wow-inequalities/02-data/intermediate/wos_sample/dda4399f3b7609eaef6d1705bcbc4802-turley-ruth-and-sai/info.yaml

abstract: '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  We searched for published and unpublished studies in 28 bibliographic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 date.

  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 1.01).

  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 bias.

  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.'
affiliation: 'Turley, R (Corresponding Author), Cardiff Univ, Informat Serv, SURE,
  1st Floor,Heath Pk, Cardiff CF14 4YS, S Glam, Wales.

  Turley, Ruth, Cardiff Univ, Informat Serv, SURE, Cardiff CF14 4YS, S Glam, Wales.

  Saith, Ruhi, Oxford Policy Management, New Delhi, India.

  Bhan, Nandita, Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev \& Hlth, Boston,
  MA 02115 USA.

  Rehfuess, Eva, Univ Munich, Inst Med Informat Biometry \& Epidemiol, Munich, Germany.

  Carter, Ben, Univ Birmingham, Sch Canc Sci, Canc Res UK Clin Trials Unit, Birmingham,
  W Midlands, England.'
article-number: CD010067
author: Turley, Ruth and Saith, Ruhi and Bhan, Nandita and Rehfuess, Eva and Carter,
  Ben
author-email: ruthturley@rocketmail.com
author_list:
- family: Turley
  given: Ruth
- family: Saith
  given: Ruhi
- family: Bhan
  given: Nandita
- family: Rehfuess
  given: Eva
- family: Carter
  given: Ben
da: '2023-09-28'
doi: 10.1002/14651858.CD010067.pub2
eissn: 1361-6137
files: []
issn: 1469-493X
journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
keywords-plus: 'IMPROVEMENT PROGRAMS; PROPERTY-RIGHTS; IMPACT; WATER; SANITATION;

  DIARRHEA; SALVADOR; CHILDREN; HYGIENE; AREAS'
language: English
number: '1'
number-of-cited-references: '82'
orcid-numbers: Carter, Ben/0000-0003-0318-8865
papis_id: da2100fed31b7031686375991c5c1f2d
ref: Turley2013slumupgrading
researcherid-numbers: 'Rehfuess, Eva Annette/ABD-8167-2021

  '
tags:
- relevant
- review
times-cited: '95'
title: Slum upgrading strategies involving physical environment and infrastructure
  interventions and their effects on health and socio-economic outcomes (Review)
type: article
unique-id: WOS:000314315200029
usage-count-last-180-days: '3'
usage-count-since-2013: '135'
web-of-science-categories: Medicine, General \& Internal
year: '2013'