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.

Syndromic surveillance system during mass gathering of Panchkroshi Yatra festival, Ujjain, Madhya Pradesh, India.

Background: The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation- Panchkroshi Yatra. Methods: A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results: In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion: Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.

Utility of constructed wetlands for treatment of hospital effluent and antibiotic resistant bacteria in resource limited settings: A case study in Ujjain, India.

Increasing generation of wastewater and its indiscriminate disposal is detrimental to human and animal health. Resource-limited settings often struggle for efficient wastewater treatment systems owing to lack of funds and operational difficulties. Therefore, alternative treatment systems involving low expenditure and simplistic operations are need of the hour. Constructed wetlands are one such alternative that can efficiently remove variety of pollutants from wastewater. In this study, we have assessed the utility of constructed wetlands for treatment of hospital wastewater in Ujjain. An in-house wetland system was designed and constructed using Typha latifolia and Phragmites karka. Results showed that wetland was efficient for removal of various physico-chemical and biological contaminants, namely, biochemical-oxygen-demand (77.1%), chemical-oxygen-demand (64.9%), turbidity (68.3%), suspended-solids (63%), total-phosphorus (58.7%), nitrate-nitrogen (33%), fecal coliforms (96.8%), and total coliforms (95.6%). Paired t test revealed that removal efficiencies for various parameters were significantly different among Phragmites, Typha, and control cells (p ≤ 0.05). Study also depicted that most of the bacterial isolates in inlet wastewater were selectively resistant to antibiotics (ciprofloxacin and sulphamethaxazole) as well and these isolates were also removed. Precisely, Typha was fairly suitable for antibiotic resistant bacteria removal. Thus, constructed wetlands were found to be one of the suitable options for wastewater treatment in resource-limited settings. PRACTITIONER POINTS: Constructed wetlands are one of the suitable options for wastewater treatment in resource limited settings. These systems involve wetland vegetation, soil, and associated microbial assemblages to improve the water quality. Typha and Phragmites were found to be efficient for treating the hospital wastewater. Experiments showed that antibiotic resistant bacteria may also be removed through constructed wetland systems. Easy operation, cost effectiveness, and efficiency are important attributes.

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.

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 ).

Monitoring of Water Quality, Antibiotic Residues, and Antibiotic-Resistant Escherichiacoli in the Kshipra River in India over a 3-Year Period.

The emergence of antibiotic resistance is a major global and environmental health issue, yet the presence of antibiotic residues and resistance in the water and sediment of a river subjected to excessive anthropogenic activities and their relationship with water quality of the river are not well studied. The objectives of the present study were a) to investigate the occurrence of antibiotic residues and antibiotic-resistant Escherichiacoli (E.coli) in the water and sediment of the Kshipra river in India at seven selected sites during different seasons of the years 2014, 2015, and 2016 and b) to investigate the association between antibiotic residues and antibiotic-resistant E.coli in water and sediment and measured water quality parameters of the river. Antibiotic residues and resistant E.coli were present in the water and sediment and were associated with the measured water quality parameters. Sulfamethoxazole was the most frequently detected antibiotic in water at the highest concentration of 4.66 µg/L and was positively correlated with the water quality parameters. Significant (p < 0.05) seasonal and spatial variations of antibiotic-resistant E.coli in water and sediment were found. The resistance of E.coli to antibiotics (e.g., sulfamethiazole, norfloxacin, ciprofloxacine, cefotaxime, co-trimoxazole, ceftazidime, meropenem, ampicillin, amikacin, metronidazole, tetracycline, and tigecycline) had varying associations with the measured water and sediment quality parameters. Based on the results of this study, it is suggested that regular monitoring and surveillance of water quality, including antibiotic residues and antibiotic resistance, of all rivers should be taken up as a key priority, in national and Global Action Plans as these can have implications for the buildup of antibiotic resistance.

Ethanol exposure induces cerebellar neuronal loss in rats

Ethanol exposure causes cerebellar dysfunction and cerebellar ataxia. Cerebellar Purkinje cells damage has not been explained as a constant finding in studies addressing the alcoholic brain or in experimental studies. The present study aimed to find out the changes of cerebellar Purkinje cells in adult rats. Adult rats were divided into control (C) and ethanol treated (E) groups eight animal each. The rats in group E were exposed to ethanol 1g/kg bodyweight for three months. Moderate ethanol intake produces significant reduction in the count of Purkinje cells in the anterior lobe of cerebellum with irregular shrunken outline losing their characteristic pyriform shape. Eosinophilic swelling seen adjacent to Purkinje cell bodies. Purkinje cells were observed without a prominent nucleolus or well defined nuclear membrane. Pyknosis of Purkinje cells was also observed

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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.

Mass bathing events in River Kshipra, Central India- influence on the water quality and the antibiotic susceptibility pattern of commensal E.coli.

BACKGROUND: Antibiotic resistance is one of the major global health emergencies. One potential source of dissemination of resistant bacteria is mass gatherings, e.g. mass bathing events. We evaluated the physicochemical parameters of water quality and the antibiotic resistance pattern in commensal Escherichia coli from river-water and river-sediment in pre-, during- and post-mass bathing events in river Kshipra, Central India. METHOD/DESIGN: Water and sediment samples were collected from three selected points during eight mass bathing events during 2014-2016. Water quality parameters (physical, chemical and microbiological) were analyzed using standard methods. In river water and sediment samples, antibiotic susceptibility patterns of isolated E. coli to 17 antibiotics were tested. RESULTS: pH, turbidity and dissolved oxygen were significantly lower and total dissolved solid, free carbon dioxide were higher during mass bathing, whilst TSS, BOD and COD were lowest in pre-bathing and highest in post-bathing period. E.coli with multi drug resistance (MDR) or extended spectrum beta-lactamase (ESBL) production were between 9-44% and 6-24%, respectively in river-water as well as river-sediment. Total coliform count/ml and E. coli count were higher during-and post-bathing in river water than in pre-bathing period. Thus, the percentage of resistance was significantly higher during and post-bathing period (p<.05) than in pre-bathing. Colony forming unit (CFU)/ml in river-sediment was much higher than in river-water. Percentage of resistance was significantly higher in river-water (p<.05) than in river-sediment. CONCLUSIONS: Antibiotic resistance in E.coli isolated from the Kshipra River showed significant variation during mass bathing events. Guidelines and regulatory standards are needed to control environmental dissemination of resistant bacteria.

Seasonal Variations in Water-Quality, Antibiotic Residues, Resistant Bacteria and Antibiotic Resistance Genes of Escherichia coli Isolates from Water and Sediments of the Kshipra River in Central India.

OBJECTIVES: To characterize the seasonal variation, over one year, in water-quality, antibiotic residue levels, antibiotic resistance genes and antibiotic resistance in Escherichia coli isolates from water and sediment of the Kshipra River in Central India. METHODS: Water and sediment samples were collected from seven selected points from the Kshipra River in the Indian city of Ujjain in the summer, rainy season, autumn and winter seasons in 2014. Water quality parameters (physical, chemical and microbiological) were analyzed using standard methods. High-performance liquid chromatography⁻tandem mass spectrometry was used to determine the concentrations of antibiotic residues. In river water and sediment samples, antibiotic resistance and multidrug resistance patterns of isolated E. coli to 17 antibiotics were tested and genes coding for resistance and phylogenetic groups were detected using multiplex polymerase chain reaction. One-way analysis of variance (ANOVA) and Fisher tests were applied to determine seasonal variation. RESULTS: In river water, seasonal variation was significantly associated with various water quality parameters, presence of sulfamethoxazole residues, bacteria resistant to ampicillin, cefepime, meropenem, amikacin, gentamicin, tigecycline, multidrug resistance and CTX-M-1 gene. The majority of the Extended Spectrum Beta-Lactamase (ESBL)-producing E. coli isolates from river water and sediment in all different seasons belonged to phylogenetic group A or B1. CONCLUSIONS: Antibiotic pollution, resistance and resistance genes in the Kshipra River showed significant seasonal variation. Guidelines and regulatory standards are needed to control environmental dissemination of these “pollutants” in this holy river.

A Three-Year Follow-Up Study of Antibiotic and Metal Residues, Antibiotic Resistance and Resistance Genes, Focusing on Kshipra-A River Associated with Holy Religious Mass-Bathing in India: Protocol Paper.

BACKGROUND: Antibiotic resistance (ABR) is one of the major health emergencies for global society. Little is known about the ABR of environmental bacteria and therefore it is important to understand ABR reservoirs in the environment and their potential impact on health. METHOD/DESIGN: Quantitative and qualitative data will be collected during a 3-year follow-up study of a river associated with religious mass-bathing in Central India. Surface-water and sediment samples will be collected from seven locations at regular intervals for 3 years during religious mass-bathing and in absence of it to monitor water-quality, antibiotic residues, resistant bacteria, antibiotic resistance genes and metals. Approval has been obtained from the Ethics Committee of R.D. Gardi Medical College, Ujjain, India (No. 2013/07/17-311). RESULTS: The results will address the issue of antibiotic residues and antibiotic resistance with a focus on a river environment in India within a typical socio-behavioural context of religious mass-bathing. It will enhance our understanding about the relationship between antibiotic residue levels, water-quality, heavy metals and antibiotic resistance patterns in Escherichia coli isolated from river-water and sediment, and seasonal differences that are associated with religious mass-bathing. We will also document, identify and clarify the genetic differences/similarities relating to phenotypic antibiotic resistance in bacteria in rivers during religious mass-bathing or during periods when there is no mass-bathing.