Slum Upgrading Strategies And Their Effects On Health And-Books Pdf

Slum upgrading strategies and their effects on health and
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The International Initiative for Impact Evaluation 3ie is an international grant making NGO. promoting evidence informed development policies and programmes We are the global. leader in funding producing and synthesising high quality evidence of what works for. whom why and at what cost We believe that better and policy relevant evidence will make. development more effective and improve people s lives. 3ie systematic reviews, 3ie systematic reviews appraise and synthesise the available high quality evidence on the. effectiveness of social and economic development interventions in low and middle income. countries These reviews follow scientifically recognised review methods and are peer. reviewed and quality assured according to internationally accepted standards 3ie is. providing leadership in demonstrating rigorous and innovative review methodologies such. as using theory based approaches suited to inform policy and programming in the dynamic. contexts and challenges of low and middle income countries. About this review, Slum upgrading strategies and their effects on health and socio economic outcomes a. systematic review was submitted in partial fulfilment of the requirements of SR2 3 issued. under Systematic Review Window 2 This review is available on the 3ie website 3ie is. publishing this report as received from the authors it has been formatted to 3ie style This. review has also been published in the Cochrane Collaboration Library and is available here. 3ie is publishing this final version as received All content is the sole responsibility of the. authors and does not represent the opinions of 3ie its donors or its board of commissioners. Any errors are also the sole responsibility of the authors Comments or queries should be. directed to the corresponding author Ruth Turley ruthturley rocketmail com. Major funding for this systematic review was provided by UK aid the Bill Melinda Gates. Foundation and the Hewlett Foundation A complete listing of all of 3ie s donors can be. found on the 3ie website, Suggested citation Turley R Saith R Bhan N Rehfuess E and Carter B 2013 Slum. upgrading strategies and their effects on health and socio economic outcomes a systematic. review 3ie Systematic Review 13 London International Initiative for Impact Evaluation. 3ie systematic review executive editors Philip Davies and Beryl Leach. Managing editor Deepthy Menon, Technical editor Hugh Waddington. Production manager Pradeep Singh, Cover design John F McGill and Akarsh Gupta.
International Initiative for Impact Evaluation 3ie 2013 2016. Slum upgrading strategies and their effects on health and socio. economic outcomes a systematic review, Ruth Turley. Cardiff University, Ruhi Saith, Oxford Policy Management. Nandita Bhan, Harvard School of Public Health, Eva Rehfuess. Ludwig Maximilian University of Munich, Ben Carter. University of Birmingham, 3ie Systematic Review 13.
August 2013, Background, Slums are densely populated neglected parts of cities where housing and living conditions. are exceptionally poor In situ slum upgrading at its basic level involves improving the. physical environment of the existing area such as improving and installing basic. infrastructure like water sanitation solid waste collection electricity storm water drainage. access roads and footpaths and street lighting as well as home improvements and. securing land tenure, Objectives, To explore the effects of slum upgrading strategies involving physical environment and. infrastructure interventions on the health quality of life and socio economic wellbeing of. urban slum dwellers in low and middle income countries LMIC. Where reported data were collected on the perspectives of slum dwellers regarding their. needs preferences for and satisfaction with interventions received. Search methods, We searched for published and unpublished studies in 28 bibliographic databases including. multidisciplinary for example Scopus and specialist databases covering health social. science urban planning environment and LMIC topics. Snowballing techniques included searching websites journal handsearching contacting. authors and reference list checking Searches were not restricted by language or publication. Selection criteria, We included studies examining the impact of slum upgrading strategies involving physical. environment or infrastructure improvements with or without additional co interventions on. the health quality of life and socio economic wellbeing of LMIC urban slum dwellers. Randomised controlled trials RCTs controlled before and after studies CBAs and. interrupted time series ITS were eligible for the main analysis Controlled studies with only. post intervention data CPI and uncontrolled before and after UBA studies were included. in a separate narrative to examine consistency of results and to supplement evidence gaps. in the main analysis, Data collection and analysis.
Two authors independently extracted data and assessed risk of bias for each study. Differences between the included study interventions and outcomes precluded meta. analysis so the results were presented in a narrative summary with illustrative harvest plots. The body of evidence for outcomes within the main analysis was assessed according to. GRADE as very low low moderate or high quality, Main results. We identified 10 488 unique records with 323 screened as full text Five studies were included. for the main analysis one RCT with a low risk two CBAs with a moderate risk and two CBAs. with a high risk of bias Three CBAs evaluated multicomponent slum upgrading strategies. Road paving only was evaluated in one RCT and water supply in one CBA A total of 3453. households or observations were included within the four studies reporting sample sizes. Most health outcomes in the main studies related to communicable diseases for which. the body of evidence was judged to be low quality One CBA with a moderate risk of bias. found that diarrhoeal incidence was reduced in households which received water. connections from a private water company risk ratio RR 0 53 95 confidence interval. CI 0 27 to 1 04 and the severity of diarrhoeal episodes RR 0 48 95 CI 0 19 to 1 22. There was no effect for duration of diarrhoea Road paving did not result in changes in. parasitic infections or sickness in one RCT After multicomponent slum upgrading claims. for a waterborne disease as opposed to a non waterborne disease reduced RR 0 64. 95 CI 0 27 to 0 98 in one CBA with a high risk of bias but there was no change in. sanitation related mortality in a CBA with a moderate risk of bias. The majority of socio economic outcomes reported within the main studies related to. financial poverty for which the body of evidence was of very low quality Results were. mixed amongst the main studies one RCT and two CBAs reported no effect on the. income of slum dwellers following slum upgrading One further CBA found significant. reduction in monthly water expenditure mean difference MD 17 11 pesos 95 CI 32 6. to 1 62 One RCT also showed mixed results for employment variables finding no effect. on unemployment levels but increased weekly worked hours MD 4 68 95 CI 0 46 to. 9 82 and lower risk of residents intending to migrate for work RR 0 78 95 CI 0 60 to. There was no evidence available to assess the impact of slum upgrading on non. communicable diseases or social capital Maternal and perinatal conditions infant. mortality nutritional deficiencies injuries self reported quality of life education and crime. were evaluated in one study each, Nine supporting studies were included that measured varying outcomes 6794. households or observations within eight studies reporting sample sizes One CPI. evaluated cement flooring only while three UBAs and five CPIs evaluated. multicomponent slum upgrading strategies All studies but one had a high risk of. The studies reinforced main study findings for diarrhoea incidence and water related. expenditure Findings for parasitic infections and financial poverty were inconsistent with. the main studies In addition supporting studies reported a number of disparate. outcomes that were not evaluated in the main studies. Five supporting studies included some limited information on slum dweller perspectives. They indicated the importance of appropriate siting of facilities preference for private. facilities delivering synergistic interventions together and ensuring that infrastructure. was fit for purpose and systems were provided for cleaning maintenance and repair. Authors conclusions, A high risk of bias within the included studies heterogeneity and evidence gaps prevent. firm conclusions on the effect of slum upgrading strategies on health and socio economic. wellbeing The most common health and socio economic outcomes reported were. communicable diseases and indicators of financial poverty There was a limited but. consistent body of evidence to suggest that slum upgrading may reduce the incidence of. diarrhoeal diseases and water related expenditure, The information available on slum dwellers perspectives provided some insight to. barriers and facilitators for successful implementation and maintenance of. interventions, The availability and use of reliable comparable outcome measures to determine the.
effect of slum upgrading on health quality of life and socio economic wellbeing would. make a useful contribution to new research in this important area Given the complexity. in delivering slum upgrading evaluations should look to incorporate process and. qualitative information alongside quantitative effectiveness data to determine which. particular interventions work or don t work and for whom. Plain language summary, The effect of slum upgrading on slum dwellers health quality of life and social wellbeing. Low and middle income countries LMIC are home to over 90 of the one billion people. living in slums Urban slums describe parts of cities where living conditions are. exceptionally poor The slums lack basic services and often have many people crowded. into small living spaces Slums can provide shelter and proximity to jobs and communities. are often social and supportive However poor living conditions and health are closely. related and illnesses such as diarrhoea malaria cholera and respiratory diseases are. Slum upgrading basically involves improving the physical environment for example the. water supply sanitation waste collection electricity drainage road paving and street. lighting Additional strategies may be included to improve access to health education. and social services increase residents income and secure legal rights to the land. We found five main studies with suitable methods for examining the effect of slum. upgrading on health quality of life and social wellbeing for example poverty Nine. supporting studies were also included which used methods that could indicate. associations between interventions and outcomes but could not assess whether. interventions caused the effect Only one main study had a low risk of bias with the rest. having a mixed or high risk of bias The majority of supporting studies had a high risk of. bias meaning their methods had several limitations that made the study results unreliable. In addition the studies measured different interventions and outcomes making it difficult to. compare results, Overall there was limited but consistent evidence to suggest that slum upgrading may. reduce diarrhoea in slum dwellers and their water related expenses There were mixed. results for whether slum upgrading reduced parasitic infections general measures of. communicable diseases financial poverty and unemployment outcomes There was very. little information on other health or social outcomes or which types of interventions were. most beneficial Some of the studies asked slum dwellers for their views and their. experiences of slum upgrading interventions They suggested a number of reasons why. facilities were not used as intended and which may have reduced the benefits. Future research with improved study designs and common outcome measures is needed. to determine how best to improve the conditions of existing slums and to offer the most. benefit to the health quality of life and social wellbeing of slum dwellers. Abstract i, Plain language summary v, List of figures vii. 1 Background 1, 1 1 Description of the issue 1, 1 2 Description of the intervention 2. 1 3 How the intervention might work 3, 1 4 Why it is important to do this review 4.
2 Objectives 6, 3 Methods 7, 3 1 Criteria for considering studies for this review 7. 3 2 Search methods for identification of studies 10. 3 3 Data collection and analysis 12, 4 Results 17, 4 1 Description of studies 17. 4 2 Risk of bias in included studies 19, 4 3 Effects of interventions 24. 5 Discussion 37, 5 1 Summary of main results 37, 5 2 Overall completeness and applicability of evidence 43. 5 3 Quality of the evidence 47, 5 4 Potential biases in the review process 48.
5 5 Agreements and disagreements with other studies or reviews 48. 6 Authors conclusions 50, 6 1 Implications for practice 50. 6 2 Implications for research 51, 7 Acknowledgements 53. 8 Contributions of authors 54, 9 Declarations of interest 55. 10 Differences between protocol and review 56, 11 Published notes 57. 12 Summary of findings tables 98, 13 Additional tables 103.
Slums are densely populated neglected parts of cities where housing and living conditions are exceptionally poor In situ slum upgrading at its basic level involves improving the

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