International Institute for Population Sciences, Mumbai
Population and Development
A study of 360 safai karamcharis employed with the Municipal orporation of Greater Mumbai suggests that policies aimed at uplifting conservancy work may actually be institutionalising caste-based occupations. This article describes the... more
A study of 360 safai karamcharis employed with the Municipal orporation of Greater Mumbai suggests that policies aimed at uplifting conservancy work may actually be institutionalising caste-based occupations. This article describes the situation that keeps generations of safai karamcharis in this occupation, and recommends practical
solutions to break the vicious cycle.
solutions to break the vicious cycle.
- by Dr. Hemangi Kadlak and +2
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This study aims to assess the exposure of those involved in street sweeping to the development of musculoskeletal disorders (MSDs) and related disabilities and tries to identify the individual risk factors thereof. A cross-sectional... more
This study aims to assess the exposure of those involved in street sweeping to the development of musculoskeletal disorders (MSDs) and related disabilities and tries to identify the individual risk factors thereof. A cross-sectional survey was conducted among street sweepers together with a comparison group. A modified Standardized Nordic Questionnaire was adopted to measure the prevalence of MSDs and related disabilities. The impact of the occupation of sweeping on the development of MSDs and related disabilities was assessed using the propensity score matching (PSM) method. A multivariate logistic regression model was employed to identify the individual risk factors. Street sweepers (n=180) and a comparison group (n=180), working for at least a year as formal employees of the Municipal Corporation of Greater Mumbai (MCGM), were randomly selected from 6 municipal wards. The prevalence of the MSDs was significantly higher among the sweepers for shoulders (32%), wrists/hands (29%), elbows (27%) and neck (17%) compared with the comparison group, in which the prevalence was 11%, 19%, 9% and 11%, respectively. The disabilities too were significantly higher among the street sweepers for the lower back (27%), upper back (27%), wrists/hands (26%), shoulders (24%) and elbows (23%) compared with the comparison group, for which the figures were 18%, 19%, 13%, 9% and 6% respectively. The PSM method highlighted that the occupation of sweeping raised the risk of developing MSDs and disabilities particularly for the shoulders (17-16%), wrists/hands (14% each), elbows (13% each) and the upper back (12-13%). After adjusting the age, body mass index and the caste of the street sweepers, the number of years of engagement in street sweeping and the location of work emerged as potential risk factors in the development of MSDs and, thereby, related disabilities. The study concluded that the occupation of street sweeping raises the risk of MSDs and related disabilities. This study recommends preventive and curative measures to deal with MSDs among street sweepers.
Objective: The study aims to assess the impact of municipal waste loading occupation upon developing musculoskeletal disorders (MSDs) and thereby disabilities among waste loaders. Additionally, the study has identified the potential risk... more
Objective: The study aims to assess the impact of municipal waste loading occupation upon developing musculoskeletal disorders (MSDs) and thereby disabilities among waste loaders. Additionally, the study has identified the potential risk factors raising MSDs and disabilities. Material and Methods: A cross-sectional case-control design survey was conducted in 6 out of 24 municipal wards of Mumbai during March-September 2015. The study population consisted of municipal waste loaders (N = 180) and a control group (N = 180). The Standardized Modified Nordic questionnaire was adopted to measures the MSDs and thereby disabilities in the past 12 months. A Propensity Score Matching (PSM) method was applied to assess the impact of waste loading occupation on developing MSDs and disabilities. Results: Waste loaders had a significantly higher risk of developing MSDs as well as disabilities than the control group particularly for low back, hip/ thigh upper back and shoulder. Propensity Score Matching results revealed that the MSDs were significantly higher among waste loaders for hip/thigh (22%), low back (19%), shoulder (18%), and upper back (15%) than matched control group. Likewise, MSDs-related disabilities were found to be significantly higher among waste loaders for low back (20%), hip/ thigh (18%) upper back (13%) and shoulder (8%) than the control group. Duration of work, substance use and mental health were found to be the potential psychosocial factors for developing the risk of MSDs and disabilities. Conclusions: The municipal waste loading occupation raised the risk of MSDs and related disabilities among waste loaders compared to the control group. The preventive and curative measures are strongly recommended to minimize the burden of MSDs and disabilities. Int J Occup Med Environ Health 2017;30
- by Pradeep S Salve (PhD) and +1
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Municipal solid waste loaders collect and load waste into waste carrying compactor from different areas of the Mumbai city. Waste loaders are vulnerable to develop communicable and non-communicable disease due to the nature of work. This... more
Municipal solid waste loaders collect and load waste into waste carrying compactor from different areas of the Mumbai city. Waste loaders are vulnerable to develop communicable and non-communicable disease due to the nature of work. This paper attempts to understand the occupation related morbidities and health seeking behavior of solid waste loaders. A primary survey was conducted with a total 160 municipal waste loaders in M/East ward of Municipal Corporation of Greatem Mumbai. The waste loaders are found to have high prevalence rate of low back pain, shoulder pain and hip/thigh pain in past 12 months. Almost 75 per cent of them reported eye related problems; two-thirds had breathlessness and 42 per cent workers reported injuries in past six months. The years of working, smoking, alcohol consumption and chewing tobacco significantly contribute for raising the prevalence of morbidities. Loaders with higher age, income and years of working spend more on their health treatment. At the outset waste loaders have higher prevalence of injury/accident, skin disease ,respiratory disease, eye disease and musculoskeletal disorders. The municipal corporation should take preventive measures and hold periodical health camps for minimizing the health risk among the waste loaders.
Study assesses the effects of solid-waste loading on workers, the resultant development of occupational morbidities, and economic burden of these morbidities. A cross-sectional survey was conducted with 360 municipal workers from six of... more
Study assesses the effects of solid-waste loading on workers, the resultant development of
occupational morbidities, and economic burden of these morbidities. A cross-sectional survey
was conducted with 360 municipal workers from six of 24 municipal wards in Mumbai. The
nearest neighborhood method of Propensity Score Matching (PSM) examined the impact of
waste-loading on the development of morbidities and to identify the risk factors – multiple
logistic regression analysis was performed. The prevalence of musculoskeletal disorders
(MSDs), injury, eye and skin infections found significantly higher for waste-loaders compared
to comparison group. The PSM method revealed that the occupation of waste-loading significantly
raised the risk of injury (34%), MSDs (23%), eye (19%), skin infection (15%) and disability
(15%), compared to comparison group. Significantly higher health expenditure is
observed among waste-loaders who have sought treatment in private health facility than
public. The study recommends to offer assistance the medical insurance for reducing the
financial burden on waste-loaders.
occupational morbidities, and economic burden of these morbidities. A cross-sectional survey
was conducted with 360 municipal workers from six of 24 municipal wards in Mumbai. The
nearest neighborhood method of Propensity Score Matching (PSM) examined the impact of
waste-loading on the development of morbidities and to identify the risk factors – multiple
logistic regression analysis was performed. The prevalence of musculoskeletal disorders
(MSDs), injury, eye and skin infections found significantly higher for waste-loaders compared
to comparison group. The PSM method revealed that the occupation of waste-loading significantly
raised the risk of injury (34%), MSDs (23%), eye (19%), skin infection (15%) and disability
(15%), compared to comparison group. Significantly higher health expenditure is
observed among waste-loaders who have sought treatment in private health facility than
public. The study recommends to offer assistance the medical insurance for reducing the
financial burden on waste-loaders.
The issues of women safai karamcharis are less discussed in academic sphere compared to male safai karamcharis and given minimum importance. These women face multiple problems at the family level, at the working places and in the society;... more
The issues of women safai karamcharis are less discussed in academic sphere compared to male safai karamcharis and given minimum importance. These women face multiple problems at the family level, at the working places and in the society; their problems are largely unheard. In the light of this limitation, the present study aimed to give visibility to their problems and their coping mechanisms. It is a collaborative work of three different surveys conducted with 115 safai karamcharis women in Nagpur (60), Kalyan (30) and Mumbai (25) cities applying qualitative and quantitative methods in Maharashtra. The results revealed that women aged 19 years to 46 years are engaged in safai kam and majority of them are widowed or currently married. Almost three-fourths of women resumed this occupation through preferential treatment (PT) case and those of direct recruitment are because of their Scheduled Caste background. Health problems and discrimination at the workplace are common and most of the time neglected. There is a need to establish a strong bridge between workers and academicians who form the policies and welfare programmes for safai karamcharis in order to realize their real conditions and needs. In social sciences, theories of knowledge production have to be utilized for the upliftment or betterment of the people irrespective of the caste and gender. Keywords Caste, women, gender, safai karamchari, manual scavenger, Mumbai Article Contemporary Voice of Dalit 1-9
- by Pradeep S Salve (PhD) and +1
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Background: Smoking, alcohol consumption and chewing of tobacco affect the health of people as well as the socioeconomic structure of families, communities and eventually the nation. This study assesses the prevalence of substance use... more
Background: Smoking, alcohol consumption and chewing of tobacco affect the health of people as well as the socioeconomic structure of families, communities and eventually the nation. This study assesses the prevalence of substance use among municipal solid waste workers of Mumbai. Methods: To conduct the study, information was collected from 540 municipal workers of Mumbai with regard to substance use as well as their socioeconomic and occupational characteristics. To draw inferential statistics, the data was processed through multivariate logistic regression (MLR) and ordered logistics regression (OLR). Results: Multivariate regression suggests that waste loaders and street sweepers are significantly more likely to smoke, consume alcohol and chew tobacco with reference to the comparison group. Workers with more working years and morbid health status are significantly more likely to get involved with substance use. The results of OLR reveal that municipal waste workers are significantly more likely to consume alcohol on a daily basis (β = 0.220, p < 0.001). Conclusion: Socioeconomic characteristics significantly contribute in increasing the risk of substance use among workers. Workers defend their habit of substance use by considering it as a mechanism for coping with the filthy nature of their occupation. Evidence-based preventive measures need to be developed in order to reduce substance use among municipal solid waste workers.
- by Pradeep S Salve (PhD) and +2
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Introduction: This study investigated the correlation between substance use and non-communicable diseases according to socioeconomic status in India. Methodology: We analyzed nationally representative data from the fourth round of... more
Introduction: This study investigated the correlation between substance use and non-communicable diseases according to socioeconomic status in India. Methodology: We analyzed nationally representative data from the fourth round of National Family and Health Survey (NFHS-4), which was conducted in 2015-16, and estimated the prevalence of tobacco and alcohol consumption among 112,122 men aged 15-54 years. A logistic regression analysis was performed to estimate the effect of substance use on non-communicable diseases. Results: It was found that 45% of men in the sample used tobacco in any form and 30% consumed alcohol. Men aged 50-54 years, divorced, separated or deserted, uneducated, belonging to the scheduled tribes and in the poorest wealth quintile consumed significantly higher quantities of substances. The results show that men who consume tobacco and alcohol significantly more likely to have diabetes or heart disease. Correlation of substance use and non-communicable diseases shows that men in the age group of 50 to 54 years, who are married, with higher educational attainments and belonging to the Christian religion are significantly more likely to have diabetes or heart disease. Conclusion: This study concludes that men of low socioeconomic status, who are substance users are at higher risk of developing non-communicable diseases. The study also highlights that men who consume tobacco and alcohol are significantly more likely to develop non-communicable diseases.
- by Pradeep S Salve (PhD) and +1
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The absence of a vaccine and effective treatment for COVID-19 has created public panic and burdened the health systems in most countries. Along with health workers’, sanitation personnel are also working at the frontlines in the war... more
The absence of a vaccine and effective treatment for COVID-19 has created public panic and burdened the health systems in most countries. Along with health workers’, sanitation personnel are also working at the frontlines in the war against the disease by keeping cities clean. Sanitation workers are engaged in Drudgery, Dangerous, Dirty and Dehumanising work that makes them vulnerable for developing the chronic respiratory diseases due to the exposure of various hazardous materials and toxic gases that are emitted from the solid waste. The sanitation workers working on a contractual basis are excluded from the labour policies and welfare programs who are playing a vital role in fighting the pandemic. Women sanitation workers are even more vulnerable because most of them are non-literate, poor in financial management and under-represented in the sanitation employee’s union. The local and state governments should protect and safeguard sanitation workers by providing them with adequate protective equipment, ensure payment of paying adequate salaries and provide them with health insurance.
Paper investigates the association between labour intensive work of solid waste collection and street sweeping with the development of skin disease, respiratory disease, eye infection, musculoskeletal disorders (MSDs) and MSDs-related... more
Paper investigates the association between labour intensive work of solid waste collection and street sweeping with the development of skin disease, respiratory disease, eye infection, musculoskeletal disorders (MSDs) and MSDs-related disabilities during the service. A primary survey was conducted with 540 municipal employees adopting multistage stratified systematic sampling in 6 out of 24 municipal wards in Mumbai. The data was collected between March and September 2015, and analysis was performed in STATA13. The prevalence of self-reported morbidities among municipal workers varies from 7 to 46% in the reference period of the past 6 and 12 months. Adjusted odds of major morbidities show that the waste collectors significantly more likely to have injury/accident (OR = 11.36; p < 0.01), skin disease (OR = 4.971; p < 0.01), eye infections (OR = 3.03; p < 0.01) and MSDs (OR = 2.04; p < 0.05) in reference to comparison group. Similarly, street sweepers significantly more likely to have injury/accident (OR = 4.08; p < 0.01), skin disease (OR = 4.50; p < 0.01), respiratory disease (OR = 2.63; p < 0.01), MSDs (OR = 2.17; p < 0.01) and disability (OR = 1.92; p < 0.05) in reference to comparison group. Propensity score matching method analysis suggests that the waste collecting and street sweeping occupation significantly increases the prevalence of morbidities among exposed workers than the matched non-exposed workers. The mean expenditure on treatment of morbidities show that street sweepers spends significantly (p < 0.05) higher amount of money for injury/accident, eye infections and MSDs followed by waste collectors compared with comparison group. Workers associated with the street sweeping and waste collecting occupation has higher burden of developing morbidities and health expenditure compared with other occupation.
Objectives: The study has twofold objectives: (1) to study the geographical differences in uptake and use of menstrual absorbents among girls aged 15-24 years in India; and (2) to identify the socio-demographic factors associated with... more
Objectives: The study has twofold objectives: (1) to study the geographical differences in uptake and use of menstrual absorbents among girls aged 15-24 years in India; and (2) to identify the socio-demographic factors associated with usage of different types of menstrual absorbents. Study design: The study uses information from a nationally representative sample of 247,833 girls of 15-24 years collected in the fourth round of the National Family Health Survey (2015-2016) based on a multi-stage clustered random sampling design. Methods: The study used two-step statistical analyses: (1) bivariate and GIS-based mapping tools were used to show geographical and socioeconomic variation in the use of menstrual absorbents; (2) Multinomial Logistic Regression (MLR) and Multiple Classification Analysis (MCA) models were used to identify the factors associated with usage of different type of menstrual absorbents among Indian girls. Results: The results point to a substantial statewide variation in the use of menstrual absorbents across India ranging from the highest in Mizoram (93.4%) to the lowest in Bihar (31%). District level variations are more striking. Adjusted percentages from the MLR model show that more girls in the southern Indian states, northeastern states, and union territories tend to exclusively use Sanitary Napkins and Tampons (hereafter SNTs) compared to the states in the northwest, central, and eastern regions of India. Besides, girls with a higher level of education (35.2%, p < 0.01), belonging to the richest wealth quintile (64.7%, p < 0.01), and those who have full exposure to mass media (43.9%, p < 0.01) use SNTs more than their counterparts. Conclusions: Given that education and economic status are significant hurdles, the policy has to focus on: first, disseminating knowledge on menstrual protection via dialogue and discussions at various levels, starting from school to communities to mass media campaigns. Second, the state has to take the responsibility to ensure universal access to menstrual absorbents regardless of geographic location and economic standing of the adolescent girls. Ensuring menstrual absorbents at public places (schools and workplaces) and tax cuts can make them accessible and affordable to all.
Background: Despite decent progress in Children Full Immunisation (CFI) in India during the last decade, surprisingly, Gujarat, an economically more developed state, had the second-lowest coverage of CFI (50%) in the country, lower than... more
Background: Despite decent progress in Children Full Immunisation (CFI) in India during the last decade, surprisingly, Gujarat, an economically more developed state, had the second-lowest coverage of CFI (50%) in the country, lower than economically less developed states such as Bihar (62%). Further, the proportion of children with no immunisation in Gujarat has risen from 5% in 2005 to 9% in 2016. This paper investigated factors associated with the low level of CFI coverage in Gujarat. Methods: The study used two types of datasets: (1) the information on immunisation from 7730 children aged 12-23 months and their mothers from the fourth round of the Gujarat chapter of National Family Health Survey (NFHS 2015-16). (2) A macro (district) level data on both supply and demand-side factors of CFI are compiled from multiple sources. Bivariate and multivariate linear and logistic regression techniques were employed to identify the factors associated with CFI coverage. Results: In Gujarat, during 2015-2016, 50% of children aged 12-23 months did not receive full immuni-sation. The odds of receiving CFI was higher among children whose mothers had a Maternal and Child Protection (MCP) card (OR: 1.97, 95% CI 1.48-2.60) and those who received ''high" maternal health services utilisation (OR: 1.59, 95% CI 1.10-2.26) compared to their counterparts. The odds of receiving CFI was about three times higher among the richest households (OR: 6.50, 95% CI 3.75-11.55) compared to their counterparts in the poorer households. Macro-level analyses suggest that poverty, maternal health care, and higher-order births are defining factors of CFI coverage in Gujarat. Conclusions: In order of importance, focusing on poverty, economic inequalities, pregnancy registration, and maternal health care services utilisation are likely to improve receiving CFI uptake in Gujarat. The disadvantageous position of urban areas and non-scheduled tribes in CFI coverage needs further investigation.
- by Ravi Durga Prasad and +2
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Introduction Government of Goa initiated ST Elevation Myocardial Infarction (STEMI) – Goa project for achieving the objectives of Ayushman Bharat and Sustainable Development Goals to reduce the premature mortality from non-communicable... more
Introduction
Government of Goa initiated ST Elevation Myocardial Infarction (STEMI) – Goa project for achieving the objectives of Ayushman Bharat and Sustainable Development Goals to reduce the premature mortality from non-communicable diseases by one-third with adopting advanced health practices and modern technology. The project handles the escalating STEMI cases in Goa since December 2018.
Methods
Mix-method was used for data collection in this study and service statistics was collected from the hub and spoke hospitals. Additionally, staff engaged in the implementation of STEMI model were interviewed. We have visited 13 public health facilities including Goa Medical College where the ‘Hub-and-Spoke’ model of STEMI has institutionalized. The data was collected during October 2019 by employing the pre-designed checklist.
Results
All patients who reached the hub-hospital undergone with angiography followed by angioplasty if required. Since the initiation of the project total of 546 patients is diagnosed with the STEMI and 85 percent of patients admitted with a STEMI were thrombolized, – subsequently, 64 percent of them undergone for angiography. Considering the mortality, around 6 percent of deaths have occurred during the past six months. Our study highlights the positive effect of the Hub and Spoke model on the treatment of patients with STEMI. The hub-and-spoke model is functioning effectively under the continuous monitoring of expert cardiologists. Additionally, the model has a review committee to investigate deceased cases, advanced cardia care ambulances and modern ECGs technology.
Conclusion
The model can be implemented at a larger scale in other parts of India with the required human resource and advanced technology.
Keywords
STEMIhub-and-spokethrombolysisangiographyangioplastyIndia
Government of Goa initiated ST Elevation Myocardial Infarction (STEMI) – Goa project for achieving the objectives of Ayushman Bharat and Sustainable Development Goals to reduce the premature mortality from non-communicable diseases by one-third with adopting advanced health practices and modern technology. The project handles the escalating STEMI cases in Goa since December 2018.
Methods
Mix-method was used for data collection in this study and service statistics was collected from the hub and spoke hospitals. Additionally, staff engaged in the implementation of STEMI model were interviewed. We have visited 13 public health facilities including Goa Medical College where the ‘Hub-and-Spoke’ model of STEMI has institutionalized. The data was collected during October 2019 by employing the pre-designed checklist.
Results
All patients who reached the hub-hospital undergone with angiography followed by angioplasty if required. Since the initiation of the project total of 546 patients is diagnosed with the STEMI and 85 percent of patients admitted with a STEMI were thrombolized, – subsequently, 64 percent of them undergone for angiography. Considering the mortality, around 6 percent of deaths have occurred during the past six months. Our study highlights the positive effect of the Hub and Spoke model on the treatment of patients with STEMI. The hub-and-spoke model is functioning effectively under the continuous monitoring of expert cardiologists. Additionally, the model has a review committee to investigate deceased cases, advanced cardia care ambulances and modern ECGs technology.
Conclusion
The model can be implemented at a larger scale in other parts of India with the required human resource and advanced technology.
Keywords
STEMIhub-and-spokethrombolysisangiographyangioplastyIndia
This study estimates poverty, wealth inequality and financial inclusion, for the first time, at the sub-caste level in both Hindus and Muslims using a unique survey data collected from 7124 households in Uttar Pradesh, India, during... more
This study estimates poverty, wealth inequality and financial inclusion, for the first time, at the sub-caste level in both Hindus and Muslims using a unique survey data collected from 7124 households in Uttar Pradesh, India, during 2014-2015. The results confirm the existing hypothesis that Brahmins, Thakurs and other Hindu general castes have higher wealth accumulation, lower poverty and lesser exclusion from formal financial services than Dalits. Exclusion from formal financial services forces Dalits to depend primarily on informal financial sources for borrowing-which leads to financial misfortune and further dragging them into a vicious cycle of poverty.
- by Pradeep S Salve (PhD) and +2
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Ajay Gandhi in his study titled "Porous Boundaries: Hindu-Muslim Demarcation and Crossings in Delhi My personal experiences" provides interesting accounts of the constituents of Hindu Muslim relationship in Delhi. He argues that though... more
Ajay Gandhi in his study titled "Porous Boundaries: Hindu-Muslim Demarcation and Crossings in Delhi My personal experiences" provides interesting accounts of the constituents of Hindu Muslim relationship in Delhi. He argues that though the community boundaries are strong between two communities, the everyday movements and interactions make these boundaries porous. Here i share my experiences in Old Delhi that shed lights on how the Kabab shops around Jama musjid provides a perfect venue for inter community relations
Objectives: The present study has examined the patterns and possible correlates of coexisting morbidities among women aged 15-49 years based on biomarker measurement data at the national level in India. Methods: National Family Health... more
Objectives: The present study has examined the patterns and possible correlates of coexisting morbidities among women aged 15-49 years based on biomarker measurement data at the national level in India. Methods: National Family Health Survey conducted during 2015-16 used in the present study. Simple disease count approach was used to calculate the multimorbidity among women. Multinomial logistic regression was applied to analyze the predictors of multimorbidity among women. Results: Almost 30% of the women had any of the selected morbidity and 9% of them had two or more morbidities. Hypertension and overweight combination (3%) was the most prevalent among women. The risk of having two or more morbidities was predominantly high among women aged above 30 years, low educated women, women from the wealthier group, ever-married women and women who were consuming tobacco as compared to their counterparts. Conclusions: From the policy perspective, the identification of groups of women vulnerable to multimorbidity will help in the selection of programmatic focus and preventive public health intervention in adult phase to reduce the multimorbidity burden among women in old ages.
The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied... more
The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India’s current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost.