SLUM DISTRIBUTION: CASE STUDY OF DEHRADUN CITY

Slum is one of the characters in our urban system. They are more vulnerable section of our society in all kinds of disaster - flood, heat wave, etc. The slum population is already crossed 65.5 million (22.5 percent) that distributed in 2613 towns/cities in India as per census, 2011. In this context, slum distribution scenario has been conducted in Dehradun city, India. It is the capital city of Uttarakhand state located in the foothill of Himalaya with a population of approximately 578420 (census 2011). The aim of this study for slum distribution in wards wise within Dehradun city to draw a lesson to understand the scenario of services facilities in the selected wards – ward number 14, 20, 35 and 36. The objectives are – (1). to study the slum distribution in Dehradun city through mapping, (2) to study the slum households shared in ward wise in the administrative boundary of Dehradun city and, (3) to study the comparative scenario of services sectors such as water supply, drainage, and solid waste management. The methodology has adopted based on the secondary data available to public domain and field investigation and observation.

Measuring Vulnerability to Flash Flood of Urban Dwellers

Flash floods are unexpected, localized flood events that occur when an exceptional amount of rain falls happens over a short period of time. In South Asia, it is mostly disastrous, for example, in 2017 flash floods killed approximately 1200 people from India, Nepal, and Bangladesh. However, it is also common in Dhaka megacity, Bangladesh due to its geographic location, monsoon climatic condition and surrounding rivers. Though it is impossible to avoid them, the losses and damages of hazards can be reduced effectively by using appropriate techniques. This study aims to determine the responsible factors and measure the household vulnerability to flash flood as a tool of mitigation. The study has been conducted based on primary data. Therefore, data were collected from both slum and non-slum population to cover the entire urban habitats. Data were collected with a structured questionnaire based on five factors (social, economic, institutional, structural, and environmental) of vulnerability to flash flood. The key feature of this paper is to provide an insight into real picture of vulnerability to flash flood for urban habitants. Moreover, this practical approach is useful to quantify hazard-induced vulnerabilities not only for Dhaka megacity but also for other cities of the globe.

Oral hygiene behaviour and practices of urban slum population: a cross-sectional study

Background: Poor oral hygiene is a major etiological factor for oral diseases. Urban slums are identified as a risk group population as the burden of oral diseases is high among them. So, the aim of the study was to evaluate oral hygiene status among the urban slum population.Methods: A cross-sectional study was carried out on 480 urban slum people aged between 18 to 75 years. A cluster random sampling method was adopted. Data were collected by structured questionnaire. The questionnaire included information related to patient’s knowledge, attitude, and practices related to their oral hygiene. Descriptive statistics were used to analyse the data.Results: The majority of people brushed their teeth once a daily (58.3%) by using a toothbrush and toothpaste (65%) followed by mishri and charcoal. 81.7% of people did not use any other oral hygiene aid. The majority of people did not use interdental aids, tongue cleaner, mouthwash. The majority of people (72%) know the harmful effect of tobacco still they consume various forms of tobacco. The results showed an acute lack of oral hygiene awareness and practices as well as the effect of poor oral hygiene on systemic health.Conclusions: There is a need to educate the urban slum population regarding proper dental care, oral hygiene methods, and prevention of dental diseases through dentists, outreach programs, effective oral health education, and promotion programs to make healthy individuals and healthy society.

Coping with the financial hardships caused by ill health – Urban Slums of Jaipur, India

Accountability of any health system does not ends with improving health. The vulnerability (to incur catastrophic health expenditure and coping mechanism) of this slum population was mostly pertaining to availability of acceptable healthcare services, accessing healthcare services and being forced to pay for it out-of-pocket. Determinant factors for vulnerability to incur catastrophic health expenditure and coping mechanism majorly included services availed. Determinants that affected the choice of coping mechanism were availing ANC/PNC services (OR = 3.8; P < 0.05); availed out-patients services for two or more times (OR = 2.6; P < 0.05); and availed in-patients services for one or more times (including deceased members in last one year) (OR = 10.2; P < 0.001). Similarly, households vulnerable to incur CHE were those which paid to avail in-patients services for one or more times (OR = 55.3; p < 0.001), childbirth services for one or more times (OR = 6.5; p < 0.05) Out-patient services (OR = 11.3; p < 0.001), and ANC/PNC services (OR = 6.7; p < 0.05. The household with more number of the households were two times more likely to incur CHE (OR = 2.5; p < .0001).

Knowledge of Pulmonary Tuberculosis among Urban Slum and Rural Population of West Tripura District - A Comparative Study

BACKGROUND Globally, tuberculosis (TB) is one of the top 10 causes of death due to infectious diseases. TB continues to rank among world’s most serious health problems despite effective diagnostic & treatment measures. The objectives of the study were to asses and compare the knowledge of tuberculosis among rural and urban slum population and identify the factors associated with their knowledge of tuberculosis. METHODS A cross sectional study was conducted and multistage random sampling technique was applied for selection of the individual study subjects. Data was collected using a semi-structured and pre-tested interview schedule. RESULTS 200 individuals were included in the study with an overall mean age (SD) of the individuals of 36.66 (± 13.091) years. 189 (94.5) participants had heard of tuberculosis. 36 (37.9 %) urban slum and 20 (21.3 %) rural participants said that cough is the most common symptom of pulmonary tuberculosis. 42 (52.5 % among rural population was having good knowledge (rural vs. urban; 52.5 % vs. 47.5 %) compared to urban slum population. Literacy (P = 0.049) and family type (P = 0.044) have played a significant role in acquiring good knowledge of tuberculosis among the participants irrespective of their place of residence. CONCLUSIONS There was no significant difference in the knowledge of TB among rural and urban slum population. Literate persons were more aware compared to illiterate population irrespective of their place of living. In spite of having good awareness regarding TB, in general the knowledge level on risk factors was not satisfactory and needs further improvement. Therefore, a special drive has to be started for imparting knowledge to the community regarding risk factors as this could prevent further occurrence or progress of TB. KEYWORDS Tuberculosis, Knowledge of TB, Urban Rural Difference

PERCEPTION ABOUT ORAL CANCER AND ITS RISK FACTORS IN AN URBAN-SLUM POPULATION OF JODHPUR CITY

Background: India contributes for one-third of the total burden of oral cancer worldwide. Lower socioeconomic groups are more affected with oral cancer as they are more attracted towards tobacco consumption and diagnosed in later stages due to lack of health-related awareness and diagnostic tools. Therefore, this study was conducted to assess the knowledge and awareness about oral cancer, its risk factors and to ascertain the distribution of risk factors in the urban slum population. Methods: A cross-sectional survey conducted in the urban-slum population of Jodhpur in 2019 using cluster sampling strategy to collect data from 1200 participants. The semi-structured questionnaire was used to obtain information on knowledge and awareness for oral cancer, its risk factors, signs, symptoms and distribution of different patterns of risk factors for oral cancer. Results: Out of surveyed 1200 participants, 48.5 % were males and 51.4 % were females. 46.6% males and 53.4% females of the study population heard about oral cancer Among study population, 28.9 % reported tobacco, 27.8% smoking, 29.8% alcohol and 27% betel-nut chewing as risk factor of oral cancer. Almost 53% considered oral cancer as a consequence of dental treatment and 49% believed that it can transmitted through close contact. The knowledge about signs or symptoms of oral cancer was quite low in urban-slums. Consumption of various risk factors like tobacco, alcohol, both alcohol and tobacco, arecanut were significantly associated with gender. Conclusion: This study highlights the lack of awareness regarding oral cancer and its risk factors in the urban-slum population. A significant number of the population in the study were tobacco or alcohol users which makes them more vulnerable to oral malignant diseases. This emphasized the need for health education interventions for raising oral cancer awareness in these high-risk groups. Keywords: Awareness, oral cancer, tobacco, urban slum

Smokeless tobacco and its dependence among the urban-slum population of Jodhpur city

Background: Socio-economic status can be an important determinant for patterns of tobacco consumption and its related health risks. Easy availability and affordable price may lead to the indulgence of smokeless tobacco; this deprived the section of society towards addiction of smokeless tobacco. Therefore, this study was conducted to ascertain smokeless tobacco use and its dependence in urban slum population of Jodhpur city.Methods: A cross-sectional survey was conducted in the urban-slum population of Jodhpur in 2019. A cluster sampling strategy was used to collect data from 1200 participants in different slums of Jodhpur city. The semi-structured questionnaire was used to obtain information on tobacco usage and willingness to quit.Results: Out of surveyed 1200 participants, 48.5% were males and 51.4% were females. 65.7% of the tobacco users reported in study population. Among tobacco user’s majority were using smokeless tobacco (75.4%), followed by 14.8% dual tobacco users and 9.8% were smoking tobacco. Out of female and male tobacco users, 95% females and 86.3% males were using smokeless forms of tobacco respectively. The frequency of daily tobacco use, time of tobacco chewing, duration of tobacco use was significantly associated with gender. No significant association was found between willingness to quit and gender.Conclusions: Smokeless tobacco was prevalent as compared to smoking form in urban-slums of Jodhpur city. Younger population and women were more attracted towards smokeless tobacco and willingness to quit tobacco was equally prevalent among males and females. An effective health education strategy for tobacco cessation should be designed according to age and gender of urban-slums.

Trade-offs between cost and accuracy in active case finding for tuberculosis: A dynamic modelling analysis

Background Active case finding (ACF) may be valuable in tuberculosis (TB) control, but questions remain about its optimum implementation in different settings. For example, smear microscopy misses up to half of TB cases, yet is cheap and detects the most infectious TB cases. What, then, is the incremental value of using more sensitive and specific, yet more costly, tests such as Xpert MTB/RIF in ACF in a high-burden setting? Methods and findings We constructed a dynamic transmission model of TB, calibrated to be consistent with an urban slum population in India. We applied this model to compare the potential cost and impact of 2 hypothetical approaches following initial symptom screening: (i) ‘moderate accuracy’ testing employing a microscopy-like test (i.e., lower cost but also lower accuracy) for bacteriological confirmation and (ii) ‘high accuracy’ testing employing an Xpert-like test (higher cost but also higher accuracy, while also detecting rifampicin resistance). Results suggest that ACF using a moderate-accuracy test could in fact cost more overall than using a high-accuracy test. Under an illustrative budget of US$20 million in a slum population of 2 million, high-accuracy testing would avert 1.14 (95% credible interval 0.75–1.99, with p = 0.28) cases relative to each case averted by moderate-accuracy testing. Test specificity is a key driver: High-accuracy testing would be significantly more impactful at the 5% significance level, as long as the high-accuracy test has specificity at least 3 percentage points greater than the moderate-accuracy test. Additional factors promoting the impact of high-accuracy testing are that (i) its ability to detect rifampicin resistance can lead to long-term cost savings in second-line treatment and (ii) its higher sensitivity contributes to the overall cases averted by ACF. Amongst the limitations of this study, our cost model has a narrow focus on the commodity costs of testing and treatment; our estimates should not be taken as indicative of the overall cost of ACF. There remains uncertainty about the true specificity of tests such as smear and Xpert-like tests in ACF, relating to the accuracy of the reference standard under such conditions. Conclusions Our results suggest that cheaper diagnostics do not necessarily translate to less costly ACF, as any savings from the test cost can be strongly outweighed by factors including false-positive TB treatment, reduced sensitivity, and foregone savings in second-line treatment. In resource-limited settings, it is therefore important to take all of these factors into account when designing cost-effective strategies for ACF.

Relationship between availability of basic amenities and proportion of Slum population in Maharashtra

The urban centers offering diverse employment opportunities and means of livelihood are the main centers of attraction for migration. But the availability of infrastructure is low to accommodate the invariably growing population. The access to basic amenities like electricity, drinking water, toilet facility, wastewater outlet and clean fuel are critical determinants of quality of urbanization. And if it lacks, then it would facilitates the growth of slum. In this paper it being tried to capture the interdependent relationship between basic amenities and slum population residing in the class I towns in Maharashtra; largest slum populated state of India. As the slum is all about the situation or condition in which the people of medium and lower strata are living. A detailed analysis of proportion of slum population and availability of amenities which includes good housing condition, treated tap water as the source of drinking water, electricity as the source of lightning, households having latrine and bathing facility within the premises, waste water outlet connected to closed drainage, and households availing the banking facilities. This may be a limitation of the study that only these indicators have been taken to assess the availability of amenities and to calculate the amenity index of class I towns of the state of Maharashtra. To achieve the sustainable development goal (Sustainable cities and communities), we have to control the growth of slum population and to combat the formation of slum; we have to analyze the situation of basic infrastructure provided in urban centers. Amenities and slum population has policy implications as to reduce the slum population, provide basic amenities to the households which will improve their standard of living and ultimately lead to reduction in growth of slum and check the future slum formation.