Introduction: Food environments are viewed as the interface where individuals interact with the w... more Introduction: Food environments are viewed as the interface where individuals interact with the wider food system to procure and/or consume food. Institutional food environment characteristics have been associated with health outcomes including obesity and nutrition-related non-communicable diseases (NR-NCDs) in studies from high income countries. The objectives of this study were (1) to map and characterise the food-outlets within a Ghanaian university campus; and (2) to assess the healthiness of the food outlets. Methods: Data collection was undertaken based on geospatial open-source technologies and the collaborative mapping platform OpenStreetMap using a systematic approach involving three phases: remote mapping, groundtruthing, and food-outlet survey. Spatial analyses were performed using Quantum Geographical Information System (QGIS) and comprised kernel density, buffer, and average nearest neighbour analyses to assess outlet distribution, density, and proximity. A classification system was developed to assess the healthiness of food-outlets within the University foodscape. Results: Food-outlets were unevenly distributed over the University foodscape, with many outlets clustered closer to student residencies. Informal food-outlets were the most frequent food-outlet type. Compared to NCD-healthy foodoutlets, NCD-unhealthy food-outlets dominated the foodscape (50.7% vs 39.9%) with 9.4% being NCD-intermediate, suggesting a less-healthy university foodscape. More NCD-unhealthy food outlets than NCD-healthy food outlets clustered around student residences. This difference was statistically significant for food outlets within a 100-m buffer (p < 0.001) of student residence and those within 100 and 500 m from departmental buildings/lecture halls (at 5% level of significance). Conclusion: Further action, including research to ascertain how the features of the University's food environment have or are influencing students' dietary behaviours are needed to inform interventions aimed at creating healthier foodscapes in the study University and other campuses and to lead the way towards the creation of healthy food environments at the home, work, and community levels. Keywords: University foodscape, Food outlet healthiness, Non-communicable disease, Ghana, Humanitarian OpenStreetMap, Volunteered and collaborative mapping
Objective To identify factors associated with accessing and utilisation of healthcare and provisi... more Objective To identify factors associated with accessing and utilisation of healthcare and provision of health services in slums.
Design A scoping review incorporating a conceptual framework for configuring reported factors.
Data sources MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.
Eligibility criteria Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries.
Data extraction and synthesis Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.
Results Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.
Conclusion The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.
Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An unde... more Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32–50) versus 38 (IQR:29–50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the “prompt and urgent” levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.
ISPRS International Journal of Geo-Information, 2022
This paper is an Editorial for the Special Issue titled “OpenStreetMap as a multidisciplinary nex... more This paper is an Editorial for the Special Issue titled “OpenStreetMap as a multidisciplinary nexus: perspectives, practices and procedures”. The Special Issue is largely based on the talks presented in the 2019 and 2020 editions of the Academic Track at the State of the Map conferences. As such, it represents the most pressing and relevant issues and topics considered by the academic community in relation to OpenStreetMap (OSM)—a global project and community aimed to create and maintain a free and editable database and map of the world. In this Editorial, we survey the papers included in the Special Issue, grouping them into three research perspectives: applications of OSM for studies within other disciplines, OSM data quality, and dynamics in OSM. This survey reveals that these perspectives, while being distinct, are also interrelated. This calls for the formalization of an ‘OSM science’ that will provide the conceptual grounds to advance the scientific study of OSM, not as a set of individualized efforts but as a unified approach.
The majority of urban inhabitants in low-and middle-income country (LMIC) cities live in deprived... more The majority of urban inhabitants in low-and middle-income country (LMIC) cities live in deprived urban areas. However, policy efforts and the monitoring of global goals and agendas such as the United Nation's Sustainable Development Goals (SDGs) and UN-Habitat New Urban Agenda are hindered by the unavailability of statistical and spatial data at metropolitan, city and sub-city scales. Deprivation is a complex and multidimensional concept, and presently, there is a strong focus within the existing literature on household-level (including individual) deprivation and less on area-level deprivation and this is problematic because deprivation at the area and household-level are known to interrelate and result in multiple challenges for individuals and communities. Within this scoping review, we build on existing literature that focuses on household-or area-level deprivation to arrive at a combined understanding of how urban deprivation is defined in relation to LMIC cities. The scoping review of existing literature was used in conjunction with local stakeholder workshops to produce a framework titled "Domains of Deprivation Framework". The Domains of Deprivation Framework conceptualizes urban deprivation at three different scales, including at the household scale, within the area scale and at the area connect scale. It includes nine domains, (1) SocioEconomic Status and (2) Housing Domains (Household scale); (3) Social Hazards & Assets, (4) Physical Hazards & Assets, (5) Unplanned Urbanization and (6) Contamination (Within Area scale); and (7) Infrastructure, (8) Facilities & Services and (9) City Governance (Area Connect scale). The Domains of Deprivation Framework is designed to support diverse urban, health, poverty, and development initiatives globally to characterize and address deprivation in LMIC cities from a holistic perspective, combining traditional data sources (e.g., surveys or census data) with new data sources (e.g., Earth Observation data).
ISPRS International Journal of Geo-Information, 2022
The academic community frequently engages with OpenStreetMap (OSM) as a data source and research ... more The academic community frequently engages with OpenStreetMap (OSM) as a data source and research subject, acknowledging its complex and contextual nature. However, existing literature rarely considers the position of academic research in relation to the OSM community. In this paper we explore the extent and nature of engagement between the academic research community and the larger communities in OSM. An analysis of OSM-related publications from 2016 to 2019 and seven interviews conducted with members of one research group engaged in OSM-related research are described. The literature analysis seeks to uncover general engagement patterns while the interviews are used to identify possible causal structures explaining how these patterns may emerge within the context of a specific research group. Results indicate that academic papers generally show few signs of engagement and adopt data-oriented perspectives on the OSM project and product. The interviews expose that more complex perspectives and deeper engagement exist within the research group to which the interviewees belong, e.g., engaging in OSM mapping and direct interactions based on specific points-of-contact in the OSM community. Several conclusions and recommendations emerge, most notably: that every engagement with OSM includes an interpretive act which must be acknowledged and that the academic community should act to triangulate its interpretation of the data and OSM community by diversifying their engagement. This could be achieved through channels such as more direct interactions and inviting members of the OSM community to participate in the design and evaluation of research projects and programmes.
Objectives To survey on the availability and use of primary care services in slum populations. De... more Objectives To survey on the availability and use of primary care services in slum populations. Design Retrospective, cross-sectional, household, individual and healthcare provider surveys. Setting Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). Participants Residents of slums and informal settlements. Primary and secondary outcome measures Primary care consultation rates by type of provider and facility. Results We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than singlehanded providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/ nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.
ISPRS International Journal of Geo-Information, 2021
This paper examines OpenStreetMap data quality at different stages of a participatory mapping pro... more This paper examines OpenStreetMap data quality at different stages of a participatory mapping process in seven slums in Africa and Asia. Data were drawn from an OpenStreetMap-based participatory mapping process developed as part of a research project focusing on understanding inequalities in healthcare access of slum residents in the Global South. Descriptive statistics and qualitative analysis were employed to examine the following research question: What is the spatial data quality of collaborative remote mapping achieved by volunteer mappers in morphologically complex urban areas? Findings show that the completeness achieved by remote mapping largely depends on the morphology and characteristics of slums such as building density and rooftop architecture, varying from 84% in the best case, to zero in the most difficult site. The major scientific contribution of this study is to provide evidence on the spatial data quality of remotely mapped data through volunteer mapping efforts in morphologically complex urban areas such as slums; the results could provide insights into how much fieldwork would be needed in what level of complexity and to what extent the involvement of local volunteers in these efforts is required.
Introduction Tracking the progress of universal health coverage (UHC) is typically at a country l... more Introduction Tracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC. Methods We conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods. Results We surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4-47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp). Conclusions Slums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.
Background:
Slums or informal settlements characterize most large cities in LMIC. Previous evide... more Background: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
Marine protected areas (MPAs) are rapidly spreading to meet global conservation targets, but new ... more Marine protected areas (MPAs) are rapidly spreading to meet global conservation targets, but new governance arrangements can have unintended impacts on socioeconomic development that can undermine and counteract their intended outcomes. We use an exploratory mixed-method research design to understand these development impacts and their underlying mechanisms, guided by an innovative activity space framework that situates marine resource management and conservation in a network of relationships between communities, human services, and nature. Qualitative research-based on 22 interviews in Koh Sdach Archipelago, Cambodia-demonstrates how the local community experienced improving relationships with the state and a slowing deterioration of marine resources, but also social division, heightened livelihood anxiety, and potentially a false sense of economic security. We hypothesise on this basis that marine conservation could impede socioeconomic development, for which we find support in our quantitative analysis across Cambodia, the Philippines, and Timor-Leste: MPAs materialised in better-off communities but were associated with slower and partly regressive socioeconomic development, in particular decreasing wealth and increasing child mortality. These findings suggest that the rapid global expansion of MPA coverage in its current, environmental-conservation-focused form is problematic as it disregards local social realities. Livelihood adaptation support should complement the implementation of marine resource governance mechanisms to mitigate unintended negative consequences.
COVID-19 Pandemic, Geospatial Information, and Community Resilience, 2021
Created by volunteers since 2004, OpenStreetMap (OSM) is a global geographic database available u... more Created by volunteers since 2004, OpenStreetMap (OSM) is a global geographic database available under an open access license and currently used by a multitude of actors worldwide. This chapter describes the role played by OSM during the early months (from January to July 2020) of the ongoing COVID-19 pandemic, which-in contrast to past disasters and epidemics-is a global event impacting both developed and developing countries. A large number of COVID-19-related OSM use cases were collected and grouped into a number of research frameworks which are analyzed separately: dashboards and services simply using OSM as a basemap, applications using raw OSM data, initiatives to collect new OSM data, imports of authoritative data into OSM, and traditional academic research on OSM in the COVID-19 response. The wealth of examples provided in the chapter, including an analysis of OSM tile usage in two countries (Italy and China) deeply affected in the earliest months of 2020, prove that OSM has been and still is heavily used to address the COVID-19 crisis, although with types and mechanisms that are often different depending on the affected area or country and the related communities.
Abstract
Introduction
With COVID-19, there is urgency for policymakers to understand and respon... more Abstract
Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.
Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.
Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.
Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
Life Below Water. Encyclopedia of the UN Sustainable Development Goals, 2020
Marine protected areas (MPAs) are often heralded as the solution to issues associated with the ov... more Marine protected areas (MPAs) are often heralded as the solution to issues associated with the overexploitation of natural resources. There are extensive international targets for the declaration of MPAs, which are likely unachievable. However, these targets drive countries to make quick and often short-sighted decisions regarding MPA development, encouraging a quantity over quality approach. As a result, numerous targets are yet to be met as per the 2030 timeline, and the proposed interventions to fulfil these targets have, in some instances, impeded conservation, negatively impacting local people. The time-lag between the declaration of MPAs and the recovery of previously overexploited populations can be upwards of a decade, and this success depends entirely on local community buy-in. As a method of encouraging community engagement, marine tourism is often proposed as an alternative livelihood strategy. Nevertheless, MPA declaration continues, expecting that they will support both communities and their environment. Tourism has its own impacts. This study explores the realities and contexts of the interactions between communities, tourism and MPAs. Particular focus is placed on the Sustainable Development Goal (SDG) 14.7 ‘increase the economic benefits from sustainable use of marine resources’. We examine some case-studies from Southeast Asia to evaluate the synergistic relationship between tourism, communities and effective environmental management. Critically, we examine how marine tourism can support livelihoods to the degree required to minimise marine environmental degradation and sufficiently meet SDG 14 in order to ‘sustain life below water’.
Social media platforms are seeing increasing adoption by public transport agencies, as they provi... more Social media platforms are seeing increasing adoption by public transport agencies, as they provide a cost-effective, reliable, and timely mechanism for sharing information with passengers and other travellers. In this paper, we use a case study of the @GamesTravel2014 Twitter account to evaluate how this social media platform was used over the course of the 2014 Commonwealth Games in Glasgow, Scotland to provide and share transport-related information and respond to information requests. The case study provides an exemplar for the public co-ordination of information from multiple partners in a complex environment during a time of transport disruption. We evaluate both the structure and intent of the @GamesTravel2014 social media strategy via interviews with involved parties and an analysis of Tweets related to the account. Findings indicate the potential for future applications of social media by transport operators and authorities in producing a more effective network of communication with passengers.
Background
Household surveys are a key epidemiological, medical, and social research method. In ... more Background
Household surveys are a key epidemiological, medical, and social research method. In poor urban environments, such as slums, censuses can often be out-of-date or fail to record transient residents, maps may be incomplete, and access to sites can be limit, all of which prohibits obtaining an accurate sampling frame. This article describes a method to conduct a survey in slum settings in the context of the NIHR Global Health Research Unit on Improving Health in Slums project.
Methods
We identify four key steps: obtaining site access, generation of a sampling frame, sampling, and field data collection. Stakeholder identification and engagement is required to negotiate access. A spatially-referenced sampling frame can be generated by: remote participatory mapping from satellite imagery; local participatory mapping and ground-truthing; and identification of all residents of each structure. We propose to use a spatially-regulated sampling method to ensure spatial coverage across the site. Finally, data collection using tablet devices and open-source software can be conducted using the generated sample and maps.
Discussion
Slums are home to a growing population who face some of the highest burdens of disease yet who remain relatively understudied. Difficulties conducting surveys in these locations may explain this disparity. We propose a generalisable, scientifically valid method that is sustainable and ensures community engagement.
State of the Map featured a full day of academic talks. Building upon the motto of SotM 2019 in "... more State of the Map featured a full day of academic talks. Building upon the motto of SotM 2019 in "Bridging the Map" the Academic Track session was aimed to provide the bridge to join together the experience, understanding, ideas, concepts and skills from different groups of researchers, academics and scientists from around the world. In particular, the Academic Track session was meant to build this bridge that connects members of the OpenStreetMap community and the academic community by providing an open passage for exchange of ideas, communication and opportunities for increased collaboration. These proceedings include 14 abstracts accepted as oral presentations and 6 abstracts presented as posters. Contributions were received from different academic fields, for example geography, remote sensing, computer and information sciences, geomatics, GIScience, the humanities and social sciences, and even from industry actors. We are particularly delighted to have included abstracts from both experienced researchers and students. Overall, it is our hope that these proceedings accurately showcase the ongoing innovation and maturity of scientific investigations and research into OpenStreetMap, showing how it as a research object converges multiple research areas together. Our aim is to show how the sum total of investigations of issues like Volunteered Geographic Information, geo-information, and geo-digital processes and representation shed light on the relations between crowds, real-world applications, technological developments, and scientific research.
Introduction: Food environments are viewed as the interface where individuals interact with the w... more Introduction: Food environments are viewed as the interface where individuals interact with the wider food system to procure and/or consume food. Institutional food environment characteristics have been associated with health outcomes including obesity and nutrition-related non-communicable diseases (NR-NCDs) in studies from high income countries. The objectives of this study were (1) to map and characterise the food-outlets within a Ghanaian university campus; and (2) to assess the healthiness of the food outlets. Methods: Data collection was undertaken based on geospatial open-source technologies and the collaborative mapping platform OpenStreetMap using a systematic approach involving three phases: remote mapping, groundtruthing, and food-outlet survey. Spatial analyses were performed using Quantum Geographical Information System (QGIS) and comprised kernel density, buffer, and average nearest neighbour analyses to assess outlet distribution, density, and proximity. A classification system was developed to assess the healthiness of food-outlets within the University foodscape. Results: Food-outlets were unevenly distributed over the University foodscape, with many outlets clustered closer to student residencies. Informal food-outlets were the most frequent food-outlet type. Compared to NCD-healthy foodoutlets, NCD-unhealthy food-outlets dominated the foodscape (50.7% vs 39.9%) with 9.4% being NCD-intermediate, suggesting a less-healthy university foodscape. More NCD-unhealthy food outlets than NCD-healthy food outlets clustered around student residences. This difference was statistically significant for food outlets within a 100-m buffer (p < 0.001) of student residence and those within 100 and 500 m from departmental buildings/lecture halls (at 5% level of significance). Conclusion: Further action, including research to ascertain how the features of the University's food environment have or are influencing students' dietary behaviours are needed to inform interventions aimed at creating healthier foodscapes in the study University and other campuses and to lead the way towards the creation of healthy food environments at the home, work, and community levels. Keywords: University foodscape, Food outlet healthiness, Non-communicable disease, Ghana, Humanitarian OpenStreetMap, Volunteered and collaborative mapping
Objective To identify factors associated with accessing and utilisation of healthcare and provisi... more Objective To identify factors associated with accessing and utilisation of healthcare and provision of health services in slums.
Design A scoping review incorporating a conceptual framework for configuring reported factors.
Data sources MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.
Eligibility criteria Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries.
Data extraction and synthesis Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.
Results Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.
Conclusion The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.
Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An unde... more Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32–50) versus 38 (IQR:29–50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the “prompt and urgent” levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.
ISPRS International Journal of Geo-Information, 2022
This paper is an Editorial for the Special Issue titled “OpenStreetMap as a multidisciplinary nex... more This paper is an Editorial for the Special Issue titled “OpenStreetMap as a multidisciplinary nexus: perspectives, practices and procedures”. The Special Issue is largely based on the talks presented in the 2019 and 2020 editions of the Academic Track at the State of the Map conferences. As such, it represents the most pressing and relevant issues and topics considered by the academic community in relation to OpenStreetMap (OSM)—a global project and community aimed to create and maintain a free and editable database and map of the world. In this Editorial, we survey the papers included in the Special Issue, grouping them into three research perspectives: applications of OSM for studies within other disciplines, OSM data quality, and dynamics in OSM. This survey reveals that these perspectives, while being distinct, are also interrelated. This calls for the formalization of an ‘OSM science’ that will provide the conceptual grounds to advance the scientific study of OSM, not as a set of individualized efforts but as a unified approach.
The majority of urban inhabitants in low-and middle-income country (LMIC) cities live in deprived... more The majority of urban inhabitants in low-and middle-income country (LMIC) cities live in deprived urban areas. However, policy efforts and the monitoring of global goals and agendas such as the United Nation's Sustainable Development Goals (SDGs) and UN-Habitat New Urban Agenda are hindered by the unavailability of statistical and spatial data at metropolitan, city and sub-city scales. Deprivation is a complex and multidimensional concept, and presently, there is a strong focus within the existing literature on household-level (including individual) deprivation and less on area-level deprivation and this is problematic because deprivation at the area and household-level are known to interrelate and result in multiple challenges for individuals and communities. Within this scoping review, we build on existing literature that focuses on household-or area-level deprivation to arrive at a combined understanding of how urban deprivation is defined in relation to LMIC cities. The scoping review of existing literature was used in conjunction with local stakeholder workshops to produce a framework titled "Domains of Deprivation Framework". The Domains of Deprivation Framework conceptualizes urban deprivation at three different scales, including at the household scale, within the area scale and at the area connect scale. It includes nine domains, (1) SocioEconomic Status and (2) Housing Domains (Household scale); (3) Social Hazards & Assets, (4) Physical Hazards & Assets, (5) Unplanned Urbanization and (6) Contamination (Within Area scale); and (7) Infrastructure, (8) Facilities & Services and (9) City Governance (Area Connect scale). The Domains of Deprivation Framework is designed to support diverse urban, health, poverty, and development initiatives globally to characterize and address deprivation in LMIC cities from a holistic perspective, combining traditional data sources (e.g., surveys or census data) with new data sources (e.g., Earth Observation data).
ISPRS International Journal of Geo-Information, 2022
The academic community frequently engages with OpenStreetMap (OSM) as a data source and research ... more The academic community frequently engages with OpenStreetMap (OSM) as a data source and research subject, acknowledging its complex and contextual nature. However, existing literature rarely considers the position of academic research in relation to the OSM community. In this paper we explore the extent and nature of engagement between the academic research community and the larger communities in OSM. An analysis of OSM-related publications from 2016 to 2019 and seven interviews conducted with members of one research group engaged in OSM-related research are described. The literature analysis seeks to uncover general engagement patterns while the interviews are used to identify possible causal structures explaining how these patterns may emerge within the context of a specific research group. Results indicate that academic papers generally show few signs of engagement and adopt data-oriented perspectives on the OSM project and product. The interviews expose that more complex perspectives and deeper engagement exist within the research group to which the interviewees belong, e.g., engaging in OSM mapping and direct interactions based on specific points-of-contact in the OSM community. Several conclusions and recommendations emerge, most notably: that every engagement with OSM includes an interpretive act which must be acknowledged and that the academic community should act to triangulate its interpretation of the data and OSM community by diversifying their engagement. This could be achieved through channels such as more direct interactions and inviting members of the OSM community to participate in the design and evaluation of research projects and programmes.
Objectives To survey on the availability and use of primary care services in slum populations. De... more Objectives To survey on the availability and use of primary care services in slum populations. Design Retrospective, cross-sectional, household, individual and healthcare provider surveys. Setting Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). Participants Residents of slums and informal settlements. Primary and secondary outcome measures Primary care consultation rates by type of provider and facility. Results We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than singlehanded providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/ nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.
ISPRS International Journal of Geo-Information, 2021
This paper examines OpenStreetMap data quality at different stages of a participatory mapping pro... more This paper examines OpenStreetMap data quality at different stages of a participatory mapping process in seven slums in Africa and Asia. Data were drawn from an OpenStreetMap-based participatory mapping process developed as part of a research project focusing on understanding inequalities in healthcare access of slum residents in the Global South. Descriptive statistics and qualitative analysis were employed to examine the following research question: What is the spatial data quality of collaborative remote mapping achieved by volunteer mappers in morphologically complex urban areas? Findings show that the completeness achieved by remote mapping largely depends on the morphology and characteristics of slums such as building density and rooftop architecture, varying from 84% in the best case, to zero in the most difficult site. The major scientific contribution of this study is to provide evidence on the spatial data quality of remotely mapped data through volunteer mapping efforts in morphologically complex urban areas such as slums; the results could provide insights into how much fieldwork would be needed in what level of complexity and to what extent the involvement of local volunteers in these efforts is required.
Introduction Tracking the progress of universal health coverage (UHC) is typically at a country l... more Introduction Tracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC. Methods We conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods. Results We surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4-47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp). Conclusions Slums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.
Background:
Slums or informal settlements characterize most large cities in LMIC. Previous evide... more Background: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
Marine protected areas (MPAs) are rapidly spreading to meet global conservation targets, but new ... more Marine protected areas (MPAs) are rapidly spreading to meet global conservation targets, but new governance arrangements can have unintended impacts on socioeconomic development that can undermine and counteract their intended outcomes. We use an exploratory mixed-method research design to understand these development impacts and their underlying mechanisms, guided by an innovative activity space framework that situates marine resource management and conservation in a network of relationships between communities, human services, and nature. Qualitative research-based on 22 interviews in Koh Sdach Archipelago, Cambodia-demonstrates how the local community experienced improving relationships with the state and a slowing deterioration of marine resources, but also social division, heightened livelihood anxiety, and potentially a false sense of economic security. We hypothesise on this basis that marine conservation could impede socioeconomic development, for which we find support in our quantitative analysis across Cambodia, the Philippines, and Timor-Leste: MPAs materialised in better-off communities but were associated with slower and partly regressive socioeconomic development, in particular decreasing wealth and increasing child mortality. These findings suggest that the rapid global expansion of MPA coverage in its current, environmental-conservation-focused form is problematic as it disregards local social realities. Livelihood adaptation support should complement the implementation of marine resource governance mechanisms to mitigate unintended negative consequences.
COVID-19 Pandemic, Geospatial Information, and Community Resilience, 2021
Created by volunteers since 2004, OpenStreetMap (OSM) is a global geographic database available u... more Created by volunteers since 2004, OpenStreetMap (OSM) is a global geographic database available under an open access license and currently used by a multitude of actors worldwide. This chapter describes the role played by OSM during the early months (from January to July 2020) of the ongoing COVID-19 pandemic, which-in contrast to past disasters and epidemics-is a global event impacting both developed and developing countries. A large number of COVID-19-related OSM use cases were collected and grouped into a number of research frameworks which are analyzed separately: dashboards and services simply using OSM as a basemap, applications using raw OSM data, initiatives to collect new OSM data, imports of authoritative data into OSM, and traditional academic research on OSM in the COVID-19 response. The wealth of examples provided in the chapter, including an analysis of OSM tile usage in two countries (Italy and China) deeply affected in the earliest months of 2020, prove that OSM has been and still is heavily used to address the COVID-19 crisis, although with types and mechanisms that are often different depending on the affected area or country and the related communities.
Abstract
Introduction
With COVID-19, there is urgency for policymakers to understand and respon... more Abstract
Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.
Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.
Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.
Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
Life Below Water. Encyclopedia of the UN Sustainable Development Goals, 2020
Marine protected areas (MPAs) are often heralded as the solution to issues associated with the ov... more Marine protected areas (MPAs) are often heralded as the solution to issues associated with the overexploitation of natural resources. There are extensive international targets for the declaration of MPAs, which are likely unachievable. However, these targets drive countries to make quick and often short-sighted decisions regarding MPA development, encouraging a quantity over quality approach. As a result, numerous targets are yet to be met as per the 2030 timeline, and the proposed interventions to fulfil these targets have, in some instances, impeded conservation, negatively impacting local people. The time-lag between the declaration of MPAs and the recovery of previously overexploited populations can be upwards of a decade, and this success depends entirely on local community buy-in. As a method of encouraging community engagement, marine tourism is often proposed as an alternative livelihood strategy. Nevertheless, MPA declaration continues, expecting that they will support both communities and their environment. Tourism has its own impacts. This study explores the realities and contexts of the interactions between communities, tourism and MPAs. Particular focus is placed on the Sustainable Development Goal (SDG) 14.7 ‘increase the economic benefits from sustainable use of marine resources’. We examine some case-studies from Southeast Asia to evaluate the synergistic relationship between tourism, communities and effective environmental management. Critically, we examine how marine tourism can support livelihoods to the degree required to minimise marine environmental degradation and sufficiently meet SDG 14 in order to ‘sustain life below water’.
Social media platforms are seeing increasing adoption by public transport agencies, as they provi... more Social media platforms are seeing increasing adoption by public transport agencies, as they provide a cost-effective, reliable, and timely mechanism for sharing information with passengers and other travellers. In this paper, we use a case study of the @GamesTravel2014 Twitter account to evaluate how this social media platform was used over the course of the 2014 Commonwealth Games in Glasgow, Scotland to provide and share transport-related information and respond to information requests. The case study provides an exemplar for the public co-ordination of information from multiple partners in a complex environment during a time of transport disruption. We evaluate both the structure and intent of the @GamesTravel2014 social media strategy via interviews with involved parties and an analysis of Tweets related to the account. Findings indicate the potential for future applications of social media by transport operators and authorities in producing a more effective network of communication with passengers.
Background
Household surveys are a key epidemiological, medical, and social research method. In ... more Background
Household surveys are a key epidemiological, medical, and social research method. In poor urban environments, such as slums, censuses can often be out-of-date or fail to record transient residents, maps may be incomplete, and access to sites can be limit, all of which prohibits obtaining an accurate sampling frame. This article describes a method to conduct a survey in slum settings in the context of the NIHR Global Health Research Unit on Improving Health in Slums project.
Methods
We identify four key steps: obtaining site access, generation of a sampling frame, sampling, and field data collection. Stakeholder identification and engagement is required to negotiate access. A spatially-referenced sampling frame can be generated by: remote participatory mapping from satellite imagery; local participatory mapping and ground-truthing; and identification of all residents of each structure. We propose to use a spatially-regulated sampling method to ensure spatial coverage across the site. Finally, data collection using tablet devices and open-source software can be conducted using the generated sample and maps.
Discussion
Slums are home to a growing population who face some of the highest burdens of disease yet who remain relatively understudied. Difficulties conducting surveys in these locations may explain this disparity. We propose a generalisable, scientifically valid method that is sustainable and ensures community engagement.
State of the Map featured a full day of academic talks. Building upon the motto of SotM 2019 in "... more State of the Map featured a full day of academic talks. Building upon the motto of SotM 2019 in "Bridging the Map" the Academic Track session was aimed to provide the bridge to join together the experience, understanding, ideas, concepts and skills from different groups of researchers, academics and scientists from around the world. In particular, the Academic Track session was meant to build this bridge that connects members of the OpenStreetMap community and the academic community by providing an open passage for exchange of ideas, communication and opportunities for increased collaboration. These proceedings include 14 abstracts accepted as oral presentations and 6 abstracts presented as posters. Contributions were received from different academic fields, for example geography, remote sensing, computer and information sciences, geomatics, GIScience, the humanities and social sciences, and even from industry actors. We are particularly delighted to have included abstracts from both experienced researchers and students. Overall, it is our hope that these proceedings accurately showcase the ongoing innovation and maturity of scientific investigations and research into OpenStreetMap, showing how it as a research object converges multiple research areas together. Our aim is to show how the sum total of investigations of issues like Volunteered Geographic Information, geo-information, and geo-digital processes and representation shed light on the relations between crowds, real-world applications, technological developments, and scientific research.
Uploads
Keywords: University foodscape, Food outlet healthiness, Non-communicable disease, Ghana, Humanitarian OpenStreetMap, Volunteered and collaborative mapping
Design A scoping review incorporating a conceptual framework for configuring reported factors.
Data sources MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.
Eligibility criteria Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries.
Data extraction and synthesis Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.
Results Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.
Conclusion The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.
Systematic review registration number https://osf.io/694t2.
Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations.
Methods:
We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented.
Results:
We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales.
Conclusions:
Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
Introduction
With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.
Methods
In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.
Results
Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.
Conclusion
Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
Household surveys are a key epidemiological, medical, and social research method. In poor urban environments, such as slums, censuses can often be out-of-date or fail to record transient residents, maps may be incomplete, and access to sites can be limit, all of which prohibits obtaining an accurate sampling frame. This article describes a method to conduct a survey in slum settings in the context of the NIHR Global Health Research Unit on Improving Health in Slums project.
Methods
We identify four key steps: obtaining site access, generation of a sampling frame, sampling, and field data collection. Stakeholder identification and engagement is required to negotiate access. A spatially-referenced sampling frame can be generated by: remote participatory mapping from satellite imagery; local participatory mapping and ground-truthing; and identification of all residents of each structure. We propose to use a spatially-regulated sampling method to ensure spatial coverage across the site. Finally, data collection using tablet devices and open-source software can be conducted using the generated sample and maps.
Discussion
Slums are home to a growing population who face some of the highest burdens of disease yet who remain relatively understudied. Difficulties conducting surveys in these locations may explain this disparity. We propose a generalisable, scientifically valid method that is sustainable and ensures community engagement.
Keywords: University foodscape, Food outlet healthiness, Non-communicable disease, Ghana, Humanitarian OpenStreetMap, Volunteered and collaborative mapping
Design A scoping review incorporating a conceptual framework for configuring reported factors.
Data sources MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.
Eligibility criteria Empirical studies of all designs reporting relevant factors in slums in low and middle-income countries.
Data extraction and synthesis Studies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.
Results Of the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.
Conclusion The scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.
Systematic review registration number https://osf.io/694t2.
Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations.
Methods:
We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented.
Results:
We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales.
Conclusions:
Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
Introduction
With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.
Methods
In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.
Results
Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.
Conclusion
Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
Household surveys are a key epidemiological, medical, and social research method. In poor urban environments, such as slums, censuses can often be out-of-date or fail to record transient residents, maps may be incomplete, and access to sites can be limit, all of which prohibits obtaining an accurate sampling frame. This article describes a method to conduct a survey in slum settings in the context of the NIHR Global Health Research Unit on Improving Health in Slums project.
Methods
We identify four key steps: obtaining site access, generation of a sampling frame, sampling, and field data collection. Stakeholder identification and engagement is required to negotiate access. A spatially-referenced sampling frame can be generated by: remote participatory mapping from satellite imagery; local participatory mapping and ground-truthing; and identification of all residents of each structure. We propose to use a spatially-regulated sampling method to ensure spatial coverage across the site. Finally, data collection using tablet devices and open-source software can be conducted using the generated sample and maps.
Discussion
Slums are home to a growing population who face some of the highest burdens of disease yet who remain relatively understudied. Difficulties conducting surveys in these locations may explain this disparity. We propose a generalisable, scientifically valid method that is sustainable and ensures community engagement.