Predictors of indoor PM2.5 and CO in an urban slum settlement in Fort Portal city, Uganda

Water, sanitation and hygiene (WASH) factors are responsible for 11.4% of deaths in Zambia, making WASH a key public health concern. Despite annual waterborne disease outbreaks in the nation’s peri-urban (slum) settlements being linked to poor WASH, few studies have proactively analysed and conceptualised peri-urban WASH and its maintaining factors. Our study aimed to (a) establish residents’ definition of peri-urban WASH and their WASH priorities; and (b) use ecological theory to analyse the peri-urban WASH ecosystem, highlighting maintaining factors. Our study incorporated 16 young people (aged 17–24) residing in peri-urban Lusaka, Zambia in a photovoice exercise. Participants took photographs answering the framing question, ‘What is WASH in your community?’ Then, through contextualisation and basic codifying, participants told the stories of their photographs and made posters to summarise problems and WASH priorities. Participant contextualisation and codifying further underwent theoretical thematic analysis to pinpoint causal factors alongside key players, dissecting the peri-urban WASH ecosystem via the five-tier ecological theory ranging from intrapersonal to public policy levels. Via ecological theory, peri-urban WASH was defined as: (a) poor practice (intrapersonal, interpersonal); (b) a health hazard (community norm); (c) substandard and unregulated (public policy, organisational); and (d) offering hope for change (intrapersonal, interpersonal). Linked to these themes, participant findings revealed a community level gap, with public policy level standards, regulations and implementation having minimal impact on overall peri-urban WASH and public health due to shallow community engagement and poor acknowledgement of the WASH realities of high-density locations. Rather than a top-down approach, participants recommended increased government–resident collaboration, offering residents more ownership and empowerment for intervention, implementation and defending of preferred peri-urban WASH standards.

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Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽

10.1136/bmjopen-2020-045997 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045997

Author(s):

Abhijit Pakhare ◽

Ankur Joshi ◽

Rasha Anwar ◽

Khushbu Dubey ◽

Sanjeev Kumar ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Multivariate Analysis ◽

Urban Slum ◽

Primary Care Providers ◽

Health Facilities ◽

Care Providers ◽

Community Based ◽

Public Health Facilities ◽

Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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