Mumbai metropolitan region eye care facility survey: Mumbai Eye Disease Study (MEDiS) report #1

Purpose: To examine the eye care practice in the Mumbai Metropolitan Region (MMR). Methods: This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income – low (<INR 0.3 m), middle (INR 0.31–1.8 m), and high (>1.8 m). We analyzed the collected data to estimate the eye care demand– supply, quality of eye care, health?seeking behavior, gap in eye care delivery, and eye care expenditure. Results: We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low? and middle?income groups than in the high?income group (48%–50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out?of?pocket spending was between 60% and 83%. Lower?income group people preferred public facilities. Conclusion: MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less?expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city?specific eye health issues.

Impact of individual counseling on the knowledge and attitudes of type 2 diabetics regarding diabetic retinopathy: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study – Report 3

Purpose: Baseline knowledge and attitudes regarding diabetic retinopathy (DR) have not been previously reported for type 2 diabetes mellitus adults (T2DM) in Dharavi, one of the largest slums in Mumbai. Furthermore, a pre? and post?intervention survey study regarding this topic has not been conducted to date in Dharavi. This pre? and post?intervention survey study analyzes the impacts of DR counseling sessions administered individually on the knowledge and attitudes of T2DM participants recruited from Dharavi. Methods: Potential subjects (>30 years old) from Dharavi were enrolled by community workers and screened for T2DM. Those with confirmed T2DM were each registered for an individual DR counseling session. A survey was distributed to participants before the counseling session to determine their baseline knowledge and attitudes. The same survey was distributed after the counseling session, and changes in pre? and post?survey responses were analyzed. Results: Exactly 1718 T2DM study participants were given pre? and post?surveys. Before the counseling, T2DM participants showed low baseline knowledge and attitudes regarding DR, with only 30.8% (530/1718) participants being aware that diabetes can affect the eye. Participants showed significant improvements after the counseling session, with more participants showing willingness to attend DR screenings (pre: 38.3.%, post: 56.8%; P < 0.0001) and more becoming aware that diabetes can affect the eye (90.4%, 1553/1718; P < 0.0001). Conclusion: Targeted educational interventions for T2DM individuals from the slums of western India, such as Dharavi, can lead to significant improvements in knowledge and attitudes, representing a promising avenue in tackling the burden of avoidable blindness caused by DR in India.

A hospital based exploratory study to assess the reasons and timings of seeking abortion services in a tertiary care hospital in Mumbai

Background: The adoption of the Medical Termination of Pregnancy (MTP) Act has allowed for abortion on the grounds of medical and social reasons since 1972.The aim of the present study is to establish the demographic of women seeking abortion care services and to determine the role of different factors in the timing of seeking an abortion.Methods: A retrospective hospital record-based study was carried out among pregnant women seeking an MTP in a tertiary care hospital in Mumbai. The records of women seeking MTP over a 5-year period from January 2012 to December 2016 were accessed and data pertaining to their demographic and obstetric history was recorded. Statistical tests of significance and analysis were done.Results: A total of 803 women underwent an MTP from January 2012 to December 2016. The number of deliveries during the same time period was 13735. The most common age group was 25-30 years. Stratification in terms of the educational backgrounds showed that 45.7% had received only secondary school education while 12.7% had no schooling. Majority of the women (74.8%) availed an MTP in the first trimester, out of which, most of them (36.9%) had 2 previous pregnancies. Most women coming in the second trimester (43.6%) hadn’t conceived before.Conclusions: Education didn’t seem to be a significant factor in determining the timing of seeking an MTP. School education did not necessarily include exposure to sexual education. Experience in terms of parity was more relevant in identifying signs of pregnancy and seeking appropriate services in a timely manner.

Historic migration to South Asia in the last two millennia: A case of Jewish and Parsi populations

The South Asian populations have a mosaic of ancestries likely due to the interactions of long-term populations of the landmassand those of East and West Eurasia. Apart from prehistoric dispersals, there are some known population movements to India. Inthis study, we focussed on the migration of Jewish and Parsi populations on temporal and spatial scales. The existence of Jewishand Parsi communities in India are recorded since ancient times. However, due to the lack of high-resolution genetic data, theirorigin and affiliation with other Indian and non-Indian populations remains shrouded in legends. Earlier genetic studies onpopulations of Indian Jews have found evidence for a minor shared ancestry of Indian Jews with Middle Eastern (Jews)populations, whereas for Parsis, the Iranian link was proposed. Recently, in our high-resolution study, we were able to quantifythe admixture dynamics of these groups, which has suggested a male-biased admixture. Here, we added the newly availableancient samples and revisited the interplay of genes and cultures. Thus, in this study we reconstructed a broad genetic profile ofIndian Jews and Parsis to paint a fine-grained picture of these ethnic groups.

Risk Factors And Road Traffic Accidents On Mumbai–Pune Expressway

INTRODUCTION:Road traffic injuries are the leading cause of death among people aged between 15 and 29 years. Road traffic crashes cost most countries 3% of their gross domestic product. Without sustained action, road traffic crashes are predicted to become the seventh leading cause of death by 2030.METHODS:170 patients who met with an accident on Mumbai-Pune Expressway and who presented to Emergency Department of MGM Medical College and Hospital were studied and analyzed.RESULTS:In our study we noted that human factors (68%) contributed the most followed by vehicle (12%) and infrastructure (7%) among which over speeding (65.07%), alcohol (34.70%), fatigue/ sleep (34.22%), obstacle (21.70%) were the most common responsible factors for RTAs.CONCLUSION:Maximum RTA’s occurs in the productive age group. The need for drivers / road user’s education, road maintenance and putting in place a well-organized rescue and pre-hospital care team is emphasized.

A study of Stress of police constables in Mumbai police stations

Background: The research paper examines the stressors encountered by the employees in policedepartment and especially police constables. The purpose of the study is to determine if the stress levels aresignificantly different for different designations and trying to ascertain through interviews the reasons ofstress which hinders their performance and the measures taken by Mumbai police department to reducethe stress.Methods: A random sample of 90 police constables from 10 police stations was selected. The data wascollected from self constructed questionnaire and personal interviews. One way ANOVA was done to findif the difference in stress was significantly different in 4 different job designations.Results: The possible suggestions to reduce stress among police constables that were reached at:Humanrelations approach, Participative management Healthy superior – subordinate relationship, Better workingconditions, effective leadership.Conclusion:Causes of stress among Mumbai police constables are identified as Long and impossible hoursof duty, Tremendous pressure of job, Lack of effective leadership, Arbitrary postings and transfers etc.

Rising Maternal Mortality in Mumbai Metropolitan Region: Need for Action.

Data from the past suggest that maternal deaths mostly occurred due to obstetric complications, like postpartum hemorrhage, sepsis or maternal morbidities, like eclampsia and cardiac diseases. This trend, however, has changed over a period of time in developing countries, like India where increasing number of maternal deaths have been attributed in recent years to preventable infectious causes, such as hepatitis, tuberculosis and malaria. Rising maternal mortality ratio (MMR) due to infections indicates there are several loop holes in the basic healthcare system at various levels in their prevention and control. Although maternal mortality worldwide is decreasing progressively, curbing maternal deaths in certain developing regions of the World including few parts of India and Mumbai Metropolitan Region at a faster rate is essential in order to achieve the United Nations Fifth Millennium Development Goal of 2015.

Perception of young adults toward hookah use in Mumbai.

BACKGROUND: The use of tobacco has been on the rise globally including in India, posing a grave public health problem. Recently, tobacco use through hookah smoking has increased among young adults in India, Middle East, Southwest Asia, Africa, Europe and North America. Hookah prevalence of 0.4‑15% has been reported in India. AIM: The aim of the study was to understand perception of hookah use among young adults in Mumbai. MATERIALS AND METHODS: A total of 500 college students, with/without hookah habit, were given a self‑administered questionnaire to indicate their perception of hookah use, using yes/no responses. The responses were analyzed in the users/non‑users and considered significantly different at P < 0.05. RESULTS: Responses were received from 122 hookah users and 325 non‑users. The perception of hookah use between users and non‑users and males and females, showed significant differences (P < 0.05), with respect to hookah being injurious to health, causes cancer, is addictive, influence of a close friend, flavors, curiosity toward hookah use and willingness to prepare hookah at home. Whereas, differences in the groups perception of hookah as safer than cigarettes, harmful air quality, ambience, cool look and means of socializing, was not observed. CONCLUSION: The perception of young adults in Mumbai, toward hookah use, indicates an increased trend to use hookah. We recommend deterrents for hookah use by display of health warnings on hookah assembly and the tobacco products, implementation of government policies on hookah and tobacco use and punitive measures for offenders.

Economic burden of hypertension care on households of Malwani slum of Mumbai: a cross-sectional study.

Background: Hypertension is a chronic non-communicable disease that effects adversely on heart, brain and kidney. Nearly 2/3rd of all hypertensive patients live in low and middle income countries, so the economic burden of hypertension is huge. India is one of those countries which spent more than 1/3rd of all income on CVD and hypertension. This study was conceptualized to study the disease and economic burden of hypertension. Methods: A cross-sectional study was conducted in New Collector Compound (NCC) of Malwani. Five plots of NCC were selected by simple random sampling. A list of hypertensive patients was prepared by house-to-house survey. Fifty per cent patients were selected randomly for studying economic burden. Results: The study covered 447 households and 2360 persons. Eighty participants (3.4%) were found hypertensive. The average annual total cost of hypertension and related disorders was Rs. 7154. It was Rs. 6073 and Rs. 8235 for government and private respectively. Only 7.50% households were not incurring any cost of illness. The average annual out of pocket expenditure (OOPE) was Rs. 4042 and Rs. 7621 for government and private facilities respectively. Fifteen per cent households were incurring catastrophic expenditure at highest threshold of 40%. The catastrophic spending led to impoverishment of 34.2% households. Conclusions: High prevalence of hypertension, high OOPE, high incidence of catastrophic spending and impoverishment among households intensively reflect the need of interventions. Early preventive measures may be a key in controlling economic and disease burden. There is need to provide the financial risk protection against the OOPE for outpatient care.

Bedside Index of Severity in Acute Pancreatitis (BISAP) score for predicting prognosis in acute pancreatitis.

Introduction: Bedside Index of Severity in Acute Pancreatitis (BISAP) is a simple bedside tool which helps in early identification of risk of higher mortality in acute pancreatitis. Objectives: Our aim was to study clinical and laboratory profiles of patients with acute pancreatitis presenting to a tertiary care hospital in Mumbai, India and to stratify patients according to their risk of mortality by applying the BISAP score and its correlation with Computed Tomography Severity Index (CTSI). Material and methods: Patients who came to Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital, Mumbai with definitive features of acute pancreatitis from January, 2013 to April, 2013 were prospectively observed for 24 hours and their clinical information was collected. CT abdomen was used as the gold standard for the diagnosis of acute pancreatitis. Descriptive analysis for various patient variables was performed using SPSS. Results: Alcoholism was the most common etiology; 97% patients presented with abdominal pain. Higher serum amylase, lipase and blood urea nitrogen levels, hypocalcemia, presence of systemic inflammatory response syndrome and bilateral pleural effusion were found to significantly associate with mortality. There was a statistically significant trend for increasing mortality with increasing BISAP score (p<0.001). However, no significant correlation between BISAP score and CTSI was found [(p = 0.101), Pearson’s correlation coefficient = 0.168]. Conclusion: Traditional severity indices have not been clinically useful since they require collection of huge amount of clinical and laboratory data over time. In such circumstances, BISAP score can predict patients who are at higher risk of mortality.

Local responses to the Maharashtra gutka and pan masala ban: A report from Mumbai.

Background: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. Objective: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. Materials and Methods: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. Results: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. Conclusions : To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

Determinants of exposure to second-hand smoke at home and outside the home among students aged 11-17 years: Results from the Mumbai Student Tobacco Survey 2010.

Background: While no level of exposure to Second-hand smoke (SHS) is free of risk, 37% of students from South-East Asia region were exposed to SHS. Aims: To estimate the prevalence of exposure to SHS and identify predictors of exposure to SHS at home and outside the home among 1,511 school students aged 11-17 years. Setting: The City of Mumbai. Study Design: This study used a two-stage cluster sampling design. Materials and Methods: Mumbai Student Tobacco Survey (MSTS) was a cross-sectional study, using anonymous self-administered structured questionnaire among students. The probability of schools being selected was proportional to the enrolment into grades 8 to 10. The study aimed to sample around 60 students from selected classes in each chosen school. Statistical Analysis: Proportions, 95% confidence interval and adjusted odds ratios (AOR) were used. Results: About 79.9% students were aware about the current smoking ban at public places and 88.1% were knowledgeable about the deleterious influence of SHS on them. Overall, 16.5% of students were exposed to SHS at home, and 39.9% outside of the home. Students from families where at least one parent used tobacco were at the greatest risk of SHS exposure at home in addition to outside the home exposure. Those students who were not aware about the smoking ban in public places were at a significantly higher risk of SHS exposure outside the home. Conclusion: Self-reported tobacco use status, age, parents' tobacco use, close friends' smoking, and the route they take to school were significant determinants of exposure to SHS at home and outside the home.

HIV and malaria co-infection in Mumbai, western India.

Background & objectives: Conflicting reports exist regarding the HIV-1 infection on the risk of malaria. A transient almost one-log elevation in HIV viral load occurs during febrile malaria episodes. We prospectively studied malaria patients for HIV infection from Mumbai. Methods: A total of 171 malaria patients and 28,749 normal voluntary blood donors were studied for their HIV status. Diagnosis of malaria was done by microscopical examination of blood. HIV screening was done by detection of HIV-1 & 2 antibodies by micro well ELISA using Enzaids & J Mitra kits followed by confirmation using western blot (Innogenetics, Belgium) analysis. Results: Out of 171 malaria patients 13 (7.6%; Odds ratio= 4.45; p <0.0001) and 521 blood bank donors were found to be HIV reactive. Among 13 HIV reactive patients, eight patients were Elisa borderline reactive and western blot positive (p24), which may be due to cross-reactive antibodies. Five of 13 malaria patients found to be HIV-1 positive by ELISA and by western blot confirming HIV and malaria co-infection. Conclusion: Our findings suggest that HIV-1 and malaria co-infection can’t be ruled out in malaria endemic countries like India.

Characteristics, immunological response & treatment outcomes of HIV-2 compared with HIV-1 & dual infections (HIV 1/ 2) in Mumbai.

Background & objectives: Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). Methods: Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. Results: A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/µl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. Interpretation & conclusions: In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.

Programas de erradicação, reassentamento e urbanização das favelas: Delhi e Mumbai

Este artigo comparativo focaliza as políticas públicas adotadas para as favelas das duas maiores metrópoles indianas, Delhi, a capital política, e Mumbai, o principal centro econômico. Tentaremos entender as convergências e divergências existentes nas políticas das favelas aplicadas no período pós-independência, nas políticas de melhoria dos serviços básicos, de reassentamento e de urbanização. Como será mostrado, a explicação das principais diferenças tem como base as interações distintas de atores, públicos, privados e da sociedade civil, arraigadas em contextos urbanos específicos.