Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted

Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care

Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

Background: Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable

Urban health challenges in India lessons learned from a surveillance study in Pune

Urban health in India is gaining increasing attention due to the growing share of urban population and the changing living conditions caused by the rapid urbanization process. The rising prevalence of non-communicable diseases (NCDs) such as diabetes is partly attributed to this process making NCD prevention and control one of the biggest public health challenges in the 21st century. Though public health programs in India are increasingly targeting NCDs, data quality and availability to budget scarce resources remains a challenge. The objective of the study was to conceptualize a prototype for an urban NCD sentinel surveillance system to capture data on newly diagnosed NCD cases, taking also into account socio-spatial intraurban differences. As preliminary steps, two systematic literature reviews, mapping of healthcare providers and a knowledge attitude practice survey on disease surveillance were conducted. In total, 258 private primary healthcare providers ( allopathy, ayurveda, homeopathy and unani) participated in the survey, out of these 127 agreed to participate in the six months surveillance study, providing data on a monthly basis. The study indicates that, despite the small size and low level of infrastructure in the private clinics, these practitioners play an important role in diagnosing and treating NCDs. They can be involved in NCD surveillance, if the following major barriers are addressed: lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. Based on our findings, a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care might be an adequate approach to monitor NCD related health trends

Jungle cat (Felis chaus) in farmlands: potential benefits of coexistence and human-wildlife conflicts in West Bengal, India

Human-wildlife coexistence has increasingly been known for providing diverse ecological services to humans. However, the global repercussions of the Anthropocene epoch have changed the status and future of human-wildlife relationships. In this paper, we shed light on the significance of a positive attitude towards sharing space with animals in identifying and managing both conflict and ecological aspects of human-wildlife interactions in an agrarian landscape. We tried to understand how interactions between meso-carnivores like jungle cats (Felis chaus) and humans influence their survival in dense human populations. We evaluate the abundance and habitat use by jungle cats seasonally and diet, as well as their interactions with farmers in West Bengal, India. The mean encounter rate of jungle cats was assessed and used as a proxy for their abundance. Using a combination of direct sign surveys, we found that the habitat preference and seasonal distribution of jungle cats were influenced by the change in seasons with respect to different habitats. Our results indicate that jungle cats were more associated with human settlements during the monsoon. Scat analysis revealed the dominance of rodents in the diets of jungle cats. This activity helps to control the rodent population from destroying crops. However, our interactions with farmers showed their negative attitude towards the species due to the instances of livestock (poultry birds) depredation. We suggest that, more interdisciplinary researches are required to address how affectively socioeconomic structures shape up positive human-wildlife interaction. Planning and implementation of conservation education programmes are also necessary to help people for understanding the economic and ecological benefits provided by jungle cats and other wide-ranging carnivores

Growing Smart'? Urbanization Processes in the Pune Urban Agglomeration

The Indian city of Pune witnessed rapid growth and deep transformation processes in the last three decades. This paper assesses past developments and recent structures and processes against the concept of urban sustainability. Following an overview of the historical development, the dimensions of sustainability are discussed separately, based on empirical findings. Urban growth puts enormous pressure on Pune's land and water resources, changing the ecology of the area. The increasing water demand of Pune's growing population competes with growing energy and water demands. An assessment of future climate change impacts indicates that the storage capacity of the reservoirs is more frequently not met during the rainy season. In addition, extreme dry years can aggravate the effects of land use change on water resources in the future. The city's growth and especially the large in-migration has also changed Pune's social fabric significantly. Wealth is distributed unevenly in the city and social disparities can be observed along two fault lines, namely along classes and caste groups. The population development and the increasing socioeconomic polarization are linked to the economic development of the city. Pune's formal economy has a robust base. However, as in many cities of the Global South, the informal economy is the most relevant source of income for large parts of the population. Pune's development is challenged by informality, poor infrastructure and inadequate planning and governance. Recently new approaches towards urban renewal and smart city development were launched. These new approaches aim at overcoming blockades in the traditional planning. A special challenge for urban planning is the transformation of urban fringe areas of the city, as this process is currently taking place in an unsustainable manner. The paper concludes that urban development has to become holistic, integrative and participative and should abandon the stereotype vision of the world class city in favor of a sustainable, locally adjusted pathway of development