279 lines
8.8 KiB
YAML
279 lines
8.8 KiB
YAML
abstract: 'Background
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Slums are densely populated, neglected parts of cities where housing and
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living conditions are exceptionally poor. In situ slum upgrading, at its
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basic level, involves improving the physical environment of the existing
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area, such as improving and installing basic infrastructure like water,
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sanitation, solid waste collection, electricity, storm water drainage,
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access roads and footpaths, and street lighting, as well as home
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improvements and securing land tenure.
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Objectives
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To explore the effects of slum upgrading strategies involving physical
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environment and infrastructure interventions on the health, quality of
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life and socio-economic wellbeing of urban slum dwellers in low and
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middle income countries (LMIC). Where reported, data were collected on
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the perspectives of slum dwellers regarding their needs, preferences for
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and satisfaction with interventions received.
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Search methods
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We searched for published and unpublished studies in 28 bibliographic
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databases including multidisciplinary (for example Scopus) and
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specialist databases covering health, social science, urban planning,
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environment and LMIC topics. Snowballing techniques included searching
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websites, journal handsearching, contacting authors and reference list
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checking. Searches were not restricted by language or publication date.
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Selection criteria
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We included studies examining the impact of slum upgrading strategies
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involving physical environment or infrastructure improvements (with or
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without additional co-interventions) on the health, quality of life and
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socio-economic wellbeing of LMIC urban slum dwellers. Randomised
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controlled trials (RCTs), controlled before and after studies (CBAs) and
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interrupted time series (ITS) were eligible for the main analysis.
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Controlled studies with only post-intervention data (CPI) and
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uncontrolled before and after (UBA) studies were included in a separate
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narrative to examine consistency of results and to supplement evidence
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gaps in the main analysis.
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Data collection and analysis
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Two authors independently extracted data and assessed risk of bias for
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each study. Differences between the included study interventions and
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outcomes precluded meta-analysis so the results were presented in a
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narrative summary with illustrative harvest plots. The body of evidence
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for outcomes within the main analysis was assessed according to GRADE as
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very low, low, moderate or high quality.
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Main results
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We identified 10,488 unique records, with 323 screened as full text.
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Five studies were included for the main analysis: one RCT with a low
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risk, two CBAs with a moderate risk and two CBAs with a high risk of
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bias. Three CBAs evaluated multicomponent slum upgrading strategies.
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Road paving only was evaluated in one RCT and water supply in one CBA. A
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total of 3453 households or observations were included within the four
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studies reporting sample sizes.
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Most health outcomes in the main studies related to communicable
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diseases, for which the body of evidence was judged to be low quality.
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One CBA with a moderate risk of bias found that diarrhoeal incidence was
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reduced in households which received water connections from a private
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water company (risk ratio (RR) 0.53; 95\% confidence interval (CI) 0.27
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to 1.04) and the severity of diarrhoeal episodes (RR 0.48; 95\% CI 0.19
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to 1.22). There was no effect for duration of diarrhoea. Road paving did
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not result in changes in parasitic infections or sickness in one RCT.
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After multicomponent slum upgrading, claims for a waterborne disease as
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opposed to a non-waterborne disease reduced (RR 0.64; 95\% CI 0.27 to
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0.98) in one CBA with a high risk of bias but there was no change in
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sanitation-related mortality in a CBA with a moderate risk of bias.
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The majority of socio-economic outcomes reported within the main studies
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related to financial poverty, for which the body of evidence was of very
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low quality. Results were mixed amongst the main studies; one RCT and
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two CBAs reported no effect on the income of slum dwellers following
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slum upgrading. One further CBA found significant reduction in monthly
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water expenditure (mean difference (MD) -17.11 pesos; 95\% CI -32.6 to
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-1.62). One RCT also showed mixed results for employment variables,
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finding no effect on unemployment levels but increased weekly worked
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hours (MD 4.68; 95\% CI -0.46 to 9.82) and lower risk of residents
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intending to migrate for work (RR 0.78; 95\% CI 0.60 to 1.01).
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There was no evidence available to assess the impact of slum upgrading
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on non-communicable diseases or social capital. Maternal and perinatal
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conditions, infant mortality, nutritional deficiencies, injuries,
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self-reported quality of life, education and crime were evaluated in one
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study each.
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Nine supporting studies were included that measured varying outcomes
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(6794 households or observations within eight studies reporting sample
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sizes). One CPI evaluated cement flooring only while three UBAs and five
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CPIs evaluated multicomponent slum upgrading strategies. All studies but
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one had a high risk of bias.
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The studies reinforced main study findings for diarrhoea incidence and
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water-related expenditure. Findings for parasitic infections and
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financial poverty were inconsistent with the main studies. In addition,
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supporting studies reported a number of disparate outcomes that were not
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evaluated in the main studies.
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Five supporting studies included some limited information on slum
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dweller perspectives. They indicated the importance of appropriate
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siting of facilities, preference for private facilities, delivering
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synergistic interventions together, and ensuring that infrastructure was
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fit for purpose and systems were provided for cleaning, maintenance and
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repair.
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Authors'' conclusions
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A high risk of bias within the included studies, heterogeneity and
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evidence gaps prevent firm conclusions on the effect of slum upgrading
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strategies on health and socio-economic wellbeing. The most common
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health and socio-economic outcomes reported were communicable diseases
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and indicators of financial poverty. There was a limited but consistent
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body of evidence to suggest that slum upgrading may reduce the incidence
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of diarrhoeal diseases and water-related expenditure. The information
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available on slum dwellers'' perspectives provided some insight to
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barriers and facilitators for successful implementation and maintenance
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of interventions.
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The availability and use of reliable, comparable outcome measures to
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determine the effect of slum upgrading on health, quality of life and
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socio-economic wellbeing would make a useful contribution to new
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research in this important area. Given the complexity in delivering slum
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upgrading, evaluations should look to incorporate process and
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qualitative information alongside quantitative effectiveness data to
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determine which particular interventions work (or don''t work) and for
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whom.'
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affiliation: 'Turley, R (Corresponding Author), Cardiff Univ, Informat Serv, SURE,
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1st Floor,Heath Pk, Cardiff CF14 4YS, S Glam, Wales.
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Turley, Ruth, Cardiff Univ, Informat Serv, SURE, Cardiff CF14 4YS, S Glam, Wales.
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Saith, Ruhi, Oxford Policy Management, New Delhi, India.
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Bhan, Nandita, Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev \& Hlth, Boston,
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MA 02115 USA.
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Rehfuess, Eva, Univ Munich, Inst Med Informat Biometry \& Epidemiol, Munich, Germany.
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Carter, Ben, Univ Birmingham, Sch Canc Sci, Canc Res UK Clin Trials Unit, Birmingham,
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W Midlands, England.'
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article-number: CD010067
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author: Turley, Ruth and Saith, Ruhi and Bhan, Nandita and Rehfuess, Eva and Carter,
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Ben
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author-email: ruthturley@rocketmail.com
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author_list:
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- family: Turley
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given: Ruth
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- family: Saith
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given: Ruhi
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- family: Bhan
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given: Nandita
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- family: Rehfuess
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given: Eva
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- family: Carter
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given: Ben
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da: '2023-09-28'
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doi: 10.1002/14651858.CD010067.pub2
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eissn: 1361-6137
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files: []
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issn: 1469-493X
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journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
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keywords-plus: 'IMPROVEMENT PROGRAMS; PROPERTY-RIGHTS; IMPACT; WATER; SANITATION;
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DIARRHEA; SALVADOR; CHILDREN; HYGIENE; AREAS'
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language: English
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number: '1'
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number-of-cited-references: '82'
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orcid-numbers: Carter, Ben/0000-0003-0318-8865
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papis_id: da2100fed31b7031686375991c5c1f2d
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ref: Turley2013slumupgrading
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researcherid-numbers: 'Rehfuess, Eva Annette/ABD-8167-2021
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'
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tags:
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- relevant
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- review
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times-cited: '95'
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title: Slum upgrading strategies involving physical environment and infrastructure
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interventions and their effects on health and socio-economic outcomes (Review)
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type: Review
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unique-id: WOS:000314315200029
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usage-count-last-180-days: '3'
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usage-count-since-2013: '135'
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web-of-science-categories: Medicine, General \& Internal
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year: '2013'
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