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Contrasting children and women’s health and the determinants of health in a small-sized city

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Abstract

Contrasts that exist in urban infrastructure and accessibility of public health and social services between suburban and urban districts of mega-cities have been well defined. There has been less research in small-sized cities (population under 500,000). This cross-sectional study was done on 1,728 ever-married reproductive-aged women living in Manisa, Turkey, in the year 2000. The probability proportion to size cluster sampling approach was used in the sample selection. Data were collected for women and 7,016 inhabitants of the interviewed households. The data were collected from the women by face to face interviews. Suburban areas (illegally occupied public land called “Gecekondu” dwellings) in Manisa differ from other urban regions (legal settlements of the city) on socioeconomic factors including household occupancy, adult literacy, social class, rates of religious marriages, unemployment, health insurance coverage, migration, cultural segregation, and social status of women. Some traditional practices were also highly prevalent in gecekondu families, where poverty is more common. Although gross fertility rate (GFR), total fertility rate (TFR), and percent decrease of the TFR were higher for gecekondu women than urban women, total wanted fertility rate (TWFR) was lower. In urban neighborhoods, prevalence of contraceptive use was higher, and the infant and child mortality rates were lower; however, when rates were adjusted for mother’s age, education and number of births, the differences turned out to be nonsignificant. Women living in urban areas receive better antenatal care, child immunization services, and professional health delivery assistance and services in a health facility; these services are very scarce in gecekondu districts. Health status of gecekondu populations can be improved by social and economic support and by making health services more available and accessible, especially maternity and child health services.

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References

  1. Mathur OP. New strategies for urban poverty. Work in Progress: United Nations University. 1991;13:3.

    Google Scholar 

  2. Lacabana M, Cariola C. Globalization and metropolitan expansion: residential strategies and livelihoods in Caracas and its periphery. Environ Urban. 2003;15:65–74.

    Google Scholar 

  3. Logan JR, Alba RD, McNulty T, Fisher B. Making a place in the metropolis: locational attainment in cities and suburbs. Demography. 1996;33:443–453.

    CAS  PubMed  Google Scholar 

  4. Farley R. Residential segregation in urbanized areas of the United States in 1970: an analysis of social class and racial differences. Demography. 1977;14:497–518.

    CAS  PubMed  Google Scholar 

  5. Massey DS, Denton NA. Hyper segregation in U.S. metropolitan areas: black and Hispanic segregation along five dimensions. Demography. 1989;26:373–391.

    CAS  PubMed  Google Scholar 

  6. Hart KD, Kunitz SJ, Sell RR, Mukamel DB. Metropolitan governance, residential segregation, and mortality among African Americans. Am J Public Health. 1998;88:434–438.

    CAS  PubMed  Google Scholar 

  7. Fong E, Shibuya K. The spatial separation of the poor in Canadian cities. Demography. 2000;37:449–459.

    CAS  PubMed  Google Scholar 

  8. Shaw M, Gordon D, Dorling D, Mitchell R, Smith GD. Increasing mortality differentials by residential area level of poverty: Britain 1981–1997. Soc Sci Med. 2000;51:151–153.

    Article  CAS  PubMed  Google Scholar 

  9. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55:111–122.

    Article  CAS  PubMed  Google Scholar 

  10. Rossi-Espagnet A, Tabibzadeh I. Strengthening Urban Health Services. Geneva, Switzerland: WHO Division of Strengthening Health Services; 1995. WHO/SHS/CC/95. 1 Paper, No. 9.

    Google Scholar 

  11. World Bank. World Development Report 1993. Washington, DC: World Bank; 1993.

    Google Scholar 

  12. Abidoye RO, Ihebuzor NN. Assessment of nutritional status using anthropometric methods on 1–4 year old children in an urban ghetto in Lagos, Nigeria. Nutr Health. 2001;15:23–39.

    Google Scholar 

  13. Sohler NL, Arno PS, Chang CJ, Fang J, Schechter C. Income inequality and infant mortality in New York City. J Urban Health. 2003;80:650–657.

    PubMed  Google Scholar 

  14. Rabbani F, Merchant AT. Economic development and health status among the poor in squatter settlements of Karachi. Pak Medical Assoc. 1999;49:117–121.

    CAS  Google Scholar 

  15. Freeman HL. Mental Health and Environment. London: Churchill Livingstone; 1984.

    Google Scholar 

  16. Coleman A. Utopia on Trial: Vision and Reality in Planned Housing. London: Hiliary Shipman; 1985.

    Google Scholar 

  17. Strachan DP, Elton RA. Relationship between respiratory morbidity in children and the home environment. Family Practice. 1986;3:137–142.

    CAS  PubMed  Google Scholar 

  18. Marcus TA. Cold, condensation, climate and poverty in Glasgow. Paper presented at: Conference on Healthy Housing: Promoting Good Health; March 19–21, 1993; University of Warwick, Coventry, UK.

  19. Boardman B. Defining affordable warmth. Paper presented at: Conference on Unhealthy Housing: Prevention and Remedies; March 1987; University of Warwick, Coventry, UK.

  20. Birtchnell J, Masters N, Deahl M. Depression and physical environment. A study of young married women on a London housing estate. Br J Psychiatry. 1988;153:56–64.

    CAS  PubMed  Google Scholar 

  21. Blackman T, Evason E, Melaugh M, Woods R. Housing and health: a case study of two areas in West Belfast. J Soc Policy. 1989;18:1–26.

    CAS  PubMed  Google Scholar 

  22. Hacettepe University Institute of Population Studies. 1988 Turkish Fertility and Health Survey. Ankara, Turkey: Hacettepe University Institute of Population Studies; 1989.

    Google Scholar 

  23. Townsend P, Davidson N. Inequalities in Health, the Black Report. London: Penguin Group; 1990.

    Google Scholar 

  24. Lagasse R, Humblet PC, Lenaerts A, Godin I, Moens GF. Health and social inequalities in Belgium. Soc Sci Med. 1990;31:237–248.

    Article  CAS  PubMed  Google Scholar 

  25. Kirchgassler KU. Health and social inequalities in the Federal Republic of Germany. Soc Sci Med. 1990;31:249–256.

    Article  CAS  PubMed  Google Scholar 

  26. Aiach P, Curtis S. Social inequalities in self-reported morbidity: interpretation and comparison of data from Britain and Frace. Soc Sci Med. 1990;31:267–274.

    Article  CAS  PubMed  Google Scholar 

  27. Cook G. Health and social inequalities in Ireland. Soc Sci Med. 1990;31:285–290.

    Article  CAS  PubMed  Google Scholar 

  28. Dedeoĝlu N. Health and social inequalities in Turkey. Soc Sci Med. 1990;31:387–392.

    Article  PubMed  Google Scholar 

  29. Sufian AJM. A multivariate analysis of infant mortality in developing countries. Nüfus Bilim Dergisi (Turk J Popul Stud). 1990;12:19–30.

    CAS  Google Scholar 

  30. Dales RE, Zwanenburg H, Burnett R, Franklin CA. Respiratory health effects of home dampness and molds among Canadian children. Am J Epidemiol. 1991;134:196–203.

    CAS  PubMed  Google Scholar 

  31. Fathalla MF. Reproductive health in the world: two decades of progress and the challenge ahead. In: Khanna J, Van Look PFA, Griffin PD, eds. Reproductive Health: A Key to a Brighter Future, Biennial Report 1990–91. Special 20th Anniversary Issue. Geneva: World Health Organization; 1992:3–32.

    Google Scholar 

  32. Tezcan S, Aktekin M, Yildirim N. Anatalya il merkezindeki bir gecekondu yerlesiminde yeni ve eski gecekondu mahallelerinde toplumun demografik yapisi ve dogurganlik düzeyi (The demographic structure and fertility level of the populatioon living in the recently developed and old gecekondu neighbors in Antalya city). Nüfus Bilim Dergisi (Turk J Popul Stud). 1992;14:45–49.

    Google Scholar 

  33. Ministry of Health (Turkey). Turkish Population and Census Research 1993. Ankara, Turkey: Hacettepe University Institute of Population Studies, Macro International Inc; 1994.

    Google Scholar 

  34. Bender DE, Rivera T, Madonna D. Rutal origin as a risk factor for maternal and child health in periurban Bolivia. Soc Sci Med. 1993;37:1345–1349.

    Article  CAS  PubMed  Google Scholar 

  35. Gbesemete KP, Johnsson D. A comparison of empirical models on determinants of infant mortality: a cross-national study on Africa. Health Policy. 1993;24:155–174.

    Article  CAS  PubMed  Google Scholar 

  36. Murphy L. Allying health care and housing. Health Prog. 2005;86:17–20.

    PubMed  Google Scholar 

  37. Swenson JE, Nyugen MT, Pham BS, Vu QN, Vu DM. Factors influencing infant mortality in Vietnem. J Biosoc Sci. 1993;25:285–302.

    CAS  PubMed  Google Scholar 

  38. Najman JM. Health and poverty: past, present and the prospect for the future. Soc Sci Med. 1993;36:157–166.

    Article  CAS  PubMed  Google Scholar 

  39. Tezcan S, Yildirum N, Özkaya N., et al. Ahath gecekondu Bölgesinde Entegre AçS/AP Hizmetleri ve Toplum kalkinmasi Duojesi Durum Saptama Arastirmasi 1989 (Ahath Shanty Town, Integrated Maternal and Child Health/Family Planning Services and Community Development Project, Baseline Survey, 1989). Ankara, Turkey: UNICEF; 1993;RS-7/U.

    Google Scholar 

  40. Aktekin M, Dedeoĝlu N. Squatter areas in Antalya, Turkey and their health problems. Paper presented at: First Global and European Conference on City-93; October 25–30, 2003; Antwerp, Belgium.

  41. Atkinson SJ, Cheyne J. Immunization in urban areas: issues and strategies. Bull World Health Organ. 1994;72:183–194.

    CAS  PubMed  Google Scholar 

  42. Health Organization in the cities-workshop report in IVth National Public Health Congress. Toplum Ve Hekim (Community Physician). 1994;9:30–44.

    Google Scholar 

  43. Eser E, Mandiracioglu A, Sacaklioglu F, Karababa A, Doĝan F, Tokgöz M. Patchwork in medical education: rural internship. Am CCommun-Oriented Educ. 1994;7:303–308.

    Google Scholar 

  44. Mackenbach JP. Socio-economic inequalities in health in the Netherlands: impact of a five year research program. BMJ. 1994;309:1487–1491.

    CAS  PubMed  Google Scholar 

  45. Asthana S. Variations in poverty and health between slum settlements: contradictory findings from Visakhapatnam, India. Soc Sci Med. 1995;40:177–188.

    Article  CAS  PubMed  Google Scholar 

  46. Department of Public Health Medicine. Eastern Health and Social Services Board and Research Unit Northern Ireland Housing Executive. Northern Ireland: Health and Housing Study; 1995.

    Google Scholar 

  47. Perdue WC, Stone LA, Gostin LO. The built enviroment and its relationship to the public’s health: the legal framework. Am J Public Health. 2003;93:1390–1394.

    PubMed  Google Scholar 

  48. Evans GW. The built environment and mental health. J Urban Health. 2003;80:536–555.

    PubMed  Google Scholar 

  49. State Institute of Statistics Prime Ministry Republic of Turkey Periodical Publications’ Catalogue of the State Institute of Statistics of Turkey 2005. Available at: http:// www.die.gov.tr/yayin/sur_yay_ing.pdf Accessed March 20, 2004.

  50. Keles R. Türkiye’de Sehirlesme, Konut ve Gecekondu (Urbanisation, Housing and Shanty Town in Turkey). Istanbul Turkey: Gerçek Yayinlari; 1978.

    Google Scholar 

  51. Coruh M, Topal I. Pregnancy and pregnancy outcome in Ankara (gecekondu) adolescents. J Adolesc Health Care. 1981;1:232–235.

    Article  CAS  PubMed  Google Scholar 

  52. Dedeoĝlu N, Aktekin M, Dönmez, L. Prevalence of malnutrition and its relationship with some variables in Antalya city. çocuk Saĝliĝt ve Hastahklart Dergisi (J Pediatr). 1995;30:363–375.

    Google Scholar 

  53. Dedeoĝlu N. Kentler ve Saĝlikta e§itsizlik (Cities and inequity in health). Toplum Ve Hekim (Community Physician). 1998;13:123–125.

    Google Scholar 

  54. Dedeoĝlu N. Gecekondular ve Saĝlik Sorunlari (Gecekondu and its health problems). Bilim ve Ütopya (Sci Utopia). 1999;55:43–45.

    Google Scholar 

  55. Hacettepe University Institute of Population Studies. Turkish Population and Health Survey, 1998. Ankara, Turkey: Macro International Inc; 1999.

    Google Scholar 

  56. Brennan ME, Lancashire R. Association of childhood mortality with housing status and unemployment. J Epidemiol Community Health. 1978;32:29–33.

    Article  Google Scholar 

  57. Newman O. Defensible Space, People and Design in the Violent City. London: Architectural Press; 1972.

    Google Scholar 

  58. Burr ML, St Leger AS, Yarnell JW. Wheezing, dampness and coal fires. Community Med. 1981;3:205–209.

    CAS  PubMed  Google Scholar 

  59. Monteiro CA, Nazario CL. Evolution of enviromental determinants of health in childhood in the city of Sao Paulo, Brazil. Rev Saude Publica, 2000;34:13–18.

    CAS  PubMed  Google Scholar 

  60. Stafford M, Marmot M. Neighborhood deprivation and health: does it affect us all equally? Int J Epidemiol. 2003;32:357–366.

    Article  PubMed  Google Scholar 

  61. Kuntz AE, Mackenbach JP. Measuring Socioeconomic Inequalities in Health. Copenhagen, Denmark: WHO; 1995.

    Google Scholar 

  62. Ryan M. Monitoring effects of deprivation on health. BMJ. 1995;310:398–399.

    CAS  PubMed  Google Scholar 

  63. Kaplan G, Pamuk ER, Lynch J, Cohen RD. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996;312:999–1003.

    CAS  PubMed  Google Scholar 

  64. Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet. 1997;349:1655–1659.

    Article  CAS  PubMed  Google Scholar 

  65. Rustein SO. Pactors associated with trends in infant and child mortality in developing countries during the 1990s. Bull World Health Organ. 2000;78:1256–1270.

    Google Scholar 

  66. LeClere F, Soobader MJ. The effects of income in equlity on the health of selected US demographic groups. Am J Public Health. 2000;90:1892–1897.

    Article  CAS  PubMed  Google Scholar 

  67. Turrell G, Mengersen K. Socio-economic status and infant mortality in Australia: a national study of small urban areas, 1985–1989. Soc Sci Med. 2000;50:1209–1225.

    Article  CAS  PubMed  Google Scholar 

  68. Macintyre S, Anne E, Hiscock R, Kearns A, Der G, McKay L. What features of the home and the area might help to explain observed relationships between housing tenure and health? evidence from the west of Scotland. Health Place. 2003;9:207–218.

    Article  PubMed  Google Scholar 

  69. Kawachi I, Kennedy BP. (Socio-economic determinants of health) Health and social cohesion: why care about income inequality? BMJ. 1997;314:1037–1040.

    CAS  PubMed  Google Scholar 

  70. Castro Martin T. Women’s education and fertility: results from 26 demographic and health surveys. Stud Fam Plann. 1995;26:187–202.

    Google Scholar 

  71. Sastry N. What explains rural-urban differentials in child mortality in Brazil? Soc Sci Med. 1997;44:989–1002.

    Article  CAS  PubMed  Google Scholar 

  72. Terra De Souza AC, Cufino E, Peterson KE, Gardner J, Vasconcelos do Amaral MI, Ascherio A. Variations in infant mortality rates among municipalities in the state of Ceara, Northeast Brazil: an ecological analysis. Int J Epidemiol. 1999;28:267–275.

    Article  Google Scholar 

  73. UNESCO Statistical Yearbook 1999. Ottawa, Ontario: Renouf Publications; 1999.

  74. Toyama N, Wakai S, Nakamura Y, Arifin A. Mother’s working status and nutritional status of children under the age of 5 in urban low-income community, Surabaya, Indonesia. J Trop Pediatr. 2001;47:179–181.

    Article  CAS  PubMed  Google Scholar 

  75. UNICEF. The State of World’s Children, 2001. New York: UNICEF; 2001.

    Google Scholar 

  76. Raum E, Arabin B, Schlaud M, Walter U, Schwatrz FW. The impact of maternal education on intrauterine growth: a comparison of former West and East Germany. Int J Epidemiol. 2001;30:81–87.

    Article  CAS  PubMed  Google Scholar 

  77. Ay S, Eser E, Ozcan C. --Tukiye’de kadm ve çocuk saĝliĝi ile ilgili bazi ölçütler ile sosyoekon deĝi§kenler arasinaki ili§ki: bir ekolojik çali§ma (The relationship between some indicators related with women and children health, and socio-economic, socio-demographic variables in Turkey: an ecological study). toplum Ve Hekim (Community Physician). 2004;19:83–91.

    Google Scholar 

  78. Andersson T, Hogberg U, Bergstrom S. Community based prevention of perinatal deaths: lessons from nineteenth-century Sweden. Int J Epidemiol. 2000;29:542–548.

    Article  CAS  PubMed  Google Scholar 

  79. Khoury SA, Massad DF. Consanguinity, fertility, reproductive wastage, infant mortality and congenital malformations in Jordan. Saudi Med J. 2000;21:150–154.

    CAS  PubMed  Google Scholar 

  80. Hussian R. The impact of consanguinity and inbreeding on perinatal mortality in Karachi, Pakistan. Paediatr Perinat Epidemiol. 1998;12:370–382.

    Article  Google Scholar 

  81. Aholi P. Children and traditional practices. Vie Sante. 1990;4:11–14.

    PubMed  Google Scholar 

  82. White L, Chalmers S, Litchfield K, Savage M. Cultural diversity and child health. J Paediatr Child Health. 2004;40:589.

    Article  CAS  PubMed  Google Scholar 

  83. Kent M. Survey report: Turkey. Popul Today. 1987;15:5.

    Google Scholar 

  84. Sahin F, Akturk A, Beyazova U, et al. Screening for developmental dysplasia of the hip: results of a 7-year follow-up study. Pediatr Int. 2004;46:162–166.

    Article  PubMed  Google Scholar 

  85. Ulusoy M, Tuncbilek E. Consanguineous marriage in Turkey and its effects on infant mortality. Nufusbil Derg. 1987;9:7–26.

    CAS  PubMed  Google Scholar 

  86. Alper OM, Erengin H, Manguoglu AE, et al. Consanguineous marriages in the province of Antalya, Turkey. Ann Genet. 2004;47:129–138.

    CAS  PubMed  Google Scholar 

  87. Shrestha S. Socio-cultural factors influencing adolescent pregnancy in rural Nepal. Int. J Adolesc Med Health. 2002;13:101–109.

    Google Scholar 

  88. Goldscheider C, Mosher WD. Patterns of contraceptive use in the United States: the importance of religious factors. Stud Fam Plann. 1991;22:102–115.

    CAS  PubMed  Google Scholar 

  89. Adongo PB, Phillips JF, Binka FN. The influence of traditional religion on fertility regulation among the Kassena-Nankana of Northern Ghana. Stud Fam Plann. 1998;29:23–40.

    CAS  PubMed  Google Scholar 

  90. Akin A, ed. Maternity Health, Family Planning and Induced Abortions in Turkey: the Results of the Further Analysis on 1998 Turkish Population and Health Survey. Ankara, Turkey: Kum Baski Hizmetleri; 2002.

    Google Scholar 

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  1. Department of Public Health, Celal Bayar University, Manisa, Turkey

    Erhan Eser MD,  Gönül Dinç,  Ahmet Murat Oral &  Cemil Özcan

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  1. Erhan Eser MD
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  2. Gönül Dinç
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Eser, E., Dinç, G., Oral, A.M. et al. Contrasting children and women’s health and the determinants of health in a small-sized city. J Urban Health 82, 666–681 (2005). https://doi.org/10.1093/jurban/jti118

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