Child health in urban areas

Hypertension is a major public health problem in many sub-Saharan African countries including Ghana. The prevalence of hypertension in Ghana is on the increase and evidence suggests that awareness, management and control in urban poor communities are very low. The objective was to assess the prevalence, awareness and control of hypertension in Accra. The study was a cross-sectional study of adults in their reproductive ages (15-49 for women and 15-59 for men). The overall prevalence of hypertension was 28.3%. The prevalence increased with age in both men and women. Among respondents who had hypertension, 7.4% were aware of their condition, 3.9% were on antihypertensive medication while 3.5% of hypertensive respondents on treatment had their blood pressure controlled below 140/90 mmHg. The level of awareness and treatment was lower in men than in women. Among individuals on treatment, the level of control was higher among women compared with men. The low levels of awareness, treatment and control despite the high prevalence of hypertension should be a matter of concern to stakeholders in the health sector. Urgent medical assistance, which should be comprehensive, is advocated for implementation in such communities. The human resource needed to implement such plans should have adequate training.

Urban residents generally perform better on health indicators, leading to the belief that health conditions are better in urban areas. Urban averages, however, are deceiving. They can mask large differentials by SES and hide the problem of poor health among the impoverished. Uncovering the heterogeneity behind urban averages is crucial to improving health outcomes. This paper attempts to unmask these differentials, in the case of child malnutrition, in 16 Sub-Saharan African countries using data from Demographic and Health Surveys. Specifically, I will compare trends in malnutrition among the urban poor, urban non-poor, and rural residents. I include rural residents to assess how the urban-rural gap has changed. Because urban areas are diverse, I will examine trends in malnutrition by type of urban area (capital city vs. towns and cities). Using multilevel logistic regression, I will also test whether the urban poor have higher odds of malnutrition than the urban non-poor.

This study argues that urban health issues that consider the poor and the migrants as distinct groups in the urban context need not necessarily reflect accurate trends and patterns. Another concern is whether being urban poor as well as migrant is a double disadvantage in the utilization of safe delivery care service? Public health literature has paid little attention to the trends and factors that affect maternal and child health (MCH) among the migrants and the poor in urban India. Using data from the National Family Health Survey, 1992-93, 1998-99 and 2005-06, this study grouped the household wealth and migration status into four distinct categories: poor-migrant, poor-non migrant, non poor-migrant, non poor-non migrant. The present study identifies two distinct groups in terms of MCH care utilization in urban India – one for poor-migrant and one for non poor-non migrants. While poor-migrant women and their children were most vulnerable, non poor-non migrant women and children were the highest users of safe delivery care. This study reiterates the inequality that underlies the utilization of maternal healthcare services not only by the urban poor but also by poor-migrant women, who deserve special attention.

Bangladesh is one of the few developing countries that has been experiencing rapid urbanization. The paper examined the factors associated with infant mortality in urban area and health seeking behavior of the urban children. This study used data from the Bangladesh Urban and Health Survey 2006. Households’ socioeconomic status was measured using principal component analysis. Both descriptive and logistic regression analyses were used to assess the infant mortality differential of slum and non-slum areas. Infant mortality was astonishingly higher among the slum dwellers than among non-slum dwellers. The rich-poor gap in infant mortality is also significant. The prevalence of acute respiratory infection among the slum and non-slum children within two weeks preceding the survey was 14.3 percent and 10.8 percent respectively. In slum communities, children were 27 percent less likely to be taken to health facilities for treatment than non-slum communities. Wealth, migration status and the mother’s education are identified as important correlates of infant mortality. The findings of this study reveal that there are large differences in infant mortality rates between slum and non-slum urban areas. It will be difficult to achieve Millennium Development Goals if the government ignored the health care need of the urban poor.

Here we look at recent attempts to measure simultaneously trends in mortality and morbidity in African populations. We begin with the measures of health which are currently available for African populations including partially complete incidence data and survey data which include both self-report and objectively measured aspect of health. The relationships between different measures of health are discussed in some detail, making the point that standard measures of health status developed in high income populations seem to produce reliable and consistent results in Africa as well. The issues of selection which arise when we study the health of the elderly in relatively high mortality populations are reviewed.

Using the short form 36 as measures of self-reported health, we examined the levels and differentials of the norm-based scores in adult women in Accra Ghana. From their birth histories, we can discern strong differentials in under five mortality that are associated with education and a number of other socio-economic indices in the expected direction. Turning to the women's current health status, we find much narrower differentials in the indices of their self-reported health and indeed in several objective measures of health including height, weight, blood pressure and histories of recent hospitalization.

The present study is an effort to examine the prevalence of overweight and obesity among women, with special reference to their economic condition in urban India. An exclusive wealth index for urban India was constructed using principal component analysis (PCA) for the analysis of overweight and obesity variations among women of different economic background in urban India. The study found very high prevalence of overweight and obesity in urban areas, more noticeably among non-poor women. Further result shows that prevalence of overweight and obesity increases with age, education, media exposure and parity of women. However, for all covariates, the non-poor women have considerable higher proportion of overweight and obesity than women of poor families in urban India. The multinomial logistic regression result also shows that non-poor women are 2 and 2.6 times more on risk of being overweight and obesity respectively than their poor counterparts. Education, marital status and media exposure also shows significant and positive association with overweight and obesity status in urban India. Thus, the growing demand which is appearing now before the health planners in particular is that, to address this rising urban epidemiology with equal importance along with other prevailing issues.

In recent years, climate change has almost becomes synonyms with development of environmental hazards adversely affecting the living being. Its adverse affects are particularly large on those segments of populations where the current burden of climate-sensitive disease is high. One such category is urban poor which is characterized by cramp living spaces, lack of sanitation and safe drinking water, poor and unhygienic environmental conditions, poor socio-economic status etc. As a consequence, their major health indicators like, morbidity (due to communicable as well non-communicable diseases) and child death rate are higher than other sections of population viz, rural and urban non-poor. It has also been observed that unlike the rural areas, programs to address socio-economic development and healthcare needs in urban poor localities have limited impact on health outcomes. Why? Is it because living environment is quite degraded (inputs are rendered ineffective) or the interventions are not penetrating or accessed by all people to realize any measurable outcome?
This paper examines this phenomenon by taking India as a case. It analyses the health outcomes for urban poor in contemporary Indian communities against the backdrop socio-economic and healthcare developments, over a period of one decade.

Urban air pollution is an important environmental factor that is effecting a large portion of urban dwellers in developing economies. Due to the limitations of dose and impact nature, direct measurement of negative implications of urban air pollution is difficult and WHO has developed indirect methods such as Environmental Burden of Disease. However, in this study to measure the economic costs of urban air pollution, we find that WHO methodology needs modifications to suit local conditions.

Around 1900, after centuries of disadvantage, urban life expectancy passed its rural counterparts. The process can be linked with two broad phenomena: rising incomes and improved sanitation. We focus on Paris during the key period of the health transition (1880-1914) and assemble a longitudinal data set on mortality, income, and connection to sewer for each of the city’s 80 neighborhoods. We show that life expectancy in Paris was not very different from the rest of the country –around 50 years at age 5– but the difference between best and worst neighborhoods exceeded 10 years. These huge mortality differentials are strongly related to a variety of income indicators. Over time, mortality across neighborhoods first diverged and then converged. This pattern cannot be explained by variation in income or fixed neighborhood characteristics. It is due to the gradual diffusion of sewers that were adopted faster in rich neighborhoods than in poor ones.

The study examines the intersection between social support, food habits and health outcomes in Ghana. Patterns of fruit consumption is low in Ghana, we make the argument that fruits are not consumed because they are perceived as not filling or “heavy”, in a situation where people are managing food insecurity fruit consumption is not on the list of prioritised meals even with social supports. The data analysed are from the second round of the EDULINK project in three urban communities in Accra (659 individuals). Social support was measured by participant’s ability to ask for food help from neighbours. The total number of times fruits were consumed in a week was estimated for each participant using a food frequency questionnaire. Body mass index was measured using the body weight and height. Half of the respondents (50.1%) considered asking food help from neighbours. Fruit consumption ranged from 0-42 times in a week. About 42% of the sample was overweight/obese. Asking for food help from neighbours was decreased fruit consumption. Increase in fruit consumption decreased the probability of been overweight/obese. Age, sex and educational level of respondents were the main predictors of overweight/obesity. When people are asking for foods from neighbours fruits may not be on list of foods asked because of its cultural value.