Health Issues in Mumbai

8/10/2019 Health Issues in Mumbai

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Health issues in MumbaiMalnutrition in IndiaAccording to a 2005 report, 42% of Indias children below the age of three were

malnourished, which was greater than the statistics of sub-Saharan African region of

28%.

[12]

It is considered that one in every three malnourished children in the world lives inIndia.The estimates varies within the country.It is estimated that,Madhya pradesh is having

the highest rate of 55 % and Kerala the lowest with 27 %.[13]Although Indias economy grew

50% from 20012006, its child-malnutrition rate only dropped 1%, lagging behind countries

of similar growth rate.[14]

Malnutrition can be described as the unhealthy condition that results from not eating enough

food or not eating enough healthy food.[15]

Child malnutritionA well nourished child is one whose weight and height measurements compare very well

within the standard normal distribution of heights and weights of healthy children of same

age and sex.[16]Malnutrition impedes the social and cognitive development of a child.[14]

These irreversible damages result in lower productivity.[14]

Just as with serious malnutrition,growth delays also hinder a childs intellectual development. Sick children with chronic

malnutrition, especially when accompanied by anaemia, often suffer from a lower learning

capacity during the crucial first years of attending school.[17]Also it reduces the immune

defence mechanism,which heightens the risk of infections.[18]Due to their lower social status,

girls are far more at risk of malnutrition than boys their age. Partly as a result of this cultural

bias, up to one third of all adult women in India are underweight. Inadequate care of these

women already underdeveloped, especially during pregnancy, leads them in turn to deliver

underweight babies who are vulnerable to further malnutrition and disease.[19]

Different forms of malnutritionProtein-energy malnutrition (PEM), also known as protein-calorie malnutrition

Iron deficiency : nutritional anaemia which can lead to lessened productivity, sometimesbecoming terminal

Vitamin A deficiency, which can lead to blindness or a weakened immune system

Iodine deficiency, which can lead to serious mental or physical complaints

Foliate deficiency itself can lead to insufficient birth weight or congenital anomalies such as

spina bifida.[20]

High infant mortality rateDespite health improvements over the last thirty years, lives continue to be lost to early

childhood diseases, inadequate newborn care and childbirth-related causes. More than two

million children die every year from preventable infections.[21]

Approximately 1.72 million children die each year before turning one.[22]The under five

mortality and infant mortality rates have been declining, from 202 and 190 deaths per

thousand live births respectively in 1970 to 64 and 50 deaths per thousand live births in

2009.[22][23]However, this decline is slowing. Reduced funding for immunization leaves only

43.5% of the young fully immunized.[14]A study conducted by the Future Health Systems

Consortium in Murshidabad, West Bengal indicates that barriers to immunization coverage

are adverse geographic location, absent or inadequately trained health workers and low

perceived need for immunization.[24]Infrastructure like hospitals, roads, water and sanitation

are lacking in rural areas.[25]Shortages of healthcare providers, poor intra-partum and

newborn care, diarrheal diseases and acute respiratory infections also contribute to the high

infant mortality rate.

[22]

Hindu and Muslim infant mortality difference puzzle
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InIndia,Hindusare, on average, richer and more educated thanMuslims.But oddly, Hindus'

child mortality rate is much higher. All observable factors say Hindus should fare better, but

they don't. Economists refer to this as the Muslim mortality puzzle. The study found that the

Muslims, regardless of income, were 20 percent more likely to use toilets than Hindus who

used open defecation more often.[26]

DiseasesDiseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to

plague India due to increased resistance to drugs.[27]In 2011, India developed a totally drug-

resistantform of tuberculosis.[28]HIV/AIDS in Indiais ranked 3rd highest among countries

with the amount of HIV-infected patients.National AIDS Control Organisation,a

Government of India 'Apex Body' is making efforts for managing the HIV/AIDS epidemic in

India.[29]Diarrheal diseases are the primary causes of early childhood mortality.[30]These

diseases can be attributed to poor sanitation and inadequate safe drinking water in India.[31]

India also has the world's highest incidence ofRabies.

However in 2012 India was polio-free for the first time in its history.[32]This was achieved

because of thePulse PolioProgramme started in 1995-96 by the government ofIndia.[33]

Indians are also at particularly high risk for atherosclerosis and coronary artery disease. Thismay be attributed to a genetic predisposition to metabolic syndrome and adverse changes in

coronary artery vasodilation. NGOs such as theIndian Heart Associationand the Medwin

Foundation have been created to raise awareness of this public health issue.[34][35]

Poor sanitationSee also:Water supply and sanitation in India

As more than 122 million households have no toilets, and 33% lack access to latrines, over

50% of the population (638 million) defecate in the open.(2008 estimate)[36]This is relatively

higher than Bangladesh and Brazil (7%) and China (4%).[36]Although 211 million people

gained access to improved sanitation from 19902008, only 31% use the facilities

provided.

[36]

Only 11% of Indian rural families dispose of stools safely whereas 80% of thepopulation leave their stools in the open or throw them in the garbage.[36]Open air defecation

leads to the spread of disease and malnutrition through parasitic and bacterial infections.[37]

Safe drinking waterSeveral million more suffer from multiple episodes of diarrhoea and still others fall ill on

account of Hepatitis A, enteric fever, intestinal worms and eye and skin infections caused by

poor hygiene and unsafe drinking water.[38]

See also:Water supply and sanitation in India

Access to protected sources of drinking water has improved from 68% of the population in

1990 to 88% in 2008.[36]However, only 26% of the slum population has access to safe

drinking water,[37]and 25% of the total population has drinking water on their premises.[36]

This problem is exacerbated by falling levels of groundwater caused mainly by increasingextraction for irrigation.[36]Insufficient maintenance of the environment around water

sources, groundwater pollution, excessive arsenic and fluoride in drinking water pose a major

threat to India's health.[36]

Female health issuesMaternal deaths are similarly high. The reasons for this high mortality are that few women

have access to skilled birth attendants and fewer still to quality emergency obstetric care. In

addition, only 15 per cent of mothers receive complete antenatal care and only 58 per cent

receive iron or folate tablets or syrup.[39]

Main article:Women's health in India

Women's health in India involves numerous issues. Some of them include the following:

Malnutrition: The main cause of female malnutrition in India is the tradition

requiring women to eat last, even during pregnancy and when they are lactating.[40]
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Breast Cancer: One of the most severe and increasing problems among women in

India, resulting in higher mortality rates.

Stroke

Polycystic ovarian disease (PCOD): PCOD increases the infertility rate in females.

This condition causes many small cysts to form in the ovaries, which can negatively

affect a woman's ability to conceive.

Maternal Mortality: Indian maternal mortality rates in rural areas are one of the

highest in the world.

Abstract

Objectives.We used qualitative and quantitative data collection methods to identify the

health concerns of African American residents in an urban community and analyzed the

extent to which there were consistencies across methods in the concerns identified.

Methods.We completed 9 focus groups with 51 residents, 27 key informant interviews, and

201 community health surveys with a random sample of community residents to identify the

health issues participants considered of greatest importance. We then compared the issues

identified through these methods.

Results.Focus group participants and key informants gave priority to cancer and

cardiovascular diseases, but most respondents in the community health survey indicated that

sexually transmitted diseases, substance abuse, and obesity were conditions in need of

intervention. How respondents ranked their concerns varied in the qualitative versus the

quantitative methods.

Conclusions.Using qualitative and quantitative approaches simultaneously is useful in

determining community health concerns. Although quantitative approaches yield concrete

evidence of community needs, qualitative approaches provide a context for how these issues

can be addressed. Researchers should develop creative ways to address multiple issues that

arise when using a mixed-methods approach.

Community-based participatory research is a collaborative process in which academic and

community investigators work together to develop, implement, and evaluate interventions to

improve the health of community residents.14As part of these partnerships, formative

research that includes focus groups and key informant interviews may be conducted to

identify the health priorities and concerns of community residents and to obtain guidance

from stakeholders on how these issues should be addressed and how to develop

interventions.5,6Although this information is critical to the implementation of intervention

strategies, the generalizability of data obtained from these methods may be limited because

individuals may self-select for participation in focus groups, and key informants are often

identified using nonrandom methods. Thus, it may be important to use quantitative methods

such as population-based random surveys along with qualitative approaches to ensure that the

health priorities and concerns identified during the formative phase of academiccommunity

partnerships are most representative of the community. However, limited empirical data exist

on the congruence of data obtained using different methods.
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In 2005, members of 4 community-based organizations in Philadelphia, Pennsylvania, and

researchers and staff at the University of Pennsylvania (Figure 1)established the West

Philadelphia Consortium to Address Disparities with funding from the National Center on

Minority Health and Health Disparities.7The purpose of our academiccommunity

partnership is to conduct collaborative research to address disparities in chronic diseases that

disproportionately affect African Americans in terms of morbidity and mortality using acommunity-based participatory framework. In keeping with the principles of community-

based participatory research, the leaders of each community partner are listed as

coinvestigators (R. R., V. B., E. D., J. P.) in the research alongside the academic-based

coinvestigators. Moreover, each community partner receives its share of the funding directly.

The organizations involved have all worked with academic investigators previously and

realized that they share similar interests and could work together in a mutually beneficial

way.

Data Analysis

We used grounded theory16,17to code the qualitative data and elicit key themes. We used the

constant comparative method to compare themes across groups and key informants and to

determine relationships among them. Trained research assistants coded and analyzed focus

group and key informant transcripts using N6, 2006 version (QSR International, Melbourne,

Australia) for analyzing qualitative data. For the quantitative CHS, we first generated

descriptive statistics to characterize respondents in terms of socioeconomic background. We

then generated a list of the conditions that respondents identified when we asked them

whether there was one that needed to be improved. In the small number of cases in which

respondents identified more than 1 condition, we included the first 1 recorded in our list. We

then generated frequencies to characterize the number of individuals who identified each type

of condition. We also generated frequencies to describe the extent to which participants wereconcerned about these conditions that they identified a priori.

Health Concerns Identified Using Qualitative Methods

The majority of both key informants and focus group participants identified chronic diseases,

such as cancer and cardiovascular diseases, because of their personal health history and those

of family, friends, and community members:

I have a couple of friends with breast cancer and prostate cancer, and a friend who died a

couple of years ago, she had cancer. (Focus group participant)

Well a good friend of mine, he died of cancer. And my father, he had different cancers. And

um, I see it throughout the community and how it [can] ravage your body, and the changes it

take em through. I notice it's a horrible way to go. (Focus group participant)

My family has a history of cancer. I've had 2 mastectomies. I've had breast cancer twice.

(Key informant)

High blood pressure, stroke, cancer, diabeteseither the individual has contracted one or

maybe more of these diseases personally or someone in their family has been affected by it.

Certainly, somebody that each member of the community knows has this issue. (Key

informant)
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I picked high blood pressure and diabetes cause they affect people in my family. People I

know [are] always talking about blood pressure and diabetes. (Focus group participant)

In addition to identifying chronic illnesses, participants also identified risk factors such as

obesity and being overweight, as well as environmental factors that contribute to the excess

burden of disease among African Americans as conditions that need to be addressed:

The issue of nutrition I think is primary in the health issues I see in West Philadelphia. (Key

informant)

First comes the weight and with the weight comes the diabetes, the high blood pressure. Now

these things are not only from diet, but these things come from weight. (Focus group

participant)

I gained 35, 50 pounds. My pressure shot through the roof. As I started gaining this weight,

my pressure went up. (Focus group participant)

I think [we need] awareness on how to eliminate the possibility of cancer and cardiovascular

problems by monitoring your diet and exercise. (Key informant)

Everyone needs to have a safe living environment if you're living on the street, if you're

living in a shelter, you're not necessarily living in the best living environment, which can

impact your health. (Key informant)

Over the past 2530 years, they started injecting the beef with hormones and these things are

really impacting our health. (Focus group participant)

Just like they flood our communities with all these ads for cigarettes and all the ads for the

fast food stuff, but if I tell someone about a health fair that's been going on for 2 hours, they

know nothing about it. (Focus group participant)

[It's important to] eliminate some of these environmental hazards and educate people around

environmental issues. (Key informant)

Participants also stated that interventions should focus on increasing access to information

about these issues through education programs delivered to individuals:

Well, they have that thing called the wellness center. We need more centers like that that'sdesigned to reach out to the community and bring you in and to assist with your medical

problems slightly free of charge. (Focus group participant)

But having access to programs that benefit the residents and even having the folk that are

affected by the problems to help design the programs folk that are affected by the problem

need to be a part of the solution. (Key informant)

Violence and sexually transmitted diseases (STDs), particularly HIV/AIDS, also emerged as

health concerns, but to a much lesser degree than those reported.

Conclusions


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Obtaining input from community stakeholders is a critical component of community-based

participatory research that is necessary for obtaining guidance to develop interventions.13

Although we found that different concerns may emerge when using both qualitative and

quantitative approaches, both approaches were useful in determining health concerns of

community residents and developing creative intervention approaches for addressing those

concerns. For communityacademic partnerships, it is important to plan strategies forreaching consensus on how to address these variations in a way that is amenable to all

partners and beneficial to the participating community. Although there may be some variation

in the extent to which different issues are prioritized, data from multiple sources can be used

as the basis for developing plans for how to improve health outcomes.

We observed marked disparities in cancer screening and provider counseling rates for certain

population subgroups, especially the uninsured and those with low income or no usual source

of health care. Population subgroups whose access to care was the most compromised as

measured by not having health insurance and not having a usual source of care included

Hispanics and those below 200% FPL.

Given the well-established link between economic recession and decreased health insurance

coverage (14), and the strong relationship between health insurance and cancer screening use,

the gaps we observed for some HP measures may reflect the adverse state of the US economy

during 2008 through 2010. However, neither Pap test nor mammography use increased

during the past decade (15), suggesting that factors influencing cancer screening trends

predate the most recent economic downturn and that meeting HP 2020 targets for cervical

and breast cancer screening may be challenging. Further, our results show consistent and

persistent disparities in receipt of cancer screening and provider counseling and in health care

access for certain subgroups, suggesting that attaining HP cancer-related targets by 2020 may

be challenging in the absence of new approaches to expand health insurance coverage,

improve access to cancer screening and treatment services, better integrate clinical and

community preventive services, and improve health literacy.

One landmark development is the 2010 Patient Protection and Affordable Care Act;

components of this national legislation are intended to reduce considerably the proportion of

people who lack health insurance coverage or access to primary care providers or both. The

importance of preventive health services for cancer control is recognized in the legislation,

which makes certain servicesincluding cervical, breast, and colorectal cancer screening

available with no cost-sharing in Medicare and in all new health insurance plans effective

September 23, 2010 (16). Although newly eligible Medicaid beneficiaries also should

experience improved access to these and other preventive services under health reform, somestates may not provide equivalent coverage for existing Medicaid beneficiaries (17). It will be

especially important to monitor attainment of HP objectives among health reforms expanded

Medicaid population. The legislation also calls for development of the National Prevention

Strategy, which recommends improving integration of evidence-based clinical and

community preventive services that may lead to an expanded role for public health in cancer

screening (1820). Finally, meeting HP objectives for counseling about cancer screening and

genetic testing may require greater attention to provider-focused initiatives and interventions

(21).
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Documents

Health Issues in Mumbai