Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India.

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Interventions to promote household waste segregation: A systematic review.

Waste segregation at source, particularly at the household level, is an integral component of sustainable solid waste management, which is a critical public health issue. Although multiple interventions have been published, often with contradictory findings, few authors have conducted a comprehensive systematic synthesis of the published literature. Therefore, we undertook a systematic review to synthesize all published interventions conducted in any country in the world which targeted household-level waste segregation with or without additional focus on recycling or composting. Following PRISMA guidelines, Web of Science, Medline, Global Health, and Google Scholar were searched using a search strategy created by combining the keywords 'Waste', 'Segregation', and 'Household'. Two-stage blinded screening and consensus-based conflict resolution were done, followed by quality assessment, data extraction, and narrative synthesis. 8555 articles were identified through the database searches and an additional 196 through grey literature and citation searching. After excluding 2229 duplicates and screening title abstracts of 6522 articles, 283 full texts were reviewed, and 78 publications reporting 82 intervention studies were included in the data synthesis. High methodological heterogeneity was seen, excluding the possibility of a meta-analysis. Most (n = 60) of the interventions were conducted in high-income countries. Interventions mainly focused on information provision. However, differences in the content of information communicated and mode of delivery have not been extensively studied. Finally, our review showed that the comparison of informational interventions with provision of incentives and infrastructural modifications needs to be explored in-depth. Future studies should address these gaps and, after conducting sufficient formative research, should aim to design their interventions following the principles of behaviour change.

Survival Analysis for Cohort of Bhopal Gas Disaster Victims during 1985-2015.

Context: After the gas tragedy on the night of December 2/3, 1984, at Bhopal, the Indian Council of Medical Research (ICMR) started following up on four population cohorts with different levels of post-disaster mortality from December 3-6, 1984. Aims: The present study was undertaken to estimate the survival time of the cohort, and investigate the risk of mortality based on exposure, gender, and median age. Settings and Design: Survival analysis is generally used to evaluate factors associated with the time to an event of failure or death among any covered population. Methods and Materials: To know the cause of death and mortality rate, a retrospective cohort analysis was conducted on the outcomes of 92,320 individuals with an exposed and non-exposed group from 1985 to 2015 in Bhopal, India. Statistical Analysis Used: Basic survival analysis method, Kaplan-Meier method, and Cox proportional hazard regression model were used to analyze the mortality risk. Results: During the past 30 years, the survivability was 87.25%, and the mortality rate was 7.2% for the cohort population of Bhopal gas survivors. Cox regression analysis showed that exposed, males, and individuals above 21 years (at the time of the disaster) were at higher risk of mortality from 1985 to 2015. Conclusions: During the initial two phases, the mortality was higher in the exposed group, but over time, their survival turned out to be the same in both groups.

Composition analysis (pick analysis) of waste generated from household: A pilot study in Ujjain city, India.

Waste segregation is an essential function in improving waste management. Waste segregation not only facilitates recycling and reduces waste going to landfills, rather it can benefit our environment and human in various ways. A pick analysis of waste composition is used to characterize the household waste stream and thus can analyze the segregation rate among the residents. In addition, it can measure the actual waste sorting behaviour at the household/community level. The objective of the study was to assess feasibility of a large-scale waste composition study, identify methodological and operational challenges, and estimate the resources needed to conduct the main waste composition study in order to obtain and get indicative figures about waste generation, composition, and miss-sorted proportions. The study team went door-to-door to collect waste in colour coded bags. We also collected the socio-demographic data of the households. The collected waste was weighed and segregated to analyze the waste composition. The analysis was done among 45 households, and it was found that the per capita waste generation per day is 0.25 kg (0.24 kg from slum and 0.27 kg from non-slum). Challenges identified in conducting waste composition study were lack of standard waste fraction classifications, difficulty in recruitment of personnel to conduct study due to social taboo around waste, challenge in co-coordinating with Ujjain Municipal Corporation waste collection vehicle for collection of waste. 53 household activities were completed in 5 and half hours with INR 24685 (USD 300.5). Pick analysis could be adopted by the Ujjain Municipal Corporation after cost effective analysis to generate precise estimate of waste generation, resource recovery, efficient resource allocation and will help in future interventions and informed policy decision making to improve segregation.

Prevalence of chronic kidney disease among severely gas-exposed survivors in Bhopal, India.

Background The survivors of the 1984 Bhopal gas disaster frequently express concern of them being at higher risk of developing chronic kidney disease (CKD) as a consequence of the long-term health effects of gas exposure. We aimed to estimate the prevalence of CKD among the survivors of severely gas-exposed cohort assembled in 1985 after the Bhopal gas disaster to study the long-term health consequences of gas exposure. Methods We did this cross-sectional study with a sample size of 215 systematically selected participants among the severely gas-exposed survivors in Bhopal to estimate the prevalence of CKD. Sociodemographic and relevant past medical history of the participants was obtained using a semi-structured questionnaire and their blood and urine samples were collected. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation. Those found with reduced e-GFR and proteinuria, suggestive of CKD, were further surveyed after 3 months to differentiate CKD from acute renal damage. Results The prevalence of CKD among the severely gas-exposed cohort survivors in Bhopal was 16.7%. Multiple logistic regression analysis revealed that body mass index and level of education were significant predictors of CKD. Conclusion The prevalence of CKD among the severely exposed survivors of Bhopal was at par with the national prevalence, putting at rest the apprehension of gas-exposed survivors of being at higher risk of developing CKD.

Association of tobacco use with the tobacco-related built environment: an ecological study from urban slums of Bhopal, India.

INTRODUCTION: Tobacco is one of the biggest public health problems and a major risk factor for various non-communicable diseases (NCDs). An important aspect of tobacco control strategy could include modifications in the tobacco-related built environment. This study investigated the association between tobacco shop density and tobacco use prevalence in the urban slums of Bhopal city, India. METHODS: We conducted a cross-sectional survey to obtain the distribution of tobacco-related built environment (tobacco shops) in the neighbourhood (400-m service area) of 32 urban slum clusters of Bhopal. We plotted this distribution using the 'network service area analysis' in ArcMap 10.7.1 software. Then, we used an ecological design to determine the association between tobacco shop density and tobacco use prevalence in these 32 clusters (N = 6214 adult inhabitants). We used multiple linear regression analysis to estimate the regression coefficient (adjusted for socio-demographic variables) between tobacco use and tobacco shop density at the cluster level. RESULTS: The prevalence of tobacco use among all 32 slum clusters ranged from 22.1 to 59.6% (median 40.9% with IQR 31.8-44.2). There were 194 tobacco shops situated in the neighbourhood of all clusters. The median density of tobacco shops was 59.40/km2 (IQR 39.9-108.1/km2) in the neighbourhoods of slum clusters. Tobacco use prevalence was significantly associated with tobacco shop density (estimate or B = 0.071, p value = 0.002) after adjusting for age, literacy, wealth index, and gender ratio. CONCLUSIONS: Tobacco use prevalence is significantly associated with tobacco shop density in the slums of Bhopal city in central India. We need to develop appropriate built environment interventions to control rampant tobacco use.

Evaluation of health impacts of the improved housing conditions on under-five children in the socioeconomically underprivileged families in central India: A 1-year follow-up study protocol.

Unacceptable housing conditions prevalent in Indian urban slums adversely affect the health of residents. The Government of India initiated the Basic Services to the Urban Poor (BSUP) as a sub-mission under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), to provide basic services to the urban poor. As per the available scientific literature, the health effects of such improved housing schemes for the poor have not been studied so far in India, especially in under-five children (0-5 years old) who spend most of their time indoors. The present paper describes the protocol for a follow-up research study proposed to fill this gap. This study, funded by the Indian Council of Medical Research (Sanction No. 5/8-4/9/Env/2020-NCD-II dated 21.09.2021), will be conducted in Bhopal in the central Indian province of Madhya Pradesh for over 2 years. We will recruit 320 under-five children each from Group 1 (Beneficiary families residing in the houses constructed under BSUP) and Group 2 (Slum dwelling families eligible for improved housing but who did not avail of benefit). Eligible children will be recruited in the first household visit. During the same visit, we will record clinical history, examination findings and take anthropometric measurements of participants. We will also collect data regarding socio-economic-environmental parameters of the house. During subsequent monthly follow-up visits, we will collect primary data on morbidity profile, anthropometric details and medical history over 1 year. Approval for the study was obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2020-21/198, dated 22/06/2020). This study will evaluate the impact of different housing conditions on the health of under-five children. Finding of this research will be beneficial in guiding future housing-related policy decisions in low- and middle-income countries.

Dynamics of Household Waste Segregation Behaviour in Urban Community in Ujjain, India: A Framework Analysis.

Waste segregation practices must be socially acceptable, affordable, context-specific, and participatory, which is essential for promoting waste segregation. Therefore, this study explored the urban community members' motivation, opportunity, and household waste segregation ability. We performed a qualitative study in Ujjain city, India. Ten focus group discussions and eight in-depth interviews were conducted with female and male household members in residential and slum areas. All interviews were digitally recorded, transcribed, and translated. We used the thematic framework technique using the Motivation-Opportunity-Ability-Behaviour theory for analysis. Three themes were constructed: motivation, where household members are motivated to sort waste yet fear the consequences of improper sorting; ability, where household waste segregation is rapidly gaining acceptance as a social norm; and opportunities, involving convenient facilities and a social support system for household members towards waste segregation. This study contributes to developing a knowledge base on waste segregation behaviour and a repertoire to facilitate evidence-based management and policymaking. There is a need for educational intervention and women's self-help groups' involvement to develop community orientation and waste segregation literacy. Finally, this study emphasizes the importance of all three behavioural change components, i.e., motivation, opportunity, and ability, in managing sustainable waste segregation practices.

Respiratory morbidities and lung function abnormalities in survivors of Bhopal Gas Disaster: A cross-sectional study.

BACKGROUND: Respiratory morbidities remained significant for the last four decades among the survivors of the Bhopal gas disaster. We hypothesized that lung function abnormalities, especially small airway dysfunctions, were responsible for the ongoing respiratory morbidities. METHODS: We conducted a cross-sectional study between 2018 and 2020 in the severely exposed cohort of the Bhopal gas disaster. A standardized questionnaire was used to record their respiratory symptoms. The forced oscillometry (FOT) and spirometry were utilized for assessing lung functions. Univariate and multivariate logistic regression analyses were used to examine the association. RESULTS: Of 916 enrolled individuals (men: 442, mean age: 55.2 ± 12.3 years), 558 participated in lung function assessments. Breathlessness was the most common complaint (71.7%), followed by cough (15.1%). The R5 > upper limit of normal (ULN), R5-19 > ULN, and X5 < lower limit of normal (LLN) were observed in 29.3%, 23.3%, and 21.2% participants, respectively. Normal, obstructive, and restrictive spirometry was observed in 46.2%, 26.1%, and 27.7%, participants, respectively. FOT parameters were abnormal in 25.3% individuals with normal spirometry. Individuals with obstructive spirometry had the highest risk of having abnormal FOT parameters (adjusted odds ratio [adj OR]:3.93, 95% confidence interval [CI]: 2.24-6.89). Breathlessness showed a significant association with abnormal R5 (adj OR: 1.81; 95% CI: 1.13-2.91) and obstructive spirometry (adj OR: 2.26; 95% CI: 1.29-3.95). CONCLUSIONS: Assessment of small airway functions along with spirometry are useful to identify complex lung function abnormalities in cases of toxic inhalation.

COVID-19 testing, timeliness and positivity from ICMR's laboratory surveillance network in India: Profile of 176 million individuals tested and 188 million tests, March 2020 to January 2021.

BACKGROUND: The Indian Council of Medical Research set up a pan-national laboratory network to diagnose and monitor Coronavirus disease 2019 (COVID-19). Based on these data, we describe the epidemiology of the pandemic at national and sub-national levels and the performance of the laboratory network. METHODS: We included surveillance data for individuals tested and the number of tests from March 2020 to January 2021. We calculated the incidence of COVID-19 by age, gender and state and tests per 100,000 population, the proportion of symptomatic individuals among those tested, the proportion of repeat tests and test positivity. We computed median (Interquartile range-IQR) days needed for selected surveillance activities to describe timeliness. RESULTS: The analysis included 176 million individuals and 188 million tests. The overall incidence of COVID-19 was 0.8%, and 12,584 persons per 100,000 population were tested. 6.1% of individuals tested returned a positive result. Ten of the 37 Indian States and Union Territories accounted for about 75.6% of the total cases. Daily testing scaled up from 40,000 initially to nearly one million in March 2021. The median duration between symptom onset and sample collection was two (IQR = 0,3) days, median duration between both sample collection and testing and between testing and data entry were less than or equal to one day. Missing or invalid entries ranged from 0.01% for age to 0.7% for test outcome. CONCLUSION: The laboratory network set-up by ICMR was scaled up massively over a short period, which enabled testing a large section of the population. Although all states and territories were affected, most cases were concentrated in a few large states. Timeliness between the various surveillance activities was acceptable, indicating good responsiveness of the surveillance system.

Effects of improved information and volunteer support on segregation of solid waste at the household level in urban settings in Madhya Pradesh, India (I-MISS): protocol of a cluster randomized controlled trial.

BACKGROUND: Segregation of household waste at the source is an effective and sustainable strategy for management of municipal waste. However, household segregation levels remain insufficient as waste management approaches are mostly top down and lack local support. The realisation and recognition of effective, improved and adequate waste management may be one of the vital drivers for attaining environmental protection and improved health and well-being. The presence of a local level motivator may promote household waste segregation and ultimately pro-environmental behaviour. The present cluster randomized control trial aims to understand if volunteer based information on waste segregation (I-MISS) can effectively promote increased waste segregation practices at the household level when compared with existing routine waste segregation information in an urban Indian setting. METHODS: This paper describes the protocol of an 18 month two-group parallel,cluster randomised controlled trialin the urban setting of Ujjain, Madhya Pradesh, India. Randomization will be conducted at ward level, which is the last administrative unit of the municipality. The study will recruit 425 households in intervention and control groups. Assessments will be performed at baseline (0 months), midline (6 months), end line (12 months) and post intervention (18 months). The primary outcome will be the comparison of change in proportion of households practicing waste segregation and change in proportion of mis-sorted waste across the study period between the intervention and control groups as assessed by pick analysis. Intention to treat analysis will be conducted. Written informed consent will be obtained from all participants. DISCUSSION: The present study is designed to study whether an external motivator, a volunteer selected from the participating community and empowered with adequate training, could disseminate waste segregation information to their community, thus promoting household waste segregation and ultimately pro-environmental behaviour. The study envisages that the volunteers could link waste management service providers and the community, give a local perspective to waste management, and help to change community habits through information, constant communication and feedback. TRIAL REGISTRATION: The study is registered prospectively with Indian Council of Medical Research- Clinical Trial Registry of India ( CTRI/2020/03/024278 ).

A mixed-methods community-based participatory research to explore stakeholder's perspectives and to quantify the effect of crop residue burning on air and human health in Central India: study protocol.

BACKGROUND: Crop residue burning adversely affects air quality and consequently human health. India, being one of the largest agro-economies of the world, produces around 500 Million tonnes of crop residue annually most of which is burnt on-farm. However, integrated studies that simultaneously quantify the effects of crop residue burning while exploring the subjective determinants of the practice are lacking in India. This paper describes the protocol for a longitudinal mixed methods research study employing a community-based participatory approach to fill this gap. METHODS: Both quantitative and qualitative data will be collected in a rural setting of the central Indian province of Madhya Pradesh, over 1 year. A steering committee comprising of the research team and community representatives will be formed. The proportion of cultivable land burnt in one crop burning season will be estimated. The association between crop residue burning, level of ambient air pollutants, and pulmonary function of village residents will be determined. Focus groups, interviews, and participatory rural appraisal methods will be used to explore stakeholder perspectives about crop residue burning. Potential barriers and opportunities for substituting burning with an alternative crop residue management technique will be ascertained as the basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2019-20/1494, dt 06/01/2020). DISCUSSION: This manuscript describes the protocol for a novel community-based participatory study to investigate thoroughly the phenomenon of crop residue burning from the perspective of the agricultural community through their active collaboration. The lack of comprehensive evidence regarding the factors responsible for crop residue burning in India underlines the importance of implementing this study protocol to fill in this critical gap in knowledge. While acknowledging that findings of this study will be not generalizable to agricultural communities other than the one studied, it is expected that the study will generate baseline evidence that might be beneficial in developing and implementing an appropriate intervention strategy.

Medical schools in India: pattern of establishment and impact on public health - a Geographic Information System (GIS) based exploratory study.

BACKGROUND: Indian medical education system is on the brink of a massive reform. The government of India has recently passed the National Medical Commission Bill (NMC Bill). It seeks to eliminate the existing shortage and maldistribution of health professionals in India. It also encourages establishment of medical schools in underserved areas. Hence this study explores the geographic distribution of medical schools in India to identify such under and over served areas. Special emphasis has been given to the mapping of new medical schools opened in the last decade to identify the ongoing pattern of expansion of medical education sector in India. METHODS: All medical schools retrieved from the online database of Medical Council of India were plotted on the map of India using geographic information system. Their pattern of establishment was identified. Medical school density was calculated to analyse the effect of medical school distribution on health care indicators. RESULTS: Presence of medical schools had a positive influence on the public health profile. But medical schools were not evenly distributed in the country. The national average medical school density in India amounted to 4.08 per 10 million population. Medical school density of provinces revealed a wide range from 0 (Nagaland, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep) to 72.12 (Puducherry). Medical schools were seen to be clustered in the vicinity of major cities as well as provincial capitals. Distance matrix revealed that the median distance of a new medical school from its nearest old medical school was just 22.81 Km with an IQR of 6.29 to 56.86 Km. CONCLUSIONS: This study revealed the mal-distribution of medical schools in India. The problem is further compounded by selective opening of new medical schools within the catchment area of already established medical schools. Considering that medical schools showed a positive influence on public health, further research is needed to guide formulation of rules for medical school establishment in India.

Medicosocial characteristics as predictors of school achievements in students with intellectual and developmental disabilities: A follow-up study in ujjain and shajapur districts of Madhya Pradesh, India.

BACKGROUND: For a long time, there have been arguments about which factors influence the skill development of students with intellectual disability in rehabilitation centers. OBJECTIVE: The present follow-up study was thus planned to analyze the effect of the demographic variables related to disabled child, his/her parents and the family; their schooling pattern and types of study settings and the associated comorbidities on improvement in the performance score of students attending these study settings in one academic year. METHODS: The study was conducted among children (n = 204) with intellectual disability receiving rehabilitation services in centers run by a nongovernmental organization in two districts of Central India. RESULTS: : Application of regression analysis concluded that among various hypothesized factors higher birth order, more time spent by parents for child's development at home, high performing classes, absence of epilepsy, psychiatric comorbidities, and associated physically challenged were significantly associated with improvement in overall mean performance score. CONCLUSIONS: : The study delineates the need to motivate parents, so that they can involve themselves to develop their child's full potential. Identification of associated comorbidities is recommended and parents need to be appraised accordingly.

Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India.

Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37-0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03-0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual's characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.

The need to focus on medical education in rural districts of India.

Background: . Globally, India has the highest number of medical colleges followed by Brazil and China. The density of physicians in rural India was 3 per 10 000 population against 13 per 10 000 in urban areas. Worldwide, studies show that medical schools play an important role in overcoming the shortage of physicians locally. Hence, we studied the distribution of medical colleges in India and reviewed the shortage of established and new medical colleges in rural districts with the year 2000 as baseline. Methods: . We used the database of the Medical Council of India as on 27 April 2017; and Census 2011 data, based on the percentage of rural/urban population, for the classification of districts (rural/urban). All the 640 districts were included with 1210.9 million population. Results: . Of the 480 rural districts in India, only 132 (27.5%) had a medical college. Jharkhand, Jammu and Kashmir and Arunachal Pradesh had no medical colleges in rural districts. Madhya Pradesh, Uttar Pradesh, Bihar, Assam, Punjab, Uttarakhand, Haryana and Rajasthan had <30% of rural districts with a medical college. Of the 286 new medical colleges established since 2000 in India, 130 (45.5%) were in rural districts with uneven distribution with lower percentage of new medical colleges in states with predominance of rural population. Conclusion: . There is an overall shortage of medical colleges in rural districts of India. Paradoxically, the trend of uneven rural-urban distribution continues among the newly opened medical colleges as well.

Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India.

BACKGROUND: In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state. METHODS: We obtained a list of potential ICU facilities from various sources and then performed a cross-sectional survey by visiting each facility and determining characteristics for each facility. We collected variables with respect to infrastructure, human resources, equipment, support services, procedures performed, training courses conducted, and in-place policies or standard operating procedure documents. RESULTS: We identified a total of 123 ICUs in MP. Of 123 ICUs, 35 were level 1 facilities, 74 were level 2 facilities, and only 14 were level 3 facilities. Overall, there were 0.17 facilities per 100,000 population (95* confidence interval [CI] 0.14-0.20 per 100,000 populations). There were a total of 1816 ICU beds in the state, with an average of 2.5 beds per 100,000 population (95* CI 2.4-2.6 per 100,000 population). Of the total number of ICU beds, 250 are in level 1, 1141 are in level 2, and 425 are in level 3 facilities. This amounts to 0.34, 1.57, and 0.59 ICU beds per 100,000 population for levels 1, 2, and 3, respectively. CONCLUSION: This study could just be an eye opener for our healthcare authorities at both state and national levels to estimate the proportion of ICU beds per lac population. Similar mapping of intensive care services from other States will generate national data that is hitherto unknown.

A study of spatial and meteorological determinants of dengue outbreak in Bhopal City in 2014.

BACKGROUND & OBJECTIVES: Dengue epidemics have been linked to various climatic and environmental factors. Dengue cases are often found in clusters; identification of these clusters in early phase of epidemic can help in efficient control by implementing suitable public health interventions. In year 2014, Bhopal City in Madhya Pradesh, India witnessed an outbreak of dengue with 729 recorded cases. This study reports spatial and meteorological determinants and, demographic and clinical characteristics of the dengue outbreak in Bhopal City. METHODS: A cross-sectional survey of all confirmed cases reported to District Unit of Integrated Disease Surveillance Programme (IDSP), Bhopal was carried out during June to December 2014. Data pertaining to clinical manifestations, health seeking and expenditure were collected by visiting patient's residence. Geographic locations were recorded through GPS enabled mobile phones. Meteorological data was obtained from Indian Meteorological Department website. Multiple linear regression analysis was used to test influence of meteorological variables on number of cases. Clustering was investigated using average nearest neighbour tool and hot-spot analysis or Getis- Ord Gi* statistic was calculated using ArcMap 10. RESULTS: The incidence of confirmed dengue as per IDSP reporting was 38/100,000 population (95% CI, 35.2- 40.7), with at least one case reported from 73 (86%) of the total 85 wards. Diurnal temperature variation, relative humidity and rainfall were found to be statistically significant predictors of number of dengue cases on multiple linear regressions. Statistically significant hot-spots and cold-spots among wards were identified according to dengue case density. INTERPRETATION & CONCLUSION: Seasonal meteorological changes and sustained vector breeding contributed to the dengue epidemic in the post-monsoon period. Cases were found in geographic clusters, and therefore, findings of this study reiterate the importance of spatial analysis for understanding the pace of outbreak and identification of hot-spots.

The availability of emergency obstetric care in the context of the JSY cash transfer programme in Madhya Pradesh, India.

BACKGROUND: Since 2005, India has implemented a national cash transfer programme, the Janani Suraksha Yojana (JSY), which provides women a cash transfer upon giving birth in an existing public facility. This has resulted in a steep rise in facility births across the country. The early years of the programme saw efforts being made to strengthen the ability of facilities to provide obstetric care. Given that the JSY has been able to draw millions of women into facilities to give birth (there have been more than 50 million beneficiaries thus far), it is important to study the ability of these facilities to provide emergency obstetric care (EmOC), as the functionality of these facilities is critical to improved maternal and neonatal outcomes. We studied the availability and level of provision of EmOC signal functions in public facilities implementing the JSY programme in three districts of Madhya Pradesh (MP) state, central India. These are measured against the World Health Report (WHR) 2005benchmarks. As a comparison, we also study the functionality and contribution of private sector facilities to the provision of EmOC in these districts. METHODS: A cross-sectional survey of all healthcare facilities offering intrapartum care was conducted between February 2012 and April 2013. The EmOC signal functions performed in each facility were recorded, as were human resource data and birth numbers for each facility. RESULTS: A total of 152 facilities were surveyed of which 118 were JSY programme facilities. Eighty-six percent of childbirths occurred at programme facilities, two thirds of which occurred at facilities that did not meet standards for the provision basic emergency obstetric care. Of the 29 facilities that could perform caesareans, none could perform all the basic EmOC functions. Programme facilities provided few EmOC signal functions apart from parenteral antibiotic or oxytocic administration. Complicated EmOC provision was found predominantly in non-programme (private) facilities; only one of six facilities able to provide such care was in the public sector and therefore in the JSY programme. Only 13 % of all qualified obstetricians practiced at programme facilities. CONCLUSIONS: Given the high proportion of births in public facilities in the state, the JSY programme has an opportunity to contribute to the reduction in maternal and perinatal mortality However, for the programme to have a greater impact on outcomes; EmOC provision must be significantly improved.. While private, non-programme facilities have better human resources and perform caesareans, most women in the state give birth under the JSY programme in the public sector. A demand-side programme such as the JSY will only be effective alongside an adequate supply side (i.e., a facility able to provide EmOC).

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India.

INTRODUCTION: In low- and middle-income countries such as India, private pharmacies play an important role in medical treatments, offering advice for common illnesses such as diarrhea and respiratory tract infections. There is a need to explore the details of the dispensing practices at the private pharmacies in low- and middle-income countries. METHODOLOGY: The present study used simulated client methodology to assess the actual dispensing practices for patients with pediatric diarrhea at private pharmacies in an urban setting of an Indian province. RESULTS: This study identified 164 private pharmacies (84.10%) in the study setting that engaged in the practice of dispensing prescription drugs without prescriptions. Only about 40% asked clients if they had a prescription from a doctor. The average duration of consultations at the pharmacies was 1.3 minutes (range, 0.5-6 minutes). The dispensing of drugs was not in compliance with the recommended guidelines and regulations. The most commonly dispensed drugs were antibiotics (40.24%); of these, quinolones either alone or in combination with imidazoles were the most frequently dispensed. The other commonly dispensed drugs were antimotility drugs (31.10%) and Lactobacillus acidophilus (probiotics; 23.17%). The drugs were dispensed in inappropriate doses due to the absence of indications. CONCLUSIONS: Overuse and misuse of all these prescription drugs dispensed by pharmacies pose significant issues, such as resistance, dangerous side effects, and high costs. At the same time, the pharmacies did not dispense recommended drugs such as oral rehydration solution and zinc, which they are authorized to dispense without a prescription.