Infant mortality in the Indian slums: case studies of Calcutta metropolis and Raipur city

Socio-economic and environmental vulnerability of urban slums: a case study of slums at Jammu (India)

Rapid urban population growth, the urbanization of poverty, and the proliferation of slums are being driven to a great extent by this dynamic form of globalization. Consequently, the multifaceted effects of globalization on the poor and low-income populations in the cities need to be better understood in this context, both at the individual level and within the community. Therefore, the present study was conducted to highlight the various determinants affecting the lives and enhancing the vulnerability of the dwellers of four slum settlements present in various areas of Jammu City, India. Emphasis was made to integrate biological, physical, social, and spatial facets of vulnerability to understand the complex dynamics of urban areas in developing countries. A descriptive survey design was used for questions concerning the social and environmental aspects. Social aspects including age, sex, education, religion, caste, profession, and family income that correspond to social stratification acted as baseline information, while both indoor and outdoor environments such as housing conditions, sanitation, personal habits, solid waste disposal, disaster proneness, and air and water pollution problems were taken into consideration to assess the environmental aspect. Results indicated that the slum settlement has a migratory population with permanent or temporary settlements. The status of education and skill level is poor which results in poor economic development and social well-being of the dwellers in slums. The study also identified vulnerability of the population on social and environmental front which could result into severe health issues. The study concluded and recommended policy planning specified for slums for uplifting such unprivileged populations.

Effect of public health expenditure on maternal mortality ratio in the West African Economic and Monetary Union

INTRODUCTION

Maternal mortality in West African Economic and Monetary Union countries (WAEMU) is the highest compared with other regions in the world. The majority of health care sources in WAEMU are private and largely involve out-of-pocket expenditures, which may prevent healthcare access. Maternal mortality is an important indicator of the level of attention given to mothers before, during and after childbirth and thus of a system's overall coherence and capacity for anticipation. Therefore, the objective of this study is to analyze the effects of public health expenditure on maternal mortality in WAEMU.

METHODS

The study used panel data from the World Bank Development Indicators (WDI) from 1996 to 2018 covering 7 countries in the West African Economic and Monetary Union. The two-step least squares (2SLS) on health demand function was used to test the effect of public health expenditure on maternal mortality.

RESULTS

Public health care spending showed a significant negative association with maternal mortality. However, private health expenditure was positively associated with maternal mortality.

CONCLUSION

Public health care expenditure remains a crucial component of reducing maternal mortality. In this region, the authorities need to increase public health spending to build more health centers and improve the equipment of existing infrastructures. Additionally, it is important to reduce the financial barriers for pregnant women. To this end, the operationalization of universal health insurance could help reduce these financial barriers by reducing direct household payments.

Environmental quality, healthcare and research and development in Saudi Arabia

While global warming and climate change associated with increasing carbon dioxide are widely seen to be one of the most serious worldwide dangers to population health, little is known regarding "how" country alters the linkage between increasing CO2 emissions and population health outcomes. Current literature on the health effects of CO2 emissions recommends various factors that may establish a more robust link, including health expenditure and research and development. Therefore, the purpose of this inquiry is to examine the effectiveness of health expenditure and R&D in improving health outcomes through reducing CO2 emissions. Using data for Saudi Arabia over the period 2000-2018, the dynamic ordinary least squares (DOLS) technique shows that (i) health and R&D expenditures decrease infant mortality and increase life expectancy; (ii) health and R&D expenditures reduce CO2 emissions in all the estimated models; (iii) health and R&D expenditures can improve health outcomes through reducing CO2 emissions; and (iv) health and R&D expenditures have both direct and indirect effect on health outcomes. Policy implications and limitations are also discussed.

Institutional geographies in dying: nurses' actions and observations on dying spaces inside and outside intensive care units

This paper articulates the geographies associated with intensive care nursing work with dying patients and their families. Six focus groups were conducted with 27 registered critical care nurses who practice in hospitals in a mid-western city in the United States. The analysis is structured by three emerging themes (i) the importance of a 'good' and 'sacred' place, (ii) the body as mapped by medical specialties, and (iii) problems with procedurally driven suspension of 'do not resuscitate' orders beyond intensive care units (ICUs). Recommendations describe the need for institutional recognition of the moral importance of strong relationships between nurses, clients, and their families, and nurses' wide-ranging roles in bridging the various spatial domains of intensive care.

Causes of child deaths in India, 1985-2008: a systematic review of literature

OBJECTIVE

To understand the causes of child deaths in order to implement appropriate child survival interventions in the country. We present a systematic review of studies reporting causes of child, infant, and neonatal deaths from India for 1985 to 2008.

METHODS

PubMed, EMBASE, Google Scholar, and WHO regional databases were searched along with a hand search and personal communication with researchers in child health to obtain studies and reports for the database. Study data was summarized and analyzed using appropriate statistical tools.

RESULTS

We identified 28 published/unpublished studies and reports (6 multi-centric and 22 single sites). There was one nation wide study and rest were from 15 unique sites in 9 different states of India. There were differences in study design and cause of death assignment methods between the studies, which made comparisons and synthesis difficult. The median percentage of causes of deaths in neonatal period were sepsis/pneumonia: 24.9% (Q1: 19.6% and Q3: 33.4%); asphyxia: 18.5% (Q1: 14.2% and Q3: 21.9%); and pre-maturity/LBW: 16.8% (Q1: 12.5% and Q3: 26.5%). Amongst the infants, sepsis/pneumonia, asphyxia, and prematurity/low birth weight (LBW) remain substantial causes of deaths. The median proportional contribution of neonatal deaths to total infant deaths was 48.5% (Q1: 36.5-Q3: 57.5%). The proportion of deaths due to infectious diseases like diarrhoea, pneumonia, and measles seem to be greater in infancy, in comparison to that in neonatal period. There was no statistically significant difference in the proportional contribution of neonatal deaths to total deaths occurring during infancy (<1 year) between the two equal periods before and after 1996 (p = 0.141). There also was no difference in the proportional contribution by cause of death assignment method (Verbal autopsy vs. other methods; p = 0.715) or by study setting (urban vs. rural; p = 0.175). The median percentage of neonatal deaths by day 1 is 36.7% (Range: 20.0-58.0%). The median cumulative percentage of neonatal deaths by day 3 was 49.7% (Range 35.0-64.6%), and 70.9% (Range: 46.5-92.3%) by day 7. In addition, the timing of deaths during neonatal period seems to be static during the last 2 decades, with majority of deaths occurring during first week of life.

CONCLUSIONS

This review demonstrates the need for more studies with consistent methodological rigor investigating the causes of child death in India. We conclude that the structure of neonatal causes of death in India may be different from the rest of the world and that interventions to reduce neonatal deaths in first week of life may rapidly improve child survival in the country.

Is mortality among under-five children in Nairobi slums seasonal?

OBJECTIVE

To investigate the seasonal pattern of overall mortality among children aged below 5 years living in two informal settlements in Nairobi City.

METHODS

We used data collected from January 2003 to December 2005 in the Nairobi Urban Health and Demographic Surveillance System on demographic events (birth, death, and migration). Analyses of seasonal effects on under-five mortality are based on Poisson regression controlling for sex, age, study site and calendar year.

RESULTS

During the study period, there were 17 878 children below 5 years in the study sites. Overall 436 under-five deaths were recorded. The overall death rate for the under-five children was 19.95 per 1,000 person years. There is a significant seasonal variation of under-five mortality. The mortality risk was significantly higher in the second and third quarters of year than in the fourth quarter (RR = 1.6, CI: 1.3-2.2 and RR = 1.5, CI: 1.1-2.0).

CONCLUSION

This paper demonstrates that overall mortality among under-five children in the urban poor is seasonal. Overall during the second quarter of the year, the death rate increases by nearly twofold. This evidence generated here may help to support well targeted interventions in reducing under-five mortality in the slums.

Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

Background

Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups.

Methods

We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores.

Results

Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08).

Conclusion

Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for healthcare provision strategies to take account of both sectors.

Infant mortality in an urban slum

OBJECTIVE

Infant and child mortality are important indicators of the level of development of a society, but are usually collected by governmental agencies on a region wide scale, with little local stratification. In order to formulate appropriate local policies for intervention, it is important to know the patterns of morbidity and mortality in children in the local setting.

METHODS

This retrospective study collected and analyzed data on infant mortality for the period 1995 to 2003 in an urban slum area in Vellore, southern India from government health records maintained at the urban health clinic.

RESULTS

The infant mortality rate over this period was 37.9 per 1000 live births. Over half (54.3%) of the deaths occurred in the neonatal period. Neonatal deaths were mainly due to perinatal asphyxia (31.9%), pre-maturity (16.8%) and aspiration pneumonia or acute respiratory distress (16.8%), while infant deaths occurring after the first mth of life were mainly due to diarrheal disease (43%) and respiratory infections (21%).

CONCLUSION

These results emphasize the need to improved antenatal and perinatal care to improve survival in the neonatal period. The strikingly high death rate due to diarrheal illness highlights the requirements for better sanitation and water quality.

Cross-national variation in family influences on child health

Drawing on the family process literature, child health models, and recent studies of macro-level effects on health, we examine the effects of household structure, resources, care-giving, reproduction, and communication on child nutritional status and infant mortality. Using Demographic and Health Surveys, we analyze the influence of these factors across 42 countries in Latin America, Africa, and Asia. We also consider country-level including nontraditional family structure, level of economic development and expenditures on health care. Our results underscore the importance of family resources, decision-making, and health and feeding practices on child well-being in less developed countries. Although there is cross-national variability, the size of the variability was small relative to the overall effect. The country-level measures had modest effects on infant mortality and child nutritional status.