester of pregnancy and the second within the first 8 weeks postpartum. 16 households were sampled purposively from 12 slums in Indore, Madhya Pradesh. Data were coded and analysed thematically.
Results- Households identify and register at a facility as a priority, but leave financial and transport arrangements until the final stages. Where intentions for home delivery are influenced by strong norms and/or lack of experience with the health system in general, planning and preparation is limited. Intentions may change during pregnancy and outcomes do not always match intentions, regardless of preparedness, due to multiple influences at the individual, household and health system levels. There is a need to reconceptualise decision-making and birth preparedness as temporal processes with non-linear courses of action.  

There is yet a consensus on the effects of rapid urbanization on child health outcomes in sub-Saharan Africa. This study seeks to describe and compare trends in childhood mortality in Kenya between urban and rural areas using DHS data for 1993, 1998, 2003 and 2008/09. Infant, child and under five mortality rates by cohort and urban-rural residence and key determinants are estimated. Results show a narrowing gap in urban rural differentials in childhood mortality. Generally, childhood mortality has declined in both rural and urban areas, but the decline has been more rapid in rural areas. The narrowing gap may be attributed to the fact that most urban residents in Kenya now live in slum areas; with very poor living conditions including water and environmental sanitation, livelihoods and health services, hence the rate of decline in childhood mortality in urban areas does not match that in rural areas.

Since the levels of health and health care use are better in urban areas, the study of existing social and economic inequalities is neglected. Considering the importance and neglect of research in this area in India, this study aims to examine socio-economic inequality in maternal health care using latest data from a nationally representative survey. Using Concentration index, the level of socio-economic inequality has been measured in terms of three basic indicators of maternal health care : full antenatal care, safe delivery, and postnatal care. Though level of inequality is moderate at national level, state level variations are considerable in all three indicators.It is found that poorer states like Bihar and Uttar Pradesh have lower levels of maternal health care use and higher levels of socio-economic inequality. On the other hand states like Kerala and Tamil Nadu have almost universal coverage of maternal health care and hence almost no inequality. It is also worth nothing the states in North India have a large share in national urban population. Thus they require immediate attention not only terms of raising level of utilization of maternal health care but also reduction of existing inequality.

In 2009, more than 37 thousand Brazilians died due to traffic accidents. Of these, 35% were between 15 and 29 years old and 81.5% were men. The number of people who lose their lives in traffic accidents is rising since the beginning of the 2000´s.
Meanwhile, the mortality by this cause is declining in developed countries. Until the end of 1980´s, the pattern of deaths by traffic accidents in Spain had similarities with the one observed for Brazil. In 1989, the country invested in traffic security and mortality fell from 18.8 to 6.65 deaths / 100.000 persons in 2009. In Brazil, this rate went from 22.22 in 1990 to 20.11 deaths / 100.000 persons in 2009 (rates standardized by the Spanish population in 1981).
The aim of this article is to analyze the characteristics and changes in the patterns of traffic mortality in both countries.

An individual is rational about making healthcare choices and despite of availability of TB drugs at door steps; people are not using it as their direct healthcare choice. In the present study an attempt has been made to study the factors leading to different healthcare choices in presence of social barriers which is often attached to stigmatized diseases like TB. A small scale survey data on 367 TB patients have been collected from high TB incidence area to capture the factors responsible for various healthcare choices made for treatment of tuberculosis. Bi-variate results shows that age, sex, marital status, level of education and economic status is significantly related to mean number of healthcare choices made. Despite of this, only eight percent of patient directly went to DOTS centre for check up. It is also observed that those with earlier experience of TB in the household make more healthcare choices. Discrimination faced due to TB is also significantly influencing the number of healthcare choices made for treatment. There is clear indication that somewhere tuberculosis program has failed to gain faith and believe on treatment provided for treatment of tuberculosis within community.

It is well known that urban slums represent some of the most hazardous and unhealthy living conditions in which human populations reside today. As urban populations swell globally, accurate and up to date information on the location and distribution of the urban poor is essential for effective policymaking. However, in India, as in many other rapidly urbanizing low and middle income countries, not all slum dwellers are poor and not all poor are slum dwellers. This paper explores the sensitivity and specificity of two slum designations – survey enumerators’ and Census – in eight Indian cities using data from the third National Family and Health Survey. The gold standard of comparison is the respondents’ actual reporting of their toilet facilities, water source, housing materials, crowding and security of tenure. Preliminary analyses indicate that neither survey nor census slum designation well identify urban residents in need of services. Slum designation may be uninformative because it becomes quickly obsolete in a rapidly changing urban area, or because it puts too much of a focus on legality, among other reasons. This paper is intended to contribute to a more nuanced understanding of the heterogeneity of urban India and to inform more targeted health and development policies on behalf of the urban poor.

This paper examines the trends of socioeconomic inequality in childhood undernutrition in urban India using data from all three rounds of the National Family Health Survey conducted during 1992-2005. We analyzed the prevalence of underweight (weight-for-age) among children less than three years old. The socioeconomic predictors were: household wealth and maternal education. Principal component analysis was used to compute a separate wealth index for urban India for all three rounds of the survey. Descriptive statistics, concentration index, and pooled logistic regression technique was used to analyze the data. In general, the prevalence of underweight has declined constantly in urban India, but the current level is still high. Moreover, the decline was greater during 1992-98 than 1998-05. Socio-economic inequality in childhood undernutrition has either widened or stagnated over the study period. Result of pooled regression analysis suggests that decline in the prevalence of underweight was higher among children of the richest quintile compared to the poorest quintile, among most educated mothers compared to uneducated mothers in urban India during 1992-2005. The salient findings of this study call for separate program targeting the children of lower socio-economic groups of urban population.

The present study examines urban-rural differentials in maternal health care services in the regions of Madhya Pradesh by demographic and socio-economic characteristics using third round of District Level Household and Facility Survey (2007-08). Bivariate and multivariate techniques have been used for analysis. Result shows wide gap between rural and urban areas in utilizing maternal health care services in the regions of Madhya Pradesh. Malwa and South Central Region are the best performing region while South Western and Northern Region are the worst performing regions. Full ANC is very low in Madhya Pradesh. But there is much variation among the regions and within the regions among rural and urban areas. Almost half of the women in Madhya Pradesh had safe delivery. There also prevails noticeable difference in safe delivery and PNC. Multivariate analysis shows that education is a key factor that influences the utilization of maternal health care services.

According to census of India (2011) almost 30 per cent population lived in urban cities whereas mass majority 70 per cent are residing in rural areas. One side Metropolitan cities become the hub of economic activity or opportunity on the other side rural population; have no other alternative choice except farming. For livelihood strategy so many people daily migrants rural to urban cities, it is one of the most dominant streams of internal migration in India. Internal labour migration has become an important livelihood strategy for many poor groups across India. However, this segment of the population faces exclusion from the various mainstream programs such as education, health, adequate living conditions, minimum wages and freedom from exploitation and harassment. This increases the vulnerabilities of migrants and lead to their poor health status which has significant public health implications.
This paper is attempted to examine of living, working and health aspect of migrants cycle rickshaw pullers in Delhi. They are the most important part of transport service provider of local population in Delhi. This segment of the population faces exclusion from the various mainstream programs such as education, health, adequate living conditions, minimum wages and freedom from exploitation and harassment.