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This study aimed to identify unmet and unperceived needs for T2D self-management among those residing in Tabriz slums, Iran, in 2022.
Background:
Type 2 diabetes (T2D) and its complications are more common among slum dwellers. T2D is a lifelong disease that requires continuous care. By contrast, slum dwellers are less likely to adhere to standard health care.
Methods:
This study is cross-sectional. We included 400 patients using a systematic random sampling method. Unmet and unperceived needs were assessed through a researcher-made questionnaire. The questionnaire was developed based on Iran’s Package of Essential Non-Communicable Diseases (IraPEN) instructions and an expert panel. Data were analyzed using SPSS version 22.
Findings:
Need for more healthcare cost coverage by insurance organizations (85.5%), financial support to provide medicine (68%), free and accessible sports equipment in the area (48.5%), continuous access to blood sugar test instruments (47.8%), know how to test blood sugar and interpret the results (47.7%), more communication with healthcare providers (42.3%), and detailed education from health professionals (41.2%) were the most common unmet needs. The least perceived need was to know how to care for feet (16%).
The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents’ health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
More than half of the world’s population now live in urban areas, many of them in low- and low-middle-income countries with limited ability to support urban growth. Urban areas are inherently fragile. Many cities are desperately overcrowded, with poor building construction, limited access, poor or absent waste disposal, limited or no access to clean water, irregular supplies of food, unreliable power supplies, inadequate emergency services, and problems with crime and violence. Healthcare is often poor or absent, with an increased risk of communicable disease outbreaks. Supply chains can easily be interrupted. Urban poverty and slums are proliferating with informal dwellings in areas vulnerable to natural disasters. The nature of urban areas can increase the impact of disasters, as was shown by the impact of the COVID-19 pandemic.
The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.
This chapter examines the relationships between volunteerism and religion, between youth activism and Islamic charity. During the reign of King ʿAbdallah, informal groups that advocated volunteering flourished among youth in Saudi Arabia. The rise of youth activism in Saudi Arabia is tied to the rise of social media.
At the heart of this chapter is the Young Initiative Group (YIG), an informal organization that grew out of the efforts of youth who distributed meals during Ramadan 2009. The chapter explores how the YIG negotiated alternative forms of belonging and community through charity work. The YIG embedded its volunteering practices within the religious obligation of alms and compassion for the needy. The group’s community approach was rooted in an Islamic ethics of care. This appeared to be both a reflection of the personal religiosity of some of its founders and strategic positioning vis-à-vis the authorities, given the initiative’s lack of legal status. The YIG’s rhetorical emphasis on family-like relations among volunteers, together with a critique of consumption patterns and references to Islamic norms of benevolence, created an apolitical profile of a group that promoted social reform.
Kibera is the largest informal settlement in Nairobi, Kenya, and Africa’s largest urban informal settlement. It is a community plagued by poverty and unemployment. In response to the social disorganization common to informal settlements, criminal activity is rampant, particularly in assault and sexual violence cases. Patriarchal beliefs fuel power imbalances which consequently perpetuate violence. Kenyan societies tend to be traditionally patriarchal and characterized by male privilege and female subservience. This article explores the narrative accounts of female victims of intimate partner violence (IPV) to overcome patriarchy in Kibera, Kenya. Through a qualitative inquiry, 32 female victims of IPV were interviewed, and the data obtained were thematically analysed. The findings established that patriarchy is sustained in Kibera through control, dominance and violence. Additionally, salient partakers in advancing patriarchy are family structures and authorities. Moreover, strategies to dismantle patriarchy and IPV are proposed through these narrative accounts.
An examination of the precarity and poverty of dispossessed lives in India, see through narrative non-fiction by Katherine Boo and Sonia Faleiro and with reference to Hollywood and Bollywood cinema.
The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations.
Methods
Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression.
Results
Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5–10.3), 10.8% (95% CI: 10.4–11.2) and 6.9% (95% CI: 6.6–7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9–9.3 v. 10.7%; 95% CI: 10.2–11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4–12.1 v. 11.3%; 95% CI: 10.8–11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77–0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78–0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57–0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66–0.79) and other (adjusted OR: 0.63; 95% CI: 0.45–0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes.
Conclusions
Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.
Day-to-day policing represents a fundamental interface between citizens and states. Yet even in the most capable states, local policing varies enormously from one community to the next. The authors seek to understand this variation and in doing so make three contributions: First, they conceptualize communities and individuals as networks more or less capable of demanding high-quality policing. Second, they present original survey data and semistructured interviews on local policing from over one hundred sixty slums, eight thousand households, and one hundred seventy informal neighborhood leaders in India that contribute to the nascent empirical work on comparative policing and order. Third, they find evidence that well-connected individuals and densely connected neighborhoods express greater confidence in and satisfaction with local policing. Critically, these differences do not appear to be a function of a lower propensity for local conflict but rather of an increased capacity to leverage neighborhood leaders to mediate relations with the police. The combination of analytics and empirics in this article provides insight into the conditions under which individuals and communities experience the police as expropriators of rents or neutral providers of order.
Chapter 4 provides background on the ten aspiring global cities and their theoretical and empirical comparability. Despite important variations, the cities examined share these core features: (1) They are key national and regional nodes of business and politics. (2) They experienced major and controversial redevelopment, which has caused different forms of displacement. (3) They have intensified the use of branding and cultural policies as engine of economic growth, often thereby promoting the “creative class.” The chapter presents data showing their shared prominence and discusses the high degree of institutional variation between the cities.There is significant variation in how markets and governments combine to pursue international competitiveness policies and the associated urban redevelopment. In developmental states, an essential feature is the elimination of informal settlements, with the consequent massive and brutal displacement of the poor, as examined in Seoul, Istanbul, Buenos Aires, and Santiago. In more advanced economies, a key dynamic is the erosion of public-sector housing, as illustrated for Hamburg. Redevelopment policies weresupported by city branding and legitimized by connections to cultural industries as new engines for economic growth, as examined in Tel Aviv, Seoul, Buenos Aires, and Los Angeles.
The inhabitants of slums have developed creative ways of addressing the inherent instability of their lives. Chułek analyzes two approaches to self-organizing work on the basis of data gathered in two slum areas of Nairobi, Kibera and Korogocho, arguing that the key element of slum inhabitants’ actions is the reproduction of structures which enable their survival by making their lives predictable. These structures are evident in the work of trash pickers and orodha people, who have developed a finely-tuned infrastructure that governs their actions while allowing room for as many as possible to participate. They can also be seen in the work of hustlers, whose “brain work” is dependent on their network of relationships and on their constant improvisation. These are two examples of the way that inhabitants of Nairobi’s slums manage to maintain a sense of autonomy and agency in the face of constant economic challenge.
Chapter 4 examines the book’s main protagonists – India’s slum leaders. I first draw on my ethnographic fieldwork and survey data to explore the strategies that residents use to claim public services. I find that India’s slum residents primarily orient their collective action toward the state, in the presence of informal slum leaders, to improve local conditions. The chapter then establishes the pervasiveness of slum leaders and their central place in local distributive politics. Next, it describes how slum leaders climb into their positions of informal authority, the material incentives that motivate them to make this gritty political ascent, and the diverse problem solving activities they perform for residents. I then argue that slum leaders must demonstrate efficacy to build a following – the base upon which they collect rents, attract patronage, and seek party promotion. The chapter subsequently describes the subset of slum leaders who have become party workers, absorbed into party organizations, and given positions within their hierarchies.
Chapter 1 motivates the central puzzle of the book: Despite a shared context of informality, patronage politics, and discretionary state institutions, India’s slum settlements are not uniformly marginalized in the distributive politics of the city. Instead, they exhibit dramatic variation in their capacity to organize and push the state to extend basic public services. The chapter begins with two vignettes that illustrate divergences in settlement organization and development. It then draws on official data and my own survey findings to establish wide variation in access to public services across India’s slums. Next, the chapter provides an overview of the book’s theoretical framework and foreshadows its contributions to several literatures in the field of comparative politics. Next, it positions the study at the intersection of several literatures and establishes why extant theories are insufficient in explaining inter-settlement variation in public service delivery. Next, the chapter defines the specific type of slum under study – squatter settlements – and introduces Jaipur and Bhopal. It then turns to the research design and data and concludes by mapping the remaining chapters.
Chapter 8 concludes. It revisits the substantive and theoretical motivations of the book and provides a brief summary of its main findings. The chapter then expands on the contributions of the book to our understanding of democracy and development in India and other rapidly urbanizing countries in the Global South, and subsequently discusses the book’s implications for the design and implementation of community-driven development programs.
Chapter 7 examines the formation of party worker networks, and the reasons why they vary so remarkably in their density and partisan distribution across settlements. The chapter presents quantitative evidence that key drivers of variation in party worker density are ethnic diversity and settlement population. Higher levels of social diversity increase the fractionalization of informal leadership within a settlement. Over time, parties attempt to bring slum leaders into their fold, increasing party network density in the process. The second is the population of the settlement. A slum’s population – the size of its “vote bank” – determines electoral incentives for parties to extend scarce patronage resources and positions to maximize votes.The chapter then takes an additional step backward, probing why settlements vary in their populations and levels of ethnic diversity in the first place. I find that idiosyncratic features of the urban geography and constraints over where poor migrants settle influence settlement size and ethnic diversity, providing analytical leverage in explaining their impact on party organization and, in turn, public services.
Chapter 2 situates the book in the context of a rapidly urbanizing India. It describes India’s demographic shift to cities and towns since Independence in 1947 and the concurrent proliferation of slum settlements. The chapter further outlines the formal institutions of governance in India’s post-decentralization cities and the sources of public finance that are used to provide services to slums. It then goes on to delineate the mediated, nonprogrammatic environment in which slum residents seek access to public services. The chapter ends with a description of the organizational structures of the Bharatiya Janata Party (BJP) and Indian National Congress (INC) in Bhopal and Jaipur and how they have percolated neighborhoods.
Chapter 5 presents ethnographic narratives from eight case study settlements – four from Jaipur and four from Bhopal. The narratives trace the emergence of informal authority, party linkages, and public service delivery in each settlement, from the initial period of squatting to the present. In addition to demonstrating the mechanisms underpinning the book’s theoretical framework, the narratives address issues of historical sequencing and causality.
Chapter 6 quantitatively tests the theoretical framework with survey data from 111 squatter settlements. I find that party worker density is positive and statistically significant in its association with paved road coverage, streetlight coverage, municipal trash removal, and the provision of government medical camps. These findings hold when controlling for a wide range of potential confounders and are robust to several model specifications and post-estimation tests. Read alongside my qualitative findings, these statistical relationships provide further evidence that denser concentrations of party workers are associated with higher levels of public service provision.
Chapter 3 presents the book’s theoretical framework. It explains why settlements with dense concentrations of party workers are better positioned to demand public services than those with thin or absent networks. The discussion is set around three mechanisms undergirding this relationship: political connectivity, mobilization capacity, and the informal accountability generated by competition among party workers for a following. The chapter further considers the implications of having party workers affiliated to competing parties, which I argue has several countervailing influences on public service delivery. Next, the chapter takes a step backward in the sequencing of events and asks why settlements vary in the density and partisan balance of their party workers. I argue that two variables – settlement population and ethnic diversity – shape bottom-up incentives for residents to engage in party work and top-down incentives for parties to extend their organizational networks.