Suchergebnisse

Health parameters of tribal population had always been a concern for India's march towards Millennium development Goals (MDG's). Tribal population contributes 8.6% of total population, in spite of efforts and commitment of Government of India towards MGD, India lagged far behind from achieving and optimal health of tribal population will be a concern for achieving Sustainable development Goals SDG's also. Some of the common health problems of the tribal population face are deficiency of essential components in diet like energy malnutrition, protein calorie malnutrition and micronutrient deficiencies. Goiter, Gastrointestinal disorders, particularly dysentery and parasitic infections are very common. High prevalence of genetic disorders like sickle cell anemia and others are endemic in few tribes of India. Tribal Health is further compounded issues by social issues like excessive consumption of alcohol, poor access to contraceptive, substance abuse and gender based violence. Besides other reasons, like poor budget allocation, difficult to reach, poor access to health care facility, severe shortage of qualified health workers and workforce led to poor governance of health sector in tribal areas. Present view point reflects on the issues of inadequacy of doctors in tribal area and suggests possible solutions.

Increasing attention has been paid to quality of care (QOC) in family planning (FP) during the last few years, and there have been several initiatives to strengthen QOC in FP in the developing world. This paper reviews the quality of the FP program in India's public and private sectors, and examines six elements: choice of methods, information given to clients, technical competence, interpersonal relations, continuity of care and follow-up, and appropriate constellation of services. Overall, the paper finds that not much attention has been paid to QOC and hence the level is quite low. Evidence and observations indicate that QOC may be slightly better in the nongovernmental sector. In many areas adequate information is not available to assess QOC, especially in the private sector. Overall, substantial efforts are needed to improve QOC in FP in India. The paper discusses why QOC is poor and offers suggestions for improving each dimension. As the Government of India is actively considering revising its FP program strategy and adopting a reproductive health approach, it may be an opportune time to improve QOC in the family welfare program.

Abstract Background The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Methods Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012–2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Results Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. Conclusions CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government's efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on strengthening the public sector's ability to provide emergency obstetric care, the CY program is a potential means by which the state can ensure its poor mothers have access to necessary care if uptake is increased.

ACKNOWLEDGEMENTS The inputs and facilitation of field work from the Gujarat state government officials are acknowledged. We express our gratitude to the doctors, nurses and other health facility staff for actively participating in the study. Our special thanks to Dr. Pritam Pal for capacity building of the research team for appreciative inquiry and Mr. Sanjay Joshi for follow-up of the AI process. We appreciate the help of Dr. Purvi Shah in data collection and preparing transcripts for the study. The study was funded by the John D. and Catherine T. MacArthur Foundation. ; Peer reviewed ; Publisher PDF

Abstract Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems, protocols and procedures, and for training and research. Simply incentivizing the behaviour of women to use health facilities for childbirth via government schemes may not guarantee safe delivery.

Background: Coronavirus disease 2019 (COVID-19) has emerged as a public health crisis globally. Management of old age homes have been challenged during the ongoing pandemic crisis, as the elderlies are by far the most vulnerable population group in context to prone to infection of COVID-19 disease. Objective: The study intended to understand the effect of COVID-19 on western Indian elderly care homes, the actions taken by the administration, and the challenges faced during and post-lockdown period. Method: A total of 44 care homes across three states of western India were contacted for data collection during the period of September-December 2020. Semi-structured interviews of the administrators were taken to gather the required information to achieve the study objectives. Results: Out of 44 care homes, ten care homes reported 169 cases of coronavirus infection and seven deaths. Hence, the rate of reported COVID-19 cases was found to be 1074 per 10,000 residents. Discussion: Results of the study indicated the significant steps taken by these old-age care homes to stave off the infection spread among the occupants. It was observed that an average of 26% of the occupants was sent back to their home/relative's home before the lockdown to decongest the care homes. Care homes in western India seemed to have a very low infection rate and a very low number of deaths as compared to the Global Scenario. The present study also highlights the gaps in policy and calls for urgent action by the government for the regulation of old age homes in India.

Studies on urban metabolism have provided important insights in the material and socio political issues associated with the flow. However, there is dearth of studies that reveal how infrastructure as a hybrid of social and material construct facilitates disease emergence. The paper brings together urban metabolism, political ecology and anthropological studies to examine how the material flow of water is socially constructed and reconstructed through everyday water problems and its health burden in Ahmedabad city, India. The article geo-references the water problems and occurrence of diseases and through interviews documents the socio-spatial characteristics of water problems and health burden in two case study wards. The paper provides a situated understanding of the everyday practices that exposes the water infrastructure through leakages, reveals the citizens desire for better water quality and struggle to gain access to water using diverse 'pressure' tactics. It is this social-material construct of infrastructure that gives structure and coherence to urban space, which spatially coincides with the occurrence of diseases. The analysis reveals the socio-political drivers of the water problems, spatial inequity in water access, and identify potential hypothesis of the hot-spots of disease emergences. Attempts to bring about a desired change have to be collective and incremental that takes into consideration the diffuse interplay of power by diverse actors in managing the flow of water. The methodology offers a way forward for researchers and development agencies to improve the surveillance and monitoring of water infrastructure and public health. By bringing 'place-based' and 'people-based' approach, the analysis charts out avenues for incorporating the socio-spatiality of the everyday problems within the field of urban metabolism for improving resource use efficiencies in cities of rapidly growing economies.

High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years.

BACKGROUND: Studies on high temperatures and mortality have not focused on underdeveloped tropical regions and have reported the associations of different temperature metrics without conducting model selection. METHODS: We collected daily mortality and meteorological data including ambient temperatures and humidity in Ahmedabad during summer, 1987–2017. We proposed two cross-validation (CV) approaches to compare semiparametric quasi-Poisson models with different temperature metrics and heat wave definitions. Using the fittest model, we estimated heat-mortality associations among general population and subpopulations. We also conducted separate analyses for 1987–2002 and 2003–2017 to evaluate temporal heterogeneity. FINDINGS: The model with maximum and minimum temperatures and without heat wave indicator gave the best performance. With this model, we found a substantial and significant increase in mortality rate starting from maximum temperature at 42 °C and from minimum temperature at 28 °C: 1 °C increase in maximum and minimum temperatures at lag 0 were associated with 9.56% (95% confidence interval [CI]: 6.64%, 12.56%) and 9.82% (95% CI: 6.33%, 13.42%) increase in mortality risk, respectively. People aged ≥ 65 years and lived in South residential zone where most slums were located, were more vulnerable. We observed flatter increases in mortality risk associated with high temperatures comparing the period of 2003–2017 to 1987–2002. INTERPRETATION: The analyses provided better understanding of the relationship of high temperatures with mortality in underdeveloped tropical regions and important implications in developing heat warning system for local government. The proposed CV approaches will benefit future scientific work.

One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.