Evaluation of Water Quality, Urinary Mercury & Arsenic Investigation and Survey of Diseases Associated with Drinking Water Sources

Background: Contamination of freshwater sources can be caused by both anthropogenic and natural processes. WHO reported that 1.1 billion people worldwide consume contaminated water, and the majority of diarrheal diseases (88%) are caused by it. According to Central Pollution Control Board (CPCB), Maharashtra along with two other states contribute 80% of hazardous waste, including heavy metal pollution in India. Certain dissolved heavy metals are easily absorbed by aquatic organisms and can enter the body through drinking water, skin absorption, and biological chains, posing a health risk. Hence, the main objectives of the study were, (1) surface and groundwater quality assessment, (2) to determine the association of diseases/symptoms with different sources of drinking water used, and (3) urinary Mercury (Hg) and Arsenic (As) levels investigation in the study population. Methods: The cross-sectional study was conducted in the industrialized city of Solapur, Maharashtra, India. The study area was limited to 25 km around the industrial hub. A total of 557 people were randomly selected for the survey, with consumers from all four types of water sources i.e., surface, handpump, wells, and municipal water. Spot urine samples were collected for estimating Hg and As levels after considering inclusion and exclusion criteria. People under treatment for tuberculosis, cancer, and chronic heart, lung, or kidney ailments were excluded. Also, pregnant and lactating women were not included. One surface water, one municipal water, and five handpump water samples were collected for evaluating water quality. Samples were analyzed for pH, Total Dissolved Solids (TDS), Dissolved Oxygen (DO), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Fluoride, Ammonia, Mercury, Arsenic, Cadmium, Lead, Nickel, Copper, Zinc, Chromium, and Manganese. Results: The water samples were observed to be neutral to slightly basic. TDS was between 410 to 1898 mg/L for groundwater whereas for surface water was 378 & 450 mg/L. F concentration ranged between 0.4 to 0.9 mg/L, Zn from 0.32 to 0.57 mg/L, and NH3 was found to be <0.1 mg/L. Out of 557 people, 43 (7.7%) used surface water, 194 (34.8%) used handpump, 64 (11.5%) used well, and 256 (46%) used municipal water. Among surface water users, 14 (32.5%) people reported frequent loose stools (p-value <0.05), and 11 (25.5%) people reported frequent abdominal pain. Handpump and well water users majorly reported frequent abdominal pain and gastric discomfort (p-value <0.05) respectively. 47 people were selected for estimating urinary Hg and As levels after considering exclusion and inclusion criteria. The mean value of urinary Hg & As are 4.91 ± 0.280 & 42.04 ± 2.635 µg/L respectively.  Conclusion: In our study frequent loose stools, abdominal pain, and gastric discomfort were associated with the various sources of drinking water. Urine Hg levels were above the permissible reference value set by NHANES (USA) Survey. Additionally, it is advised that frequent drinking water monitoring be implemented in the vicinity of the industrial hub since metal accumulation may be dangerous to consumers when it is present in excess, and if found higher, necessary action should be taken to reduce exposure

School absenteeism during menstruation among adolescent girls in resettlement colonies of Delhi: a community-based cross-sectional study

Background: School absenteeism during menstruation and its related effects are preventable through identification of factors associated with it and implementation of region specific appropriate public health measures. Objectives: To assess the prevalence of school absenteeism during menstruation and its associated factors among adolescent girls residing in the resettlement colonies of Delhi. Methods: A community-based cross-sectional study was conducted in the urban resettlement colonies of Delhi during 2019 in which 712 school going adolescent girls were interviewed. The details about school absenteeism, its perceived reasons, various socio-demographic details, menstrual hygiene practices were assessed using pretested semi structured questionnaire. The data were entered in MS Excel and analysed using STATA statistical software version 14. Results: The prevalence of school absenteeism during menstruation among adolescent girls of resettlement colony was 43.1%(95% CI:39.5 – 46.7). Out of 307 girls who had school absenteeism, 285(92.8%) had missed for 1-3days. The most common self-reported reasons for school absenteeism during menstruation were pain during menstruation (75.6%) followed by staining of cloths(43.6%) and uncomfortable feeling(39.4%). Studying in government school (PR=1.4, 95% CI:1.1-2.0), suffering from menstruation-related problems(aPR=1.9, 95% CI:1.5-2.4) and pads being provided from schools(PR=1.3, 95% CI:1.1-1.7) were significantly associated with school absenteeism. Conclusions: Almost half of the adolescent girls in resettlement colonies had school absenteeism. The characteristics like government school, pads being provided from school, menstruation related problems like weakness, irritation, perceived weight gain and breast pain was significantly associated with school absenteeism. The factors associated with school absenteeism needs to be addressed with appropriate public health interventions

Knowledge, Attitude and Practice of Adolescents in Delhi regarding Diabetes and Hypertension

Background: Adolescents have become quite vulnerable to various non-communicable diseases (NCDs) like diabetes mellitus and hypertension, especially due to the tremendous changes in their lifestyle over the last few decades. Recent statistics indicate rising prevalence of these lifestyle diseases in developed as well as developing nations along with an earlier onset, with younger populations being at increased risk. As health behavior may be influenced by the level of awareness about diabetes and hypertension, a cross sectional study was designed to assess the knowledge, attitude and practice of adolescents residing in Delhi regarding diabetes and hypertension.Methodology: One thousand and five adolescents residing in urban neighborhoods of central Delhi were recruited for the study from January to December 2013 using interviewer administered questionnaires designed to elicit socio-demographic information and knowledge, attitude and practice of these adolescents towards diabetes and hypertension. Data analysis was carried out using SPSS version 16.Results: Majority of subjects were not aware or gave wrong answer when asked what was diabetes (85.6%) and hypertension (84.6%). Almost half of the subjects agreed that diabetes and hypertension were serious illnesses (49.5% and 49.9%). 38.1% and 37.3% adolescents agreed that effective management is possible for diabetes and hypertension respectively. Regular exercise and balanced dietary pattern were followed by only 27.1% and 20.6% of subjects. Knowledge of diabetes and hypertension was significantly higher among adolescents with higher level of education. Conclusion: The results of this study suggest that adolescents in Delhi have poor knowledge of diabetes and hypertension, and only a minority of subjects practice healthy lifestyle habits like regular exercise and balanced diet. In addition, education appears to be a major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about diabetes and hypertension to all adolescents in India

Status of Implementation and Opinion of Stakeholders about Antismoking Legislation in Educational Institutions of Delhi

Background: Smoking is the most important cause of lung cancer and exposure to secondhand smoke (SHS) is as harmful as active smoking. The state of Delhi has been a front runner in the implementation of the Cigarettes and Other Tobacco Products Act (COTPA), 2003 to overcome this health hazard and started the “Smoke Free Delhi” initiative in 2009. Aims: The aim of this study is to assess compliance, awareness, and support for implementation of smoke-free initiative in educational institutions in Delhi. Materials and Methods: It was a cross-sectional study conducted in educational institutions of six districts of Delhi. Participants were selected by cluster sampling from the educational institutions in the selected districts. A total of 596 participants were interviewed. Data were collected using a pretested semi-structured questionnaire. Statistical Analysis Used: Data were analyzed using SPSS (version 17.0) and expressed in percentages. Differences between the proportions were observed by Chi-square test and P < 0.05 was considered as statistically significant. Results: Out of the total, 125 (21%) reported to be current smokers. A little more than three-fifth (64.8%) of the participants were aware about the COTPA, but the awareness about the organizations implementing the act was very low, being only 7 (5.6%) among smokers, and 23 (4.9%) among nonsmokers. Regarding the awareness of places designated as “Smoke Free Zones,” majority said educational institutions, followed by airport, shopping malls, and buses/trains. Most of the participants were also aware about other steps taken to prohibit smoking at public places, such as ban on sale of tobacco products to minors (80%), advertisements displaying ill effects of smoking (72.1%), and increase in the cost of tobacco products (64.6%). Conclusion: The level of awareness about antismoking legislation was high and majority support ban on smoking. However, the mechanism of implementation of the law was unclear to most

Anti-smoking legislation in educational institutions in India: opinion of stakeholders and challenges in implementation

Background and challenges to implementation Tobacco use usually begins in adolescence, and the risk of tobacco use is highest among those who start early and continue its use for a long period. Global Youth Tobacco Survey-2009, revealed that nearly 15% of youth in India use tobacco. In the wake of international efforts and growing consciousness about harmful effects of tobacco use, the Government of India enacted “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA), in May 2003 with a view to protect public health by prohibiting smoking in public places, banning advertisements of the tobacco products, banning sale of tobacco products to minors and near educational institutions, prescribing strong health warnings including pictorial depiction on tobacco products, and regulation of tar and nicotine contents of tobacco products. Intervention or response Delhi government started the "Smoke Free Delhi" initiative in 2009. The rising trend of tobacco smoking among students in the country makes it imperative to provide a smoke-free environment in the educational institutions. The current study was undertaken with the objective to assess the status of implementation of anti-smoking legislation and perception among stakeholders in educational institutions in Delhi. Results and lessons learnt Out of the total 596 participants,125 (21%) reported to be current smokers. 64.8% of the participants were aware about the COTPA, but the awareness about the organizations implementing the act was very low, being only 7 (5.6%) among smokers, and 23 (4.9%) among nonsmokers.Regarding the awareness of places designated as “Smoke Free Zones,” majority said educational institutions, followed by airport, shopping malls, and buses/trains. A majority of the smokers (85.6%) supported ban on smoking at public places. Conclusions and key recommendations The level of awareness about antismoking legislation was high and majority support ban on smoking. However, the mechanism of implementation of the law was unclear to most

Knowledge, attitude and practice about breast cancer and Breast self-examination among reproductive age group women in community

Background Breast cancer is the most common type of cancer in Indian women. Though breast cancer cannot be prevented, its rate of survival can be improved if found at an early, more treatable stage. Therefore, promoting breast self-awareness; breast self-examination can effectively reduce mortality due to breast cancer

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

Abstract Background Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. Methods This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. Results We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). Conclusions Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity