Health profile of women ragpicker members of a nongovernmental organization in Mumbai, India.

BACKGROUND: In India, ragpickers form the base of hierarchy of informal sector of the solid waste management. Assessment of general and gender specific health of women is conducted in this study in view of dearth of published evidence. MATERIALS AND METHODS: An interventional study was conducted from October 2003 to April 2005 in Mumbai, at the field office of a nongovernmental organization working for women ragpickers. By the systematic random sampling 168 women ragpickers were selected. Both general and gender-specific health needs of this socially and occupationally marginalized group, including health seeking behavior were explored in this study. Fourteen participants were trained as health volunteers to create awareness in the local community. The data was analyzed by using SPSS version 11.0 software program (SPSS Inc., Chicago, Illinois, USA). RESULTS: Marriage at young age, multiple pregnancies, low preference toward temporary methods of contraception, high addiction were prevalent in this lower socioeconomic young workforce. Morbidity was statistically significant among ragpickers who collected rags along dumpsite than street side and door to door waste collectors (χ(2) = 27.8; df = 2; P < 0.001 significant). A need-based training program helped to improve knowledge of the participants [z = 12.7 (P < 0.05)]. CONCLUSIONS: Unfulfilled health needs of this underprivileged workforce who contributes to the ecology and economy of the city need to be addressed. Sensitization of both general public and government is essential to legitimize this occupation. This in turn may help to alleviate poverty and environmental degradation; characteristic of rapid and unplanned urbanization in India.

A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening.

Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a cluster-randomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide health-education, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n = 75360) and control arms (n = 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast.

Workplace tobacco cessation program in India: A success story.

CONTEXT: This paper describes the follow-up interventions and results of the work place tobacco cessation study. AIMS: To assess the tobacco quit rates among employees, through self report history, and validate it with rapid urine cotinine test; compare post-intervention KAP regarding tobacco consumption with the pre-intervention responses and assess the tobacco consumption pattern among contract employees and provide assistance to encourage quitting. SETTINGS AND DESIGN: This is a cohort study implemented in a chemical industry in rural Maharashtra, India. MATERIALS AND METHODS: All employees (104) were interviewed and screened for oral neoplasia. Active intervention in the form of awareness lectures, focus group discussions and if needed, pharmacotherapy was offered. Medical staff from the industrial medical unit and from a local referral hospital was trained. Awareness programs were arranged for the family members and contract employees. STATISTICAL ANALYSIS USED: Non-parametric statistical techniques and kappa. RESULTS: Forty eight per cent employees consumed tobacco. The tobacco quit rates increased with each follow-up intervention session and reached 40% at the end of one year. There was 96% agreement between self report tobacco history and results of rapid urine cotinine test. The post-intervention KAP showed considerable improvement over the pre-intervention KAP. 56% of contract employees used tobacco and 55% among them had oral pre-cancerous lesions. CONCLUSIONS: A positive atmosphere towards tobacco quitting and positive peer pressure assisting each other in tobacco cessation was remarkably noted on the entire industrial campus. A comprehensive model workplace tobacco cessation program has been established, which can be replicated elsewhere.

Establishing a model workplace tobacco cessation program in India.

BACKGROUND: Tobacco use is highly prevalent and culturally accepted in rural Maharashtra, India. AIMS: To study the knowledge, attitude, and practices (KAP) regarding tobacco consumption, identify reasons for initiation and continuation of tobacco use, identify prevalence of tobacco consumption and its relation with different precancerous lesions, provide professional help for quitting tobacco, and develop local manpower for tobacco cessation activities. SETTINGS, DESIGN, METHODS AND MATERIAL: The present study was conducted for one year in a chemical industrial unit in Ratnagiri district. All employees (104) were interviewed and screened for oral neoplasia. Their socio-demographic features, habits, awareness levels etc. were recorded. Active intervention in the form of awareness lectures, focus group discussions, one-to-one counseling and, if needed, pharmacotherapy was offered to the tobacco users. RESULTS: All employees actively participated in the program. Overall, 48.08% of the employees were found to use tobacco, among which the smokeless forms were predominant. Peer pressure and pleasure were the main reasons for initiation of tobacco consumption, and the belief that, though injurious, it would not harm them, avoiding physical discomfort on quitting and relieving stress were important factors for continuation of the habit. Employees had poor knowledge regarding the ill-effects of tobacco. 40% of tobacco users had oral precancerous lesions, which were predominant in employees consuming smokeless forms of tobacco. CONCLUSIONS: Identifying reasons for initiation and continuation of tobacco consumption along with baseline assessment of knowledge, attitudes, and practices regarding tobacco use, are important in formulating strategies for a comprehensive workplace tobacco cessation program.

Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in Mumbai, India. 1. Compliance to screening.

OBJECTIVES: This study aims to investigate the efficacy of screening by low-cost technology in down-staging and reducing mortality due to breast and cervix cancer. METHODS: The present trial is a community-based, cluster randomised controlled cohort study on screening for breast and cervix cancers (clinical breast examination and visual inspection of the cervix after application of 4% acetic acid). Univariate and multivariate logistic regression analyses are conducted to identify the predictors of participation in screening. RESULTS: The average compliance is 71.43 and 64.93% for breast and cervix cancer screening, respectively, with the highest compliance in round 1. At the end of 3 screening rounds, 94 and 84% of the eligible women were screened at least once for breast and cervix cancer, respectively. Younger women, women from other than Hindu and Muslim communities, school level-educated women, women belonging to lower-income families, Marathi-speaking women, married women and women who had previously consulted for any breast or gynaecological complaints had higher compliance to participation in screening. CONCLUSIONS: Good compliance rates to screening have been demonstrated in the trial, reflecting acceptance of the study by the society, which has implications while translating the trial into a programme.

Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in mumbai, India. 2. Compliance to referral and treatment.

OBJECTIVES: The study aims to investigate the efficacy of screening by low-cost technology in down-staging and reduction of mortality due to breast and cervix cancer. METHODS: The present trial is a community-based, cluster randomised controlled cohort study on screening for breast and cervix cancers (clinical breast examination and visual inspection of the cervix after application of 4% acetic acid). Univariate and multivariate logistic regression analyses are conducted to identify the predictors of compliance to referral among screen-positive women and to treatment among cancer cases. RESULTS: The compliance to diagnostic investigations is 73% among screen-positive women referred for breast cancer and 79% among women referred for cervix cancer. Younger women, women working in service or being self-employed, school level-educated women, mother tongue Marathi, participation in screening in all 3 rounds and women referred as screen positive for cervix cancer had higher compliance to diagnostic investigations. The compliance to treatment completion is higher in women diagnosed with breast cancer, at 95%, compared to 86% for cervix cancers and 81% for cervix pre-cancers. CONCLUSIONS: Good compliance rates along with a proper system of referral, further investigations, confirmation of diagnosis and treatment as demonstrated in this trial are crucial for successful screening programmes.