Catastrophic health expenditure and distress financing of breast cancer treatment in India: evidence from a longitudinal cohort study.

OBJECTIVE: To estimate the catastrophic health expenditure and distress financing of breast cancer treatment in India. METHODS: The unit data from a longitudinal survey that followed 500 breast cancer patients treated at Tata Memorial Centre (TMC), Mumbai from June 2019 to March 2022 were used. The catastrophic health expenditure (CHE) was estimated using households' capacity to pay and distress financing as selling assets or borrowing loans to meet cost of treatment. Bivariate and logistic regression models were used for analysis. FINDINGS: The CHE of breast cancer was estimated at 84.2% (95% CI: 80.8,87.9%) and distress financing at 72.4% (95% CI: 67.8,76.6%). Higher prevalence of CHE and distress financing was found among rural, poor, agriculture dependent households and among patients from outside of Maharashtra. About 75% of breast cancer patients had some form of reimbursement but it reduced the incidence of catastrophic health expenditure by only 14%. Nearly 80% of the patients utilised multiple financing sources to meet the cost of treatment. The significant predictors of distress financing were catastrophic health expenditure, type of patient, educational attainment, main income source, health insurance, and state of residence. CONCLUSION: In India, the CHE and distress financing of breast cancer treatment is very high. Most of the patients who had CHE were more likely to incur distress financing. Inclusion of direct non-medical cost such as accommodation, food and travel of patients and accompanying person in the ambit of reimbursement of breast cancer treatment can reduce the CHE. We suggest that city specific cancer care centre need to be strengthened under the aegis of PM-JAY to cater quality cancer care in their own states of residence. TRIAL REGISTRATION: CTRI/2019/07/020142 on 10/07/2019.

Climate uncertainty and vulnerability of urban flooding associated with regional risk using multi-criteria analysis in Mumbai, India.

The study made a comprehensive effort to examine climatic uncertainties at both yearly and monthly scales, along with mapping flood risks based on different land use categories. Recent studies have progressively been engrossed in demonstrating regional climate variations and associated flood probability to maintain the geo-ecological balance at micro to macro-regions. To carry out this investigation, various historical remote sensing record, reanalyzed and in-situ data sets were acquired with a high level of spatial precision using the Google Earth Engine (GEE) web-based remote sensing platform. Non-parametric techniques and multi-layer integration methods were then employed to illustrate the fluctuations in climate factors alongside creating maps indicating the susceptibility to floods. The study reveals an increased pattern in LST (Land Surface Temperature) (0.03 °C/year), albeit marginal declined in southern coastal regions (-0.15 °C/year) along with uneven rainfall patterns (1.42 mm/year). Moreover, long-term LULC change estimation divulges increased trends of urbanization (16.4 km2/year) together with vegetation growth (8.7 km2/year) from 2002 to 2022. Furthermore, this inquiry involves numerous environmental factors that influence the situation (elevation data, topographic wetness index, drainage density, proximity to water bodies, slope, and soil properties) as well as socio-economic attributes (population) to assess flood risk areas through the utilization of Analytical Hierarchy Process and overlay methods with assigned weights. The outcomes reveal nearly 55 percent of urban land is susceptible to flood in 2022, which were 45 and 37 percent in 2012 and 2002 separately. Additionally, 106 km2 of urban area is highly susceptible to inundation, whereas vegetation also occupies a significant proportion (52 km2). This thorough exploration offers a significant chance to formulate flood management and mitigation strategies tailored to specific regions during the era of climate change.

The effect of the tidal cycle on the phytoplankton community assemblage in a mangrove-dominated tropical tidal creek.

A comparative assessment of phytoplankton dynamics during low tide (LT) and high tide (HT) was conducted from February 2022 to January 2023 in a tropical mesotidal creek, Manori, Mumbai, India. In total, 124 phytoplankton species were recorded. The HT resulted in greater species richness (124 species) and diversity indices (Shannon-Wiener's index) than the LT (102 species). The Pielou's evenness (J') and Simpson's dominance index (1-D) did not show significant fluctuations with the tides due to the marine phytoplankton species moving rhythmically in and out of the creek with the tides. Overall, the seasonal abundance was maximum during pre-monsoon at HT (5.79 × 103 u/L) and lowest in monsoon at LT (0.45 × 103 u/L), whereas spatial abundance was maximum at S1 (HT- 4.04 × 103 u/L) at HT and lowest at S3 (LT- 0.75 × 103 u/L) at LT. The diatoms dominated in their abundance (1.83 × 103 u/L and 3.82 × 103 u/L in HT) and diversity (77 in LT and 92 in HT). The species such as Coscinodiscus centralis, Coscinodiscus granii, Coscinodiscus radiatus, Triops furca, Melosira varians, Nitzchsia palea, Chaetoceros affinis, Skeletonema marinoi, Stephanocyclus meneghinianus, Planktoniella sol and Skeletonema costatum were the dominant native residents in the creek. SIMPER analysis revealed that the maximum similarity was during the monsoon (47.65%), and the minimum was during the pre-monsoon (38.10%) at LT. However, in HT, the maximum similarity of phytoplankton shifted to post-monsoon (63.85%) and the minimum during the pre-monsoon (46.71%). The mean value of richness (d') and Shannon's diversity (H') showed a moderate phytoplankton diversity in the system. The environmental parameters (water temperature > pH > nitrate > salinity > DO > Alk > silicate) have a greater influence on the distribution of the phytoplankton community with tides as revealed by the Canonical correspondence analysis. Therefore, it has been found that tides play a significant role in the distribution and abundance of the phytoplankton community in a mesotidal creek environment.

Social cost--benefit analysis of solid waste management options with application to Mumbai, India.

Managing solid waste continues to be an environmental, technical and economic challenge, especially for developing countries. Though these countries' urban local bodies (ULBs) are moving up the waste management hierarchy, most waste is still openly dumped. One key reason for this choice is the non-accounting of (a) social costs associated with open dumping (OD) and (b) direct/indirect benefits of other options. The current study conducts a complete social cost-benefit analysis (SCBA) comparing OD to sanitary landfilling, composting, bio-methanation, incineration and gasification alternatives. The study finds that when only private costs/benefits are considered, a mix of OD and sanitary landfills is preferred; however, when external costs/benefits are factored in, the mix shifts towards alternatives like incineration and gasification. These learnings from the SCBA are then applied to Mumbai, which generates 9000 tonnes of waste daily. To determine the optimal mix for Mumbai ULB, a constrained optimization exercise is carried out considering the technical feasibility of the alternatives and the ULB's capital budget. The study finds that with the current practice of OD, the net present value (NPV) of the social costs over a 30-year horizon will be over US$ 6-9 billion. However, even if one-fifth of the ULB's capital budget is allocated towards other waste management alternatives, the mix would shift towards sophisticated technologies and the NPV of social costs would reduce to around half that amount.

COVID-19 vaccine rollout: data from informal settlements in Harare, Kampala, Lilongwe and Mumbai.

While the COVID-19 pandemic's effect on the health of low-income urban communities in the global South has not been insignificant, the results of state responses carried out without full consideration of poverty consequences have been very serious. Vaccination, which supports both health and economic recovery, is one way people can reduce the risk of further exclusion. This field note, drawing on surveys from informal settlements in Harare, Kampala, Lilongwe and Mumbai between August and November 2021 by national affiliates of Slum Dwellers International (SDI), provides a snapshot of how global vaccine inequalities have played out across these cities. We find that access to local vaccine programmes is influenced by both global supply and existing local-level inequities; that a low or unreliable supply, among other factors, limits political will to invest in reaching already underserved communities; and that local context and the heterogeneity of communities are key to understanding low vaccine uptake.

A regression-based three-phase approach to assess outdoor thermal comfort in informal micro-entrepreneurial settings in tropical Mumbai.

Urban heat poses a public health risk to the residents of megacities in developing countries because the population spends a significant amount of time outdoors to work and socialize with limited cooling resources. Understanding the drivers of outdoor comfort and heat stress in informal work settings is important to design climate-sensitive outdoor spaces and reduce heat vulnerability. We present outdoor thermal comfort perceptions (OTCPs) of people engaged in outdoor micro entrepreneurial activities in Mumbai using seasonal surveys and biometeorological observations. We propose a three-phase approach to analyze the relative importance of climatic and non-climatic variables for OTCPs. The first phase evaluates the seasonal and intra-neighborhood variation of thermal sensation votes (TSV) with respect to physiological equivalent temperature (PET) and air temperature. Second, we include physiological parameters to evaluate the seasonal and intra-neighborhood variation of overall sensation votes (OSV). Third, we consider aggregated survey responses and include behavioral and perceptual variables to determine their relative significance. We employ three linear modeling techniques to assess model performance in explaining the variability of OTCP using OSV as dependent variable. Results reveal that microclimatic parameters alone are unable to explain the variability of OTCP. Our results yield a neutral PET value (PETneutral) of 23.75 °C for Mumbai in the winter. PETneutral was higher for activities at the clothing market compared to other micro entrepreneurial activities. Acclimatization significantly improved comfort in the summer, while evaporative cooling was beneficial in the winter. Further, an ANCOVA and ordinal logistic regressions demonstrate the importance of behavioral attributes (presence in the location, expectation, beverage intake) in explaining the variance in OTCP. Our study also reveals that wind speed and humidity play an important role in shaping overall comfort in the Mumbai neighborhoods.

Linezolid resistance in Mycobacterium tuberculosis isolates at a tertiary care centre in Mumbai, India.

Background & objectives: Linezolid (LZD) is increasingly being used in tuberculosis (TB) treatment. However, LZD resistance has already been reported, which is highly alarming, given its critical therapeutic role. This study was aimed to phenotypically and genotypically assess LZD resistance in Mycobacterium tuberculosis (MTB) isolates at a laboratory in a tertiary care centre in Mumbai, India. Methods: A sample of 32 consecutive LZD-resistant MTB isolates identified by liquid culture susceptibility testing was subjected to whole-genome sequencing (WGS) on the Illumina NextSeq platform. Sequences were analyzed using BioNumerics software to predict resistance for 12 antibiotics within 15 min. Results: Sixty eight of the 2179 isolates tested for LZD resistance by MGIT-based susceptibility testing (June 2015 to June 2016) were LZD-resistant. Thirty two consecutive LZD-resistant isolates were analyzed by WGS to screen for known mutations conferring LZD resistance. WGS of 32 phenotypically LZD-resistant isolates showed that C154R in the rplC gene and G2814T in the rrl gene were the major resistance determinants. Interpretation & conclusions: LZD resistance poses an important risk to the success of treatment regimens, especially those designed for resistant isolates; such regimens are extensively used in India. As LZD-containing regimens increase in prominence, it is important to support clinical decision-making with an improved understanding of the common mutations conferring LZD resistance and their frequency in different settings.

Noise pollution in Mumbai Metropolitan Region (MMR): An emerging environmental threat.

Noise pollution in urban areas is an emerging environmental threat which local agencies and state authorities must consider in planning and development. Excessive noise is becoming a significant problem adversely affecting the physiological and psychological health of the citizens. Present study was carried out to assess and quantitatively evaluate ambient noise levels in Mumbai Metropolitan Region (MMR) consisting of 9 cities namely Bhiwandi-Nizampur, Kalyan-Dombivli, Mira-Bhayandar, Mumbai, Navi Mumbai, Panvel, Thane, Ulhasnagar and Vasai-Virar. The noise environment was assessed on the basis of equivalent continuous sound pressure levels (Leq), day-night noise levels (LDN) and noise limit exceedance factor (NEF) during day and night time of working and non-working days in four different area categories, viz. industrial, commercial, residential and silence zones. Present study shows that silence zones have been the worst affected areas where noise pollution levels and NEF indicate excessive violation of permissible noise limits due to unplanned, congested and unruly spaces for developmental and commercial activities, followed closely by residential and commercial zones. Cities with separate industrial and commercial zones showed less noisy surroundings in comparison with those cities where land use pattern of industrial and commercial zones is around or overlapping each other. It can thus be concluded that appropriate demarcation and planned use of city space is important to avoid exposure to rising noise pollution levels. Based on the noise pollution in (MMR), various control measures are suggested including awareness campaign and strict compliance of the rules and regulations.

Humanizing an Invisible Population in India: Voices from Bisexual Men Concerning Identity, Life Experiences, and Sexual Health.

Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.

The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai.

The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country. The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent, and the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence. This article traces the illustrious history of the Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.

Prevalence of Traumatic Injuries to Anterior Teeth in 9-14 Year School-going Children in Mumbai, India.

AIM: The aim of this study is to assess the prevalence and causes of traumatic dental injury (TDI) in 9-14 year school-going children in Mumbai, Maharashtra, India. MATERIALS AND METHODS: A cross-sectional study consisting of 2,055 primary and secondary school-going children aged between 9 and 14 years, from 20 municipal corporation schools of Mumbai city, was selected through a stratified random sampling technique. Children were examined clinically for any signs of TDI in the permanent anterior teeth in their respective schools by two examiners trained in using WHO criteria for oral and dental examination. Data analysis involved descriptive statistics including a frequency distribution. RESULTS: The prevalence of TDI to anterior teeth in school children of Mumbai was 16.3%. The commonest cause of trauma was fall followed by sports activities, collision, and road traffic accidents. CONCLUSION: The occurrence and various etiologies of traumatic injuries to maxillary anterior teeth in school children of Mumbai were approximately the same as found in other countries. CLINICAL SIGNIFICANCE: The present study gives a bird's eye view on the prevalence and common etiology of TDI in school children of Mumbai.

Total mercury status in an urban water body, Mithi River, Mumbai and analysis of the relation between total mercury and other pollution parameters.

Mercury is a heavy metal which has garnered attention recently in India. Minamata Convention on mercury was established on October 2013 and was joined by India on September 30, 2014. India is seen as a major mercury pollution source after China according to many studies in the past. Various mercury pollution sites that are currently recognized in India are Kodai Lake, Kodaikanal, Tamil Nadu, and Thane Creek, Mumbai. Since 1992, chlor-alkali plants have been regulated to eliminate mercury cell process of manufacturing. Also, medical and health care facilities are discarding mercury-containing equipment and processes. Various anthropogenic sources of mercury to the atmosphere include combustion of fossil fuels, processing and mining of primary metal ores, cement manufacturing units, chlor-alkali plants, and use of mercury in various products like paints, electric switches, and relays. The hazard associated with mercury pollution becomes extremely serious when we consider its ability to be transported over long-range distances. Various atmospheric transport models suggest India and other Asian countries to be a major source of long-range transport of mercury to North America. Considering the hazards of mercury and its widespread presence in our life, a study on mercury pollution in an urban water body is conducted. This study deals with Mithi River located in Mumbai Metropolitan Region (19.0760° N, 72.8777° E) to study the total mercury in water and derive its relationship with other pollution parameters.

Economic analysis and life cycle impact assessment of municipal solid waste (MSW) disposal: A case study of Mumbai, India.

Municipal solid waste (MSW) management is a major concern in Indian cities. This work rigorously assesses the relative costs and the environmental and health benefits of alternative MSW management methods. Management of MSW over the next 20 years for the city of Greater Mumbai was considered. A generic model was developed to determine the costs for (i) dumping on open ground, (ii) sanitary landfill without leachate treatment, (iii) landfilling with leachate treatment and (iv) regional composting and landfilling. LandGEM was used to quantify the gaseous emissions from landfill, while emissions from leachate and composting were taken from literature. The life cycle impact model of one tonne of MSW was developed using OpenLCA software and the International Reference Life Cycle Data System (ILCD) 2011 method was used for impact assessment. The cost of disposal of one tonne of waste was found to be INR344 (US$5.17), INR741 (US$11.13) and INR1367 (US$20.53), respectively, for the first three scenarios. As compared to open dumping, landfill gas flaring reduced the global warming potential by 32% and leachate treatment reduced freshwater ecotoxicity and total human toxicity marginally, by 20% and 60%, respectively. Composting-landfilling was the most preferred option, with a cost of INR531 tonne-1 (US$7.97), leading to a reduction in global warming potential by 79% and a slight decrease in freshwater ecotoxicity by 64%. Further, emissions due to accidental fires were also quantified. The study provides valuable insights for the selection of MSW management options for large metropolitan cities in developing countries.

Good girls and boys: findings from a cross-sectional survey on adolescent rights, relationships, and sexuality in an urban informal settlement in India.

Around 20% of India's population are adolescents aged 10-19 years. Our objective was to strengthen program interventions on gender equity, health, and participation by gauging adolescents' levels of understanding and opinions. In a cross-sectional survey, we interviewed 2005 adolescents on their opinions on rights, friendship and sex, sexual refusal and coercion, and communication with family, using a two-stage probability proportional to size sample. Opinions on gender allocations were generally equitable, although females supported clothing proscriptions. Premarital sex, multiple partners, masturbation and non-heterosexual partnerships were frowned upon. Few respondents said that they felt pressure to be sexually active, 79% said that sexual coercion was a form of violence, but 14% of older adolescents said that it would be unreasonable to refuse sex. Our interviews described young people negotiating the terrain between perceived normative expectations and contemporary aspirations, showing limited manoeuvring within assumed gender roles in which family control was prominent.

Poliovirus Excretion in Children with Primary Immunodeficiency Disorders, India.

Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication. This study aimed to estimate the proportion of primary immunodeficient children with enterovirus infection and to identify the long-term polio/nonpolio enterovirus excreters in a tertiary care unit in Mumbai, India. During September 2014-April 2017, 151 patients received diagnoses of primary immunodeficiency (PID). We isolated 8 enteroviruses (3 polioviruses and 5 nonpolio enteroviruses) in cell culture of 105 fecal samples collected from 42 patients. Only 1 patient with severe combined immunodeficiency was identified as a long-term VDPV3 excreter (for 2 years after identification of infection). Our results show that the risk of enterovirus excretion among children in India with PID is low; however, systematic screening is necessary to identify long-term poliovirus excreters until the use of oral polio vaccine is stopped.

A Framework for Assessing Uncertainty Associated with Human Health Risks from MSW Landfill Leachate Contamination.

Landfilling is a cost-effective method, which makes it a widely used practice around the world, especially in developing countries. However, because of the improper management of landfills, high leachate leakage can have adverse impacts on soils, plants, groundwater, aquatic organisms, and, subsequently, human health. A comprehensive survey of the literature finds that the probabilistic quantification of uncertainty based on estimations of the human health risks due to landfill leachate contamination has rarely been reported. Hence, in the present study, the uncertainty about the human health risks from municipal solid waste landfill leachate contamination to children and adults was quantified to investigate its long-term risks by using a Monte Carlo simulation framework for selected heavy metals. The Turbhe sanitary landfill of Navi Mumbai, India, which was commissioned in the recent past, was selected to understand the fate and transport of heavy metals in leachate. A large residential area is located near the site, which makes the risk assessment problem both crucial and challenging. In this article, an integral approach in the form of a framework has been proposed to quantify the uncertainty that is intrinsic to human health risk estimation. A set of nonparametric cubic splines was fitted to identify the nonlinear seasonal trend in leachate quality parameters. LandSim 2.5, a landfill simulator, was used to simulate the landfill activities for various time slices, and further uncertainty in noncarcinogenic human health risk was estimated using a Monte Carlo simulation followed by univariate and multivariate sensitivity analyses.

A framework for assessment and characterisation of municipal solid waste landfill leachate: an application to the Turbhe landfill, Navi Mumbai, India.

Rapid industrialisation, growing population and changing lifestyles are the root causes for the generation of huge amounts of solid waste in developing countries. In India, disposal of municipal solid waste (MSW) through open dumping is the most common waste disposal method. Unfortunately, leachate generation from landfill is high due to the prolonged and prominent monsoon season in India. As leachate generation rate is high in most of the tropical countries, long-term and extensive monitoring efforts are expected to evaluate actual environmental pollution potential due to leachate contamination. However, the leachate characterisation involves a comprehensive process, which has numerous shortcomings and uncertainties possibly due to the complex nature of landfilling process, heterogeneous waste characteristics, widely varying hydrologic conditions and selection of analytes. In order to develop a sustainable MSW management strategy for protecting the surface and ground water resources, particularly from MSW landfill leachate contamination, assessment and characterisation of leachate are necessary. Numerous studies have been conducted in the past to characterise leachate quality from various municipal landfills; unfortunately, none of these propose a framework or protocol. The present study proposes a generic framework for municipal landfill leachate assessment and characterisation. The proposed framework can be applied to design any type of landfill leachate quality monitoring programme and also to facilitate improved leachate treatment activities. A landfill site located at Turbhe, Navi Mumbai, India, which had not been investigated earlier, has been selected as a case study. The proposed framework has been demonstrated on the Turbhe landfill site which is a comparatively new and the only sanitary landfill in Navi Mumbai.

Prevalence and Assessment of Factors Associated With Malnutrition in Children Residing in Slums of Mumbai: A Cross-Sectional Study.

Background Malnutrition in children continues to be a serious public health problem in India. Therefore, this study aims to evaluate the prevalence of malnutrition and assess factors contributing to it in children of the marginalized slum population of India, masked in the metropolitan cities.  Methods A retrospective data analysis with a cross-sectional model was conducted by medical volunteers affiliated with the Rotaract Club of Medicrew who had organized a free pediatric health check-up camp in the Dharavi village of Mumbai, India for children under five. Children under five years of age group of either sex residing in the slums of Dharavi and whose parents consented are included in the study. Neonates, children older than five years of age, and children whose parents did not consent for them to be included in the study were excluded. A pretested, pre-validated questionnaire was administered, and statistical analysis was done with p-values <0.05 considered to be statistically significant. Results  A total of 126 children were included. Out of these children, 109 of them (86.50%) had a mid-arm circumference of more than 12.5 cm (normal), 11 (8.73%) were between 11.5 cm and 12.5 cm (moderate acute malnutrition), and five (4.77%) were less than 11.5 cm (severe acute malnutrition). Among the 126 kids, 86 kids were above the age of two and their BMI was assessed, 36 (44.19%) were found to be underweight (<5th percentile) while 14 (16.3%) were obese (>95th percentile), and four (4.65%) were overweight (85th-95th percentile). For 106 (84.13%) of these children, the caregivers were mothers while others were fathers (n=4; 3.18%), grandmothers (n=5; 3.97%), sisters (n=5; 3.97%), and aunts (n=6; 4.76%). Out of those who had commenced receiving formal education, only 39 (55.71%) were in an appropriate grade for their age. The mean expenditure on food as a proportion of the total household income was 36.40% (standard deviation (SD) 15.0%). On the single-item sleep quality scale, the sleep of only 36 kids (28.58%) was reported by their caregivers as excellent. A high proportion of other medical problems were reported in the children. Conclusion Our study reports a substantial burden of malnutrition among children residing in the slums of Dharavi. Rigorous strengthening and conceptualization of on-ground nutritional programs targeted toward slum children should be done by Indian healthcare policymakers.

Assessment of coping capacity of public health facilities with health emergency situations during an event of flood in Mumbai.

BACKGROUND: Floods had been a repeated phenomenon in India, causing considerable losses to properties, life and infrastructure, and public utilities. Floods are found to be a common natural disaster occurring not only in developing countries but also in developed nations. Hospital preparedness against disaster could help in the management of the surge of patients in an effective manner. This study aims to assess the capacity of public health facilities for coping up with health emergency situations during an event of flood in Mumbai. MATERIALS AND METHODS: A cross-sectional study was conducted among 38 public health facilities in Mumbai. A purposive sampling technique was used for the selection of the health facilities. Administrative staff, medical officers, and pharmacy in charges were included in the study. RESULTS: The study revealed that surge capacities in hospitals were adequate as they had additional beds for monsoon-related diseases for the preceding flood situation. There was a triage policy, and the staff were trained on the same. Procurement of drugs was easy because of a good networking system between hospitals. Due to this networking system, patients were also transferred to the nearest healthcare facility in a short span of time. CONCLUSION: The response during an event of a flood in the health facilities of Mumbai city was good as they have regular training sessions to be prepared for the emergency situations during monsoon as they have repeated exposure to floods.

Mumbai metropolitan region eye care facility survey: Mumbai Eye Disease Study (MEDiS) report #1.

Purpose: To examine the eye care practice in the Mumbai Metropolitan Region (MMR). Methods: This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income - low (1.8 m). We analyzed the collected data to estimate the eye care demand-supply, quality of eye care, health-seeking behavior, gap in eye care delivery, and eye care expenditure. Results: We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low- and middle-income groups than in the high-income group (48%-50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out-of-pocket spending was between 60% and 83%. Lower-income group people preferred public facilities. Conclusion: MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less-expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city-specific eye health issues.