Measuring quality of antenatal care: a secondary analysis of national survey data from India.

OBJECTIVE: To assess the coverage and adequacy of antenatal care services (ANC) available to women and examine the socio-economic determinants affecting service utilisation. DESIGN: Secondary data analysis of a population-based national survey. SETTING: India, 2015/16. SAMPLE: In all, 190 898 women between 15 and 49 years of age who had a live birth during the 5 years preceding the survey. METHODS: Ordinal logistic regression. MAIN OUTCOME VARIABLE: Adequacy of ANC services received was measured under four categories - delivery of services by skilled personnel, timely provision of services, sufficiency and appropriateness of content. Quality of care was categorised as adequate ANC, inadequate ANC and no ANC. RESULTS: Only 23.5% (95% CI 23.1-23.9%) of all women received adequate ANC, while 58.8% (95% CI 58.4-59.2%) received inadequate and 17.7% (95% CI 17.4-18.0%) received no ANC services. Regression analysis revealed that women belonging to the adolescent age group, illiterate women, and those in the poorest wealth quintile and in rural areas were less likely to receive any ANC. CONCLUSION: There is a need to improve the quality of ANC services. Currently, <25% of women of all ages receive adequate ANC. Socio-economic conditions play a vital part in determining the quality of care that women receive. TWEETABLE ABSTRACT: Nearly one out of four women in India received adequate ANC, nearly three in every five women received inadequate ANC and 18% lacked ANC for their recent live birth.

Novel anaerobic digestion process with sludge ozonation for economically feasible power production from biogas.

A novel process scheme was developed to achieve economically feasible energy recovery from anaerobic digestion. The new process scheme employs a hybrid configuration of mesophilic and thermophilic anaerobic digestion with sludge ozonation: the ozonated sludge is first degraded in a thermophilic digester and then further degraded in a mesophilic digester. In small-scale pilot experiments of the new process scheme, degradation of VSS improved by 3.5% over the control (mesophilic-only configuration) with 20% less ozone consumption. Moreover, biogas conversion also improved by 7.1% over the control. Selective enrichment of inorganic compounds during centrifugation produced a dewatered sludge cake with very low water content (59.4%). This low water content in the sludge cake improved its auto-thermal combustion potential during incineration and added to the overall energy savings. We conducted a case study to evaluate power generation from biogas for a municipal wastewater treatment plant with an average dry weather flow of 43,000 m3/d. Electricity production cost was 5.2 ¢/kWh for the advanced process with power generation, which is lower than the current market price of 7.2 ¢/kWh. The new anaerobic digestion scheme with power generation may reduce greenhouse gas emissions by about 1,000 t-CO(2)/year compared with the conventional process without power generation.

Process performance and change in sludge characteristics during anaerobic digestion of sewage sludge with ozonation.

A new process configuration combining anaerobic digestion with ozonation, and operated at long SRT, was studied with the objective of on-site reduction in sludge quantity and improving biogas recovery. The process performance with respect to solid reduction efficiency and other important process parameters like accumulation of inorganic solids, changes in sludge viscosity and dewatering characteristics were evaluated from the data of long term pilot scale continuous experiments conducted using a mixture of primary and secondary municipal sewage sludge. Due to sludge ozonation and long SRT, high VSS degradation efficiency of approximately 80% was achieved at a reactor solid concentration of 6.5%. A high fraction of inorganic solid (>50%) consisting mainly of acid insoluble and iron compounds was found to accumulate in the reactor. The high inorganic content accumulated in the digested sludge did not, however, contribute to the observed increase in sludge viscosity at high solid concentration. The sludge viscosity was largely found to depend on the organic solid concentration rather than the total solid content. Moreover, higher inorganic content in the digested sludge resulted in better sludge dewaterability. For a quick assessment of the economic feasibility of the new process, an economic index based on the unit cost of digested sludge disposal to unit electric cost is proposed.