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Background: Men, more than 50 years of age, have a higher incidence of lower urinary tract symptoms (LUTS), and this increases with the advancing age. The prevalence of LUTS varies in different geographical areas across the world, and studies have reported that LUTS in men may significantly affect the quality of life (QoL) and influence their health-seeking behavior. Early detection of LUTS is essential as it is related to several complications. This study aimed to estimate the prevalence of LUTS and factors associated with LUTS and health-seeking behavior. Methods: We interviewed 201 men (>50 years) attending two urban primary care clinics in Bangalore using the IPSS questionnaire and calculated the prevalence of LUTS. Factors associated with LUTS and health seeking-behavior were tested using the Chi-square test. A P-value less than 0.05 was considered as significant. Results: The prevalence of LUTS was 85%. LUTS was significantly associated with those having diabetes and those consuming more than two cups of tea per day. The most common symptom was nocturia (85.4%) and a weak stream (35.0%). Moderate and severe LUTS were significantly associated with poor QoL score (P < 0.0001). Only 9.3% of the men sought medical help in spite of their symptoms, and the most common reason for seeking health care was the disturbance they had due to the urinary symptoms (81.3%). Conclusions: Family physicians should be aware that a significant proportion of the men in the age group of 50 years suffer from LUTS, and eliciting the same is essential during the process of consultation.

Introduction: Water, sanitation, and hygiene (WASH) play an important role in decreasing the morbidity and mortality associated with poor WASH practices. Poor knowledge and awareness lead to an increase in communicable diseases. Objective: To assess and report the core indicators on sanitation and drinking water from urban slums using standardized WHO and UNICEF questionnaires. Materials and Methodology: The present observational cross-sectional study was conducted for 2 months i.e., from September 2019 to October 2019 in urban slums of Trikuta Nagar, a field practice area of Department of Community Medicine, GMC Jammu. Information was gathered from the head of the household as well as from other household members. About 50% of the population were selected randomly by lottery method i.e., 450 and consist of 112 households. However, at the time of the study, only 100 households were assessed because of the nonavailability of household members and some houses were locked at the time of the interview. Results: The study revealed that nearly 62% of families were of a joint type and most of the families were headed by male members. Around 82.5% of the slum members used water for drinking from improved source but only 21.5% of the household members used adequate water treatment method i.e., boiling. Besides, about 49.5% of the household members used improved sanitation facilities. Conclusion: Local administration needs to accelerate the process of supplying piped water connections to the underserved to improve their drinking water sources and also increase access to basic sanitation services at the household level.

Background and Aims: Population explosion has been India's major problem since independence. It is a major obstacle to the overall progress of the nation. Adoption of family planning methods is one of the best solutions to tackle this problem. The roots of the factors influencing family planning issues are entrenched in the socio-cultural milieu of Indian society. Uttar Pradesh is the most populated state of the country having population of 199.581 million and TFR of 3.3 (AHS 2012-2013) with high fertile trajectory. Among the family planning methods currently, male sterilization accounts for only 0.3% of all sterilizations in Uttar Pradesh (AHS 2012-2013). A strategy to promote men's involvement in effective birth control is needed to reduce the population growth. The aim of this study is: i) To access the perception of married males towards family planning. ii) To access knowledge about NSV iii) enumerate the causes for low acceptance of NSV. Methods: A cross-sectional study was carried out. Multi-stage random sampling technique was used. In the first stage, two urban slums from each Nagar-Nigam zone was selected randomly. In the second stage, from each selected slum, a sample of 24 eligible households was selected at random to achieve the desired sample size. Results: Female sterilization technique was considered as the most effective family planning method by the male respondents. Socio-cultural barriers were the most important reason for the low acceptance of NSV. Educational status was found to be the most important predictor for these socio-cultural barriers. Conclusion: Measures should be taken to remove misconceptions, to increase uptake of NSV.

Background: Domestic violence was identified as a major contributor to the global burden of ill health in terms of female morbidity leading to psychological trauma and depression, injuries, sexually transmitted diseases, suicide, and murder. Aims: The study was conducted to find out the prevalence of different types of lifetime domestic violence against women, factors associated with it, and care-seeking behavior. Settings and Design: An observational cross-sectional study conducted at a slum of Burdwan district of West Bengal, India. Methods and Material: Study was done among 320 ever-married women of 15–49 years of age using a predesigned pretested proforma from March 2019 to December 2019 by face-to-face interview. Statistical Analysis Used: Data were compiled and analyzed by EpiInfo 6 and SPSS 20 version. Results and Conclusions: The overall prevalence of any form of violence during the lifetime among the study population was 35.63%. Verbal/psychological violence was the most common form of domestic violence (91.23%) followed by physical (82.46%) and sexual violence (64.91%). Slapping and/or beating, kicking, and object throwing were the major forms of physical violence; humiliation (88.46%) was the commonest form of psychological violence and most common form of sexual violence was forced sexual intercourse (51.35%). About 20% of the study population faced violence every day. Older age, lower age at marriage, longer duration of marriage, lower education of husband and wife, lower family income, unemployment of the husband, and alcohol consumption of husband were associated with the occurrence of domestic violence. We have found that the prevalence of domestic violence in this group of population is high. The alarming issue is that approximately one-third of women (32.46%) who faced violence in their lifetime had never sought any help. The findings indicate to develop appropriate and culturally relevant public health interventions to increase awareness.

Background and Aims: Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city. Methods: Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants. Statistical Analysis: Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries. Results: Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry. Conclusion: Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.

Background Malnutrition is still a great barrier to the growth and development of children, especially in India. Children from the underprivileged sections of the society like slum children are more vulnerable to both undernutrition and overnutrition. This study aimed to estimate the magnitude of malnutrition among school-going children in a slum area of Kolkata and to elicit the association of nutritional status with parental education. Methods A cross-sectional observational study was conducted from November 2017 to May 2018 among 508 school-going children of 6 years to 19 years of age in slums of Chetla, Kolkata. Out of three coeducation high schools catering to those children, two schools were randomly selected. 254 participants from each school were selected using systematic random sampling. Students, unwilling to participate and/or whose parents denied providing informed written consent were excluded. After the interview by a predesigned, pretested schedule, their anthropometric examination was conducted. Results Prevalence of stunting and severe stunting was present in 9.4% and 1.2% of subjects whereas the prevalence of thinness was 23.6% among them. The prevalence of overnutrition was 11%. Boys are more stunted (OR = 2.13, P = 0.013) and thin (OR = 1.73, P = 0.011) than girls. Poor parental education was significantly associated with both undernourishment (stunting and thinness) as well as overweight and obesity. Conclusion Substantial burden of double malnutrition was observed among school-going slum children. Parental education had an important role to prevent malnutrition of their children. Thus, periodic growth monitoring with the strengthening of the Mid-Day Meal program and awareness generation campaigns regarding malnutrition among parents of slum children are highly needed.

Background Universal Health Coverage refers to health care system that provides health care and financial protection to all the citizen. Rashtriya Swasthya Bima Yojna as National Health Insurance Scheme initiated in Chhattisgarh State in 2009 for below poverty line families. Second scheme is Mukhyamantri Swasthya Bima Yojna initiated in 2012, which covers non below poverty line families. Objectives To assess socio demographic factors among women residing in slum of Rajnandgaon, to find their universal health insurance coverage under RSBY/ MSBY and to assess the extent of concerned treatment under RSBY/MSBY. Methods It was a community based cross sectional study, conducted in the urban slum area of Rajnandgaon amongst 188 women above 18 years of age who were hospitalized 6 months prior to the study using snow ball technique as a sampling method. They were interviewed using semi structured questionnaires by the investigator with the help of anganwadi worker. Result 77.65% respondents/study subjects were enrolled under the universal health insurance (RSBY card/ MSBY card). Subjects belonging to Lower socio-economic status and having BPL card were enrolled under scheme more than upper socio-economic group. Out of 146 smart card holders, a mere 1.36% subjects incurred catastrophic OOPE. Out of 42 respondents not having smart card, 40.47% subjects incurred catastrophic OOPE. Conclusion The RSBY card reduced the inpatient OOPE. RSBY card prevented catastrophic OOP in most of the respondent. RSBY has made health services accessible to all sections of community at minimal cost.

Background: Adolescence has been recognized as a special period that requires specific attention as it marks the onset of menarche, an important milestone, and hence good hygienic practices during menstruation are crucial to maintain a healthy life. Aims and Objectives: This study was planned to assess knowledge, beliefs, and source of information regarding menstruation, and also to assess hygiene among them. Materials and Method: A cross-sectional study was carried out in urban slum area. Data were collected using pre-tested proforma during the period of 1st June to 31th August 2017. Among the 100 adolescent girls, 72% were between 15 and 19 years. A maximum of 47% were having high school education. About 47% mothers were illiterate; 27% girls had menarche at 14 years and 82% had regular cycles. About 76% had no knowledge of menses before menarche. The source of information was mother in 84%. Only 16% girls commented that bleeding initiated in uterus. About 60% girls used sanitary pad and the rest used cloth pieces. About 22% used water and no soap for hand washing. Multiple restrictions were practiced. Conclusion: This study reported that menstrual hygiene was unsatisfactory among adolescent girls. Therefore, girls should be educated about the facts of menstruation and proper hygienic practices.

Introduction: Hypertension is an important modifiable risk factor for cardiovascular disease. High salt intake is an etiological factor for hypertension. Any effective salt reduction strategy will be based on people's mind-set about salt use. Our objective for this study was to assess the knowledge, attitude, and practice for dietary salt intake by urban slum populations in Indira Colony, Chandigarh. Methodology: In 2015, we conducted a cross-sectional survey among a representative sample of 300 adults aged 18–69 years using a standardized questionnaire. Variations in the knowledge attitude and practice by gender and residence location were compared using the Chi-square tests. Results: Most of them (96%) took processed foods and 99% did not bother about the salt levels in the food. They also added salt on table. They did not buy low-sodium salts. Majority of them (75%) perceived that they are taking right amount of salt. They were clueless about the daily recommended allowance. Many participants (43%) did not know about the harmful effects of dietary salt. One-fifth (18%) of them had wrong information about dietary salt. Majority of the participants (64%) considered that lowering salt in diet is not important. Conclusion: Overall awareness level about optimal salt intake in diet was very poor among the slum residents. Recommendation: Development of effective public education initiative is the need of the hour for combatting hypertension.

Context: Anemia is a major contributor to morbidity and mortality among women of reproductive age. Progress toward reducing the burden of anemia has been little despite efforts through decades. Aims: We conducted this study to unearth the microlevel determinants of anemia among women of reproductive age. Settings and Design: This qualitative study was conducted in Urban Health Centre (UHC), Chetla. Subjects and Methods: A focus group discussion was held among all the eight health staffs, who were involved in reproductive and child health-related service delivery under UHC, Chetla. Analysis Used: A thematic analysis of the transcript was performed. Results: We found that socioeconomic factors like poverty and social neglect, diet and nutrition related factors, lack of personal hygiene, and worm infestation contributed to the burden of anemia, and this was reinforced by factors related to service delivery, such as lack of supply of drugs and supplements, and inadequate training of health workers as well as poor media accountability. Conclusions: Because of easy reversibility and implementation, health service delivery-related issues should be addressed closely through monitoring and evaluation and appropriate and timely action should be taken to improve the effectiveness of the services.

Context: Anaemia is defined as a decreased concentration of blood haemoglobin. It is one of the most common nutritional deficiency diseases observed globally affecting both developing and developed countries. Aims: To find out the prevalence of anaemia among the beneficiaries of Anaemia Mukt Bharat and its association with age and gender. Settings and Design: A cross-sectional study was conducted in Uttarakhand by AIIMS Rishikesh in a month-long campaign including 5,776 beneficiaries. Camps were organized at the hospital campus, schools, district hospitals, Community Health Centre (CHC), Primary Health Centre (PHC), subcentres (SC), Anganwadi Centres (AWCs), slum areas, adolescent health day celebration sites and Village Health and Nutrition Day (VHND) sites. Methods and Material: Data on age and gender along with haemoglobin level using HemoCue Haemoglobinometer was collected. Statistical Analysis Used: These data were entered into Microsoft Excel and analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value < 0.05 was considered as significant. Results: Out of 5,776 participants 53.2% were anaemic. Females (54.6%) were more anaemic than males (45.1%). 33.5% of pregnant females were found to be anaemic. Conclusions: Prevalence of anaemia was very high among the study participants. It shows that anaemia is a major public health problem so efforts should be taken to reduce the prevalence of anaemia and promote the health of an individual, community as well as the country.

Background and Aims: Mothers constitute an important and priority group in any community due to their high pregnancy related morbidities and mortality. The prevention of pregnancy related complications was possible with proper utilisation of maternal health care services. This study was conducted with the aim of assessing the utilisation of maternal health care services among mothers with younger child aged ≤3 years in slums of Kolkata, West Bengal and to find out the factors associated with it. Methodology: It was a community-based, observational study with cross-sectional design conducted in slums of Kolkata from June 2017 to May 2018. 30 slums [under Kolkata municipal corporation] were selected by cluster sampling technique using probability proportionate to size method. 10 mothers were selected from each slum and a total of 300 mothers were selected for the study. A pre-designed, pre-tested, structured schedule was used for data collection. Results: The mean age of the mothers was 23.83 (±3.64) years with the age ranging from 18 to 35 years. 75.7% mothers were registered in 1st trimester of pregnancy and 100% mothers received ≥4 antenatal check-ups. But only 78% mothers consumed ≥100 IFA tablets and only 23.3% mothers consumed ≥360 calcium tablets in antenatal period. 80.3% of the mothers had unsatisfactory utilisation of maternal health care services. Unsatisfactory utilisation of maternal care services was significantly associated with the younger age of the mothers, a smaller number of pregnancies and teenage marriage. Conclusion: Utilisation maternal health care services was not satisfactory among mothers in slums of Kolkata. Awareness generation and behaviour change communication among mothers is necessary for proper utilisation of the services.

Introduction: Cholera, though a preventable and treatable disease, is still regarded as an important public health problem in developing countries including India. Migration, unhygienic living conditions, overcrowding, open field defecation, and ignorance about the spread of disease are the major reasons for the occurrence of cholera in the slum areas. Cholera was detected in the stool sample of a 3-year-old child from a slum area of urban Wardha, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic. Materials and Methods: This was a cross-sectional epidemiological study, where we have used pretested, predesigned epidemiological case sheets obtained from IDSP. A case definition was proposed before beginning the investigation. Linelisting, collection of stool and water samples, immediate referral, and treatment of the patients suffering from loose stool and/or vomiting were performed. A detailed epidemiological report was made with recommendations and plan of action that was forwarded to the district health system. Results: In all, 28 suspected cases of cholera were line listed. Among the affected population, more than half of the suspected cases were from the age group of 0–10 years of age. Males were more affected when compared with females. The overall attack rate was 27% and case fatality rate was 0%. There was positive history of travel in the index case. Two of the water samples were found to be unsatisfactory for drinking. Conclusion: The investigation report was soon developed and shared with the district health authorities, and recommendations were given to prevent such outbreaks in future.

Background: The under-five children are a vulnerable age group; their mortality reflecting a country's overall development. Timely and appropriate healthcare seeking behavior, if practiced by caregivers, can have a significant impact on survival. The slum dwellers have poor health-seeking behavior due to their lower socioeconomic status, prevailing malnutrition, poor immunization status, overcrowding, poor sanitation, personal and cultural practices, beliefs, and attitude toward healthcare providers. Objectives: (1) To assess the health-seeking behavior among caregivers of under-five children during acute childhood illness (2) To find out the factors associated with their treatment-seeking behavior. Materials and Methods: A community-based cross-sectional study, among 260 caregivers, in the field practice area of Urban Health and Training Centre of a medical college was undertaken from September 1, 2016 to February 28, 2017, using a pretested semistructured questionnaire after obtaining a list of under-fives from the female health worker. Results: In total, 260 caregivers with mean of 26.61 ± 4.31 years participated in the study, 77.69% reported of some health morbidity. Around 21.92% of the caregivers gave primary care at home, 33.46% visited a chemist, and 33.08% attended health facility nearby. About 79.23% sought healthcare immediately following illness. Of the remaining 20.77% who did not seek medical advice, 75.93% used home remedies. Significant association was found between the age of the mother, educational status of the mother, religion, birth order of the child and socioeconomic status of the caregivers, and appropriate treatment seeking behavior during an episode of acute illness. Conclusion: This study attempted to identify health-seeking behavior of caregivers for children under-five and the determinants of appropriate treatment-seeking behavior. The knowledge of signs and symptoms of ill-health can reduce morbidity and mortality; however, continuous education of caregivers for recognition of symptoms and the need to seek appropriate medical care is needed. Government facility was the preferred choice for the population in the sampled slum. Treatment-seeking behavior was good among the respondents with majority having appropriate behavior. Measures can be taken to help promote awareness among those who did not have appropriate treatment seeking behavior.

Background: Elderly population in India is increasing fast which indicates a growing share of population with more special needs for health and support. Understanding the morbidities and health-seeking behavior of elderly is essential for strengthening geriatric health-care services delivery. Objectives: The objective of this study was to study the morbidity profile of elderly in urban slum areas and assess their health-seeking behavior. Methodology: A cross-sectional study was conducted in urban slums of Jorhat district of Assam, among 125 elderly selected by simple random sampling. Statistical Analysis Used: The statistical analysis was performed by Chi-square and proportions. Results: The most common morbidity found was arthritis (70.4%) followed by visual impairment (58%). Majority (83.7%) were seeking treatment for their health problems. Among those elderly who did not seek treatment, the most common reasons given were “lack of money” (81.2%) and “not feeling necessary to go to doctor as conditions were age related” (62.5%). Conclusions: More than two-third of slum-dwelling elderly in the present study were suffering from chronic morbidities; a few could not afford proper health care due to lack of money and self-medication practices were prevalent among some. This stresses the need to provide suitable health facilities and affordable health care to the elderly in slum areas to ensure their active aging. Living arrangement of the elderly was found to have significantly influenced their health-seeking behavior. Strategic implementation of policies focusing on the problems and beliefs of slum-dwelling elderly which prevent them from seeking healthcare is the need of the hour.

Background: Teachers are perhaps the closest observers of child′s academic performance and can be instrumental in detecting learning disorder (LD) early. Objectives: The present study aimed to assess the teachers′ perceptions about LD. Materials and Methods: This is a cross-sectional questionnaire-based study in the public schools located in the urban, rural and slum areas of Chandigarh. Teachers were recruited from 20 randomly selected schools out of a total of 103 schools in the Union Territory by proportionate sampling. The sample size required for α of 0.05 and power of 0.80 to detect a difference of 15% from base rate of 35% was 80. Eighty teachers of 3 rd and 4 th grades of these schools were recruited using purposive sampling. Teachers were briefed for 5 minutes about the symptoms of LD. They were asked questions using a structured questionnaire about their socio-demographic status, methods of teaching, and students′ progress and their perception about LD. Descriptive statistics was mainly used to represent nominal and ordinal data using frequency and percentages. Non-parametric statistical tests were used to assess relationship between the variables. Results: Eighty teachers were recruited, 87.5% were females, 57.5% had more than 5 years teaching experience; 56.3% of teachers thought that they were aware of LD, 67.5% of teachers perceived that they do encounter children with LD in the school, 43.8% endorsed educating such children in special schools, while 36.3% endorsed integration to regular schools. Interestingly, more than three fifth of teachers were willing to undergo special training for LD intervention. Conclusion: Teachers acknowledge that there is a need for further steps to be taken to help children with LD. They perceive opening special cells or sending such children to special schools for appropriate intervention which may not tally with the perception of clinician who may wish to provide LD intervention in hospital setting.

Coronary heart disease (CHD) is the top cause of mortality and morbidity in India. People in slums are generally at a higher risk for CHD than Indians living in more affluent areas mostly because of the higher prevalence of major CHD risk factors such as uncontrolled hypertension and tobacco use amongst them. Knowing their CHD risk perceptions and bringing them into line with the actual CHD risk is a prerequisite for effective CHD risk management. Consequently, there is need to develop tailored interventions focusing medication management and tobacco cessation to reduce growing CHD epidemic among slum dwellers and long-term CHD burden in India.

Context: The biggest challenge in implementing the primary health care principles is of equitable distribution of health care to all. The rural masses and urban slum dwellers are most vulnerable to lack of access to health care. Aim: To study access to health services among slum dwellers and rural population. Setting and Design: A cross-sectional survey in an urban slum and surrounding rural areas in field practice area of a medical college. Materials and Methods: Structured instrument along with qualitative techniques such as focus group discussions, were used to collect information on access and utilization of health services from 865 individuals of both sexes and all ages selected from urban slums, villages, and indoor and outdoor patients. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. Results: More than 50% of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases and malnutrition (especially in children), risk of lifestyle diseases as evidenced by high Body mass index in 25% of adults surveyed was found. Private medical practitioners were more accessible than government facilities. More than 60% sought treatment from private medical facilities for their own ailments (for sickness in children this proportion was 74%). People who visited government facilities were more dissatisfied with the services (30.88%) than those who visited private facilities (18.31%). This difference was significant (OR=1.99, 95% confidence interval 1.40 to 2.88; χ2 =15.95, df=1, P=0.007). The main barriers to health care identified were waiting time long, affordability, poor quality of care, distance, and attitude of health workers. Conclusion: The underprivileged in India continue to have poor access to basic determinants of good health as well as to curative services from government sources during illness.