Mental health, quality of life, and nutritional status of adolescents in Dhaka, Bangladesh: Comparison between an urban slum and a non-slum area
Introduction
According to the World Health Organization (WHO), about 450 million of the world's population suffer from mental or neurological disorders or from psychosocial problems; while one in every four persons is affected by a mental disorder at some stage in their life (WHO, 2001a). In particular, major depression, with a life time prevalence of 10–25% for females and 5–12% for males (American Psychiatric Association, 2000), is ranked fourth in terms of the global burden of disease, and is projected to be the second cause of the global disease burden within 20 years (WHO, 2001a). However, mental health issues tend to be overtaken by other health problems, especially in developing countries.
Particularly, such situations in the ever increasing slum areas is a global concern with rapid urbanization taking place in developing countries, where slum inhabitants today are estimated to constitute 60% of the inhabitants in big cities (Hussain, Ali, & Kvale, 1999). Urbanization has been shown to be associated with higher incidents of injuries from traffic accidents (United Nations Environment Programme, & WHO, 1994), respiratory illness (Lovik, Dybing & Smith, 1996; SIDRIA, 1997), cancer (Schouten, Meijer, Huveneers, & Kiemeney, 1996), cardiovascular diseases and hypertension (Barnett, Strogatz, Armstrong, & Wing, 1996; Kaufman, Owoaje, James, Rotimi, & Cooper, 1996; Mufundu, Sigola, Chifamba, & Vengesa, 1994), deterioration in infant and child mortality (Backmann, London, & Barron, 1996; Kuate Defo, 1996; Sastry, 1997), and mental health problems (Cheng, 1989; Gillis, Welman Kock, & Joyi, 1991; Mueller, 1981; Rahim & Cederblad, 1986; Shepherd, 1984; Sijuwade, 1995; Varma et al., 1997). As for children's and adolescents’ mental health, Takano, Nakamura, and Watanabe (1996) indicated that in young people urbanization increased risks such as drug, alcohol, tobacco, and risky sexual behaviours, and that these behaviours were linked to the rise of psychological problems. Also, Harpham (1994) pointed out that urbanization initiated rapid social changes, disintegration, dissolution of social relations, and decreased social control, and that these factors contributed to mental diseases particularly in young people. However, research regarding the mental health status of slum-living adolescents is lacking.
In Bangladesh, there has been no official data on mental health. As to mental health research in Bangladesh, Islam, Ali, Ferroni, Underwood and Alam (2003) conducted a community survey in urban middle-class adult population in Dhaka, and presented prevalence of psychiatric disorders as 28%. A study of a married rural population utilizing MOS-Short Form 36 (SF-36) by Ahmed, Rana, Chowdhury and Bhuiya (2002) showed consistent negative self-evaluation of mental health status, and its deterioration with the advancement of age. Khan (2002) indicated suicides in the countries of the Indian subcontinent including Bangladesh had differences from those in Western countries, showing higher organophosphate insecticides use, a higher ratio of married women, fewer elder subjects, and more problems in interpersonal relationship and life events as causative factors. As to children, Rabbani and Hossain (1999), using teachers’ reports, showed that 13.4% of urban primary school children in Dhaka had emotional, conduct or undifferentiated disorders. As to adolescents, though the reliability and validity of the Strengths and Difficulties Questionnaire (SDQ) has been assessed utilizing adolescent subjects (Goodman, Renfrew, & Mullick, 2000; Mullick & Goodman, 2001), the mental health status of such subjects remains unclear. To add to the prevailing poverty and severe health status; 33% of the total population of approximately 129 million is malnourished and the infant mortality rate in 2000 was 54 in 1000 births (United Nations Development Programme, 2002; World Bank & Bangladesh Centre for Advanced Studies, 1998), the urban growth rate in Bangladesh is projected to be 5.4% in the period 1999–2010 (Bangladesh Bureau of Statistics, 2002), and Bangladeshi urban population in 2020 is estimated to be nearly half the national total; and that of its capital Dhaka will be doubled by 2010 (WHO, 1997). A good percentage of this population increase will reside in slums due to lack of job opportunities, income and housing. Thus the mental health status of children and adolescents in urban slum population in Bangladesh needs to be evaluated.
Therefore, this study aimed at (A) clarifying the QOL, general mental health, behavioural, emotional and social problems and nutritional status of adolescents in Dhaka city, Bangladesh in comparisons between non-slum area adolescents and slum area adolescents using internationally comparable scales; and (B) finding factors (age, sex, nutritional status, educational status, job status, and family income) associated with mental health problems.
Section snippets
General population subjects
This study was conducted in Dhaka, the capital of Bangladesh. To obtain a representative cross sample of Dhaka city, six wards were randomly selected, with one non-slum area and one slum area being selected from each ward as study sites. A UN expert group established an operational definition of slums as being an area that to various extents combines the following characteristics: inadequate access to safe water; inadequate access to sanitation and other infrastructure; poor structural quality
Demographic characteristics
Demographic data are shown in Table 1. Since there was a significant age difference between the Non-Slum and Slum groups for both genders ; parametric analyses between the groups were performed using age as the covariate. Almost all of the respondents in this research were Muslim and of Bangla ethnicity. Slum adolescents had significantly lower school enrolment, literacy, family income and higher employment rates than non-slum area adolescents . There was no significant
Discussion
The present study investigated Bangladeshi urban adolescents’ QOL and mental health status utilizing internationally recognized scales. At the same time, this study showed differences in living status, QOL, mental health and nutritional status between adolescents in urban slums and those living in non-slum areas.
Slum adolescents had lower school enrolment rates, lower literacy rates, lower family incomes, lighter weights, lower BMI (in females only a tendency was observed), and higher rates of
Acknowledgements
The authors would like to express their gratitude to National Institute of Mental Health, Bangladesh, and to the interviewers Abu Ala Mahmudul Hasan, Anjuman Tahmina Ferdous, Imran Al Amin, Jasmin Khan, Khadiza Begum, Md. Saiful Islam, Shormin Sultana, Zahangir Alam, and Md. Iqbal Hossain for their enormous contribution, and without whom the data collection would have been impossible. This study was supported by Mitsubishi Foundation grants for social welfare activities.
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