Health issues in Mumbai

Malnutrition in India
According 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 in
India.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 malnutrition
A 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 malnutrition
Protein-energy malnutrition (PEM), also known as protein-calorie malnutrition
Iron deficiency : nutritional anaemia which can lead to lessened productivity, sometimes
becoming 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 rate

Despite 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

In India, Hindus are, on average, richer and more educated than Muslims. 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]

Diseases
Diseases 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 drugresistant form of tuberculosis.[28] HIV/AIDS in India is 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 of Rabies.
However in 2012 India was polio-free for the first time in its history.[32] This was achieved
because of the Pulse Polio Programme started in 1995-96 by the government of India .[33]
Indians are also at particularly high risk for atherosclerosis and coronary artery disease. This
may be attributed to a genetic predisposition to metabolic syndrome and adverse changes in
coronary artery vasodilation. NGOs such as the Indian Heart Association and the Medwin
Foundation have been created to raise awareness of this public health issue.[34][35]

Poor sanitation
See 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 the
population 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 water

Several 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 increasing
extraction 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 issues

Maternal 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]

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.14 As 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.5,6 Although 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.

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.7 The 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 a
community-based participatory framework. In keeping with the principles of communitybased 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 theory16,17 to 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 were
concerned 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)

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's
designed 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

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 for
reaching 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 services including 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, some
states 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).