Rural Indian Community Research Articles

Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators

BackgroundDespite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India.MethodsA total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque’s framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11.ResultsThe major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators.ConclusionsWe identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.

Impact of swachh bharat summer internship by medical students at a village in Trichy, Tamil Nadu

BACKGROUND: Inadequate sanitation and hygiene is one of the important public health issues in rural communities of India. Swachh Bharat Gramin was initiated by the Government of India to accelerate sanitation services in rural areas. Recently, Swachh Bharat Summer Internship (SBSI) program was introduced to involve students of higher educational institution to contribute 100 h of service for cleanliness activities and mass awareness creation in villages. The objective of this study was to assess the impact of SBSI activities by medical students at a selected village in Trichy district. MATERIALS AND METHODS: Under SBSI program, a community-based educational intervention study was done in a rural area of Trichy district from May to July 2018. The intervention was provided by a team of medical students to about 1600 individuals residing in the village. Among them, 100 individuals were included in pre- and posttest survey to assess the impact of intervention. The activities include Information, Education, and Communication, community mobilization, and participation to prevent open-air defecation (OAD), promote handwashing, and proper solid waste management. The Chi-square test was used to compare baseline and postintervention results. RESULTS: In baseline survey, 45% have ever heard about Swachh Bharat Mission (SBM), 58% were practicing OAD, and 55% were unaware about waste segregation at household level. Awareness on SBM, waste segregation at household, and practice of handwashing improved in postinterventional survey (P CONCLUSION: The internship program improved the knowledge and behavior on sanitation at the rural community, and it also provided a learning opportunity for medical students.

Development and Validation of a Tool to Assess Perceptions and Practices Regarding Hypertension and Associated Comorbidities among Primary Health Care Providers of a Rural Community in India.

Background:Primary health-care providers can play a crucial role in the prevention and early detection of non-communicable diseases. Knowledge, attitude, and practice (KAP) survey of primary health-care providers is needed to assess their gaps in knowledge, and identify barriers for effective implementation of the national program. However, such KAP instruments are lacking.Objective:The aim of this study is to develop, validate and assess the reliability of a questionnaire to determine the KAPs of primary health-care providers about hypertension and associated comorbiditiesMaterials and Methods:This study was conducted in the following steps: item construction and psychometric testing, by validity and reliability analysis.Results:The final KAP questionnaire comprised 25 knowledge items, 12 attitude items, and 8 practice items. Exploratory factor analysis using principal axis factoring with varimax rotation revealed four dimensions in the attitude section explaining 35.93% and two dimensions in practice sections explaining 65.96% of the total variance. Cronbach's alpha coefficient for attitude and practice session measured 0.65 and 0.85, respectively. A Kuder Richardson value of 0.70 was obtained for the knowledge section. ICC coefficients were 0.56 (P < 0.00) for knowledge, 0.77 (P < 0.00) for attitude and 0.88 (P < 0.00) for practice sections indicating moderate-to-good correlations. Overall, the instrument developed had acceptable validity and reliability.Conclusion:Overall, the instrument developed had acceptable validity and reliability to assess the perceptions and practices of primary healthcare providers about prevention and control of hypertension and associated comorbidities in the community.

Relationships Between Beliefs about Medication, Seizure Control and Adherence to Antiepileptic Drugs Among People with Epilepsy

Objectives: To determine the relation between beliefs about medication, seizure control and non adherence to antiepileptic drugs (AEDs) in people with epilepsy (PWE) from rural northern Indian community.

Predicting Mobile Health Technology Acceptance by the Indian Rural Community

To investigate factors that influence mobile health technology and application acceptance for health service delivery in India. The paper identifies a technology acceptance model that can be limited to the Indian rural populations. The data is collected from 60 semi-structured interviews with rural populations, including doctors. Contents of these phases were transcribed, and quotes are presented constituting a proposed technology acceptance model. Findings indicate that people in the rural community have mobile phones and are mainly used to communicate by phone calls their relatives, friends, and family members. The study also revealed that a lack of knowledge, mobile literacy, trust, social influence, individual cognitive factors, and technical infrastructure were found to influence mobile phone use for health activities. Triangulating the findings from the literature and interview, the study has identified a set of interrelated acceptance factors that the authors proposed as mobile health technology acceptance model for the rural community of India.

Do qualifications matter? A qualitative study of how villagers decide their health care providers in a developing economy.

IntroductionThe National Rural Health Mission (NRHM) was launched in India in 2005 to address the health needs of under-served populations in rural areas, and to support universal access to care. Despite this initiative, unaccredited informal providers (IPs) often remain patients’ first point of contact, which has led to inconsistencies in treatment, and has compromised the quality of care.AimTo explore the factors that influence patients’ decisions about healthcare providers in rural areas of central India.MethodsNine focus group discussions (FGDs) were held in nine villages in central India. Framework analysis using an inductive approach was used to analyse the data.ResultsThe crosscutting theme across the discussions was not choice but need—the need for affordable and accessible health care regardless of the provider’s qualification. Results highlighted that IPs play a pivotal role in villagers’ lives. Formal healthcare services were accessed infrequently, and mainly when a condition was judged severe or possibly even fatal. Even then, affordability was carefully weighed. Villagers’ distance from formal providers contributed to high cost and low preference of formal providers. When opting for IPs, familiarity and trust were more important to villagers than qualifications. IPs have operated in rural communities in India for a long time and have adapted their services to meet the needs, preferences, social norms, and economic conditions of villagers.ConclusionIPs have captured a niche and are often the first contact point in rural settings even when patients ultimately are diagnosed and treated by trained doctors. Merely tackling the undersupply of qualified doctors is not effective or sufficient to impact on the rural healthcare system: the strong and prevalent influence of IPs needs to be addressed also.

Chronotopeography

This paper explores the processes through which visceral experience is cultivated, packaged and commodi?ed in the Linguistic Landscape (LL) of South Delhi, India. We engage the theoretical concept of cultural chronotopes (Agha, 2007a) to demonstrate how spatially and temporally entwined experiences of nostalgia and modernity are produced in South Delhi’s commercial LL, and show how such positioning serves to compress or ?atten such experiences for ready consumption (Kockelman, 2006). Focusing on particularized chronotopes tied to a privileged and elite experience, imagination and aspiration, we highlight how discourses of the ‘ideal’ are reproduced and positioned as visceral through speci?c references or semiotic arrangements. In so doing, we discuss the quanti?cation of experience executed by these signs in commodifying the visceral, and the problematic way these instances propagate an idealized, sanitized and simpli?ed understanding of Indian rural communities, Indian history and Indian traditional practices.

Unintentional injury and role of different predictors among 1–5 years children: a community based cross sectional study in a rural population of a developing country

Injury has been increasing exponentially, especially in children, and it has become a public health concern. The present study was conducted with the objective of determining the prevalence and profile of unintentional injury among children of 1–5-year age group in a rural community of India and also to find out the predictors. Primary caregiver was interviewed by using a structured interview schedule. Parent supervisory behaviour was assessed using Parent Supervision Attributes Profile Questionnaire (PSAPQ), and child injury risk-taking behaviour was assessed by using injury behaviour checklist (IBC). Children encountered any unintentional injury event during last three-month period were 261 (62.7%). PSAPQ score was significantly higher in those parents where children had no episode of injury compared to others. Among four components of the PSAPQ, protectiveness (p = 0.049) and risk tolerance (p = 0.001) score had significant positive association with the incidence of unintentional injury. Binary multivariable logistic regression technique had found that age of the child, gender, primary care giver, birth order of the baby, the number of siblings, social class and IBC score has significant association with history of unintentional injury. There is utmost need for the development of effective programmes and training strategies to prevent unintentional injury among under-five children in future.

Agricultural shocks and drivers of livelihood precariousness across Indian rural communities

Spatial factors, such as environmental conditions, distance to natural resources and access to services can influence the impacts of climate change on rural household livelihood activities. But neither the determinants of precarious livelihoods nor their spatial context has been well understood. This paper investigates the drivers of livelihood precariousness using a place-based approach. We identify five community types in rural regions of the Mahanadi Delta, India; exurban, agro-industrial, rainfed agriculture, irrigated agriculture and resource periphery by clustering three types of community capitals (natural, social and physical). Based on this typology, we characterise the associations between precarious livelihood activities (unemployment or engagement in agricultural labour) with agricultural shocks and household capitals. Results demonstrate that, the type of community influences the impact of agricultural shocks on livelihoods as four of the five community types had increased likelihoods of precarious livelihoods being pursued when agricultural shocks increased. Our research demonstrates that the bundle of locally available community capitals influences households' coping strategies and livelihood opportunities. For example, higher levels of physical capital were associated with a lower likelihood of precarious livelihoods in agro-industrial communities but had no significant impact in the other four. Results also indicate that agricultural shocks drive livelihood precariousness (odds ratios between 1.03 and 1.07) for all but the best-connected communities, while access to household capitals tends to reduce it. Our results suggest that poverty alleviation programmes should include community typologies in their approach to provide place-specific interventions that would strengthen context-specific household capitals, thus reducing livelihood precariousness.

Prevalence and determinants of anxiety disorders among adolescents in a rural community from northern India.

There is scarce data available on community based prevalence of Anxiety Disorders (ADs) amongst adolescents in north Indian settings. To determine the prevalence of anxiety disorders, and associated factors amongst adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Participants (10-19 years) were enrolled through simple random sequence from a sampling frame of adolescents residing in 28 villages of Ballabgarh block using household survey technique. They were screened using Screen for Childhood Anxiety Related Emotional Disorders (SCARED) tool and then subjected to confirmatory diagnosis using Mini-International Neuropsychiatric Interview for Children/Adolescent (MINI KID). All adolescents with ADs were assessed for co-psychiatric morbidities using MINI-KID and functional impairment using Children Global Assessment Scale (CGAS). Prevalence and 95% Confidence intervals are reported. Additionally, socio-demographic factors were elicited using a semi-structured interview schedule and associations were determined using multivariable logistic regression analysis. A total of 678 adolescents participated in this study with mean age (SD) as 14.2 (2.5) years. The age adjusted prevalence of anxiety disorders was found to be 16.6% (95% CI: 16.0-17.2). The most prevalent anxiety disorder among participants was social anxiety disorders followed by specific phobias. Female sex and low socio-economic status were associated with anxiety disorders. Two third of adolescents with ADs had no functional impairment and almost one third were found to have one or more co-existing psychiatric co-morbidity. We found a high prevalence of ADs in rural north Indian community settings warranting adequate health system response at primary care level.

Collective influence of household and community capitals on agricultural employment as a measure of rural poverty in the Mahanadi Delta, India

The main determinants of agricultural employment are related to households’ access to private assets and the influence of inherited social–economic stratification and power relationships. However, despite the recommendations of rural studies which have shown the importance of multilevel approaches to rural poverty, very few studies have explored quantitatively the effects of common-pool resources and household livelihood capitals on agricultural employment. Understanding the influence of access to both common-pool resources and private assets on rural livelihoods can enrich our understanding of the drivers of rural poverty in agrarian societies, which is central to achieving sustainable development pathways. Based on a participatory assessment conducted in rural communities in India, this paper differentiates two levels of livelihood capitals (household capitals and community capitals) and quantifies them using national census data and remotely sensed satellite sensor data. We characterise the effects of these two levels of livelihood capitals on precarious agricultural employment by using multilevel logistic regression. Our study brings a new perspective on livelihood studies and rural economics by demonstrating that common-pool resources and private assets do not have the same effect on agricultural livelihoods. It identifies that a lack of access to human, financial and social capitals at the household level increases the levels of precarious agricultural employment, such as daily-wage agricultural labour. Households located in communities with greater access to collective natural capital are less likely to be agricultural labourers. The statistical models also show that proximity to rural centres and access to financial infrastructures increase the likelihood of being a landless agricultural labourer. These findings suggest that investment in rural infrastructure might increase livelihood vulnerability, if not accompanied by an improvement in the provisioning of complementary rural services, such as access to rural finance, and by the implementation of agricultural tenancy laws to protect smallholders’ productive assets.

Sexual Dysfunction among Men in Rural Tamil Nadu: Nature, Prevalence, Clinical Features, and Explanatory Models.

Background and Aim:There is a dearth of community data on nature, prevalence, clinical features, and explanatory models related to sexual dysfunction among men, particularly from rural India. This study attempted to examine different aspects of male sexual dysfunction and misconceptions in the community.Materials and Methods:Villages in Kaniyambadi Block, Vellore district were stratified, and four were randomly selected. Men living in these villages were recruited for the study. The following instruments were administered: (i) International Index of Erectile Function, (ii) Chinese Index of Premature Ejaculation (iii) Short Explanatory Model Interview, and (iv) Revised Clinical Interview Schedule. The data were analyzed using standard bivariate and multivariate statistics.Results:A total of 211 men were recruited. The majority were middle-aged (mean 40.73 years), literate (84.8%), married, and with children (72%), from nuclear families (99.6%), followed the Hindu religion (87.7%), reported satisfaction with their marriage (51.2%), had a single sexual partner (99.5%), and practised contraception (88.2%). A minority reported erectile dysfunction (29.9%), premature ejaculation (19.4%), and depression/anxiety (30.8%). Erectile dysfunction was associated with single marital status (P < 0.001), premature ejaculation (P < 0.001), worry about nocturnal emission and loss of semen (P < 0.02), and punishment by God as causal beliefs (P < 0.001). Premature ejaculation was associated with diabetes mellitus (P < 0.05), alcohol use (P < 0.05), anxiety and depression (P < 0.01), guilt about masturbation (P < 0.001), and belief that nocturnal emission is causal (P < 0.001) and erectile dysfunction (P < 0.05).Conclusion:Sexual misconception and dysfunction in men are significant problems in rural communities in India. They mandate the need for sex education in schools and the empowerment of physicians in primary and secondary care to manage such problems.

A multicentric cross-sectional study to characterize the scale and impact of polypharmacy in rural Indian communities, conducted as part of health workers training.

Context:Polypharmacy and inappropriate medication usage is one of the world's most important public health issues. Yet in rural India, where medications are readily available, little is known about polypharmacy.Aim:This study explores factors related to polypharmacy in rural India to inform the response.Settings and Design:A household survey was conducted by community health trainees, across 515 Indian villages collecting medication prescription and usage information for single illness in the past month.Methods and Material:Polypharmacy was defined as the concurrent usage of four or more medications for single illness. Data from 515 rural India villages were collected on medication usage for their last illness. Respondents who consulted one healthcare provider for this illness were included for analysis.Statistical Analysis Used:Bivariate logistic regression and multivariate generalized estimating equation analysis were used to explore associations with polypharmacy.Results:Prevalence of polypharmacy was 13% (n = 273) in the sample and ranges between 1% and 35% among Indian states. Polypharmacy was common among prescriptions for nonspecific symptoms (15%, N = 404). People aged over 61 years compared with people aged between 20 and 60 years (OR 1.11, 95% CI 1.03–1.19) and people with income of over 3,000 INR/month (OR 1.04, 95% CI 1.00–1.07) were more likely to be prescribed four or more medications.Conclusions:The study demonstrates high rates of polypharmacy, identifies vulnerable populations, and provides information to improve the response to polypharmacy in rural India.

Communication, observability and cooperation: A field experiment on collective water management in India

This study is an empirical investigation of the potential for communication and observability interventions to increase cooperation around communal water treatment systems amongst villagers in rural India. Despite the dependence of many rural communities in India on communal water sources and treatment plants for safe drinking water, they often fail to collectively manage these resources, resulting in abandoned water points and treatment systems with consequent health and mortality impacts. Results of public goods games framed in terms of the management of communal water treatment systems suggest that these communities can cooperate to provide the public good. However, public disclosure of behaviour had the very significant effect of decreasing contributions to the public good. Analysis indicates that early rounds of play were critical in this regard: the observed behaviours of other individuals at the start of play strongly determined subsequent cooperation levels. Thus, frequently-observed free-riding behaviour in early rounds of the game led other players to follow suit. Only when participants were actively encouraged to negotiate agreements, did cooperation increase significantly - albeit intermittently. Overall, findings suggest that interventions that provide opportunities for communication and negotiation may be most effective at enhancing cooperation around communal water treatment plants , while the impacts of interventions that make behaviour observable are strongly dependent on behaviour in the early stages of cooperative interaction.

Vitamin D status in Kancheepuram District, Tamil Nadu, India

BackgroundVitamin D has multifarious roles in maintenance of health and prevention of disease. The present study was undertaken to assess the vitamin D status of a rural adult south Indian population and to identify its associations with socioeconomic status and cultural practices.MethodsBetween June 2015 and July 2016, 424 healthy adults residing in Kattankulathur block in Tamil Nadu, India, provided venous blood samples and answered questions by personal interview. 25-hydroxy vitamin D was estimated by ELISA.ResultsFifty nine (13.9%) of the 424 participants had 25OHD levels below 12 ng/mL (vitamin D deficient) and 175 (41.3%) had 25OHD levels between 12 to 20 ng/mL (vitamin D insufficiency). In univariate analysis, demographic factors associated with vitamin D status included education, occupation, socioeconomic class, and birthplace; lifestyle factors included sun exposure time, skin surface exposed to sunlight, use of sunscreen, awareness of vitamin D, and consumption of fish; and hygiene related factors included source of drinking water, availability of tap water at home, and closed toilet at home. In ordinal logistic regression, the following variables were found to be independently associated with vitamin D sufficiency: Duration of daily sun exposure below 30 min (Odds ratio 0.31, 95% confidence intervals 0.14–0.71, P = 0.006), sun exposure 30–60 min (OR 0.49, 95% CI 0.30–0.80, P = 0.004), male gender (OR 2.00, 95% CI 1.30–3.09, P = 0.002), higher level of education (OR 0.80, 95% CI 0.69–0.94, P = 0.005), non-consumption of fatty fish (OR 0.48, 95% CI 0.24–0.85, P = 0.035) and presence of closed toilet system at home (OR 0.59, 95% CI 0.37–0.93).ConclusionVDD and VDI are highly prevalent in this rural Indian community. The study identifies socioeconomic and behavior patterns that negatively impact vitamin D sufficiency, thus providing a basis for targeted intervention.

Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India

BackgroundNon-optimal blood pressure (BP) levels are a major cause of disease burden globally. We describe current BP and treatment patterns in rural India and compare different approaches to BP lowering in this setting.MethodsAll individuals aged ≥40 years from 54 villages in a South Indian district were invited and 62,194 individuals (84%) participated in a cross-sectional study. Individual 10-year absolute cardiovascular disease (CVD) risk was estimated using WHO/ISH charts. Using known effects of treatment, proportions of events that would be averted under different paradigms of BP lowering therapy were estimated.ResultsAfter imputation of pre-treatment BP levels for participants on existing treatment, 76·9% (95% confidence interval, 75.7–78.0%), 5·3% (4.9–5.6%), and 17·8% (16.9–18.8%) of individuals had a 10-year CVD risk defined as low (< 20%), intermediate (20–29%), and high (≥30%, established CVD, or BP > 160/100 mmHg), respectively. Compared to the 19.6% (18.4–20.9%) of adults treated with current practice, a slightly higher or similar proportion would be treated using an intermediate (23·2% (22.0–24.3%)) or high (17·9% (16.9–18.8%) risk threshold for instituting BP lowering therapy and this would avert 87·2% (85.8–88.5%) and 62·7% (60.7–64.6%) more CVD events over ten years, respectively. These strategies were highly cost-effective relative to the current practice.ConclusionIn a rural Indian community, a substantial proportion of the population has elevated CVD risk. The more efficient and cost-effective clinical approach to BP lowering is to base treatment decisions on an estimate of an individual’s short-term absolute CVD risk rather than with BP based strategy.Clinical trial registrationClinical Trials Registry of India CTRI/2013/06/003753, 14 June 2013.

Public WiFi is for Men and Mobile Internet is for Women

Public WiFi networks are increasingly viewed as last-mile Internet solutions for rural areas given the infrastructure intensive nature of fibre optic broadband connectivity, but how inclusive are they? This study reports on interviews, observations, and practices around WiFi access points in public spaces in a rural community in India. It illustrates the ways in which Internet savvy women may continue to experience exclusions in Internet access and use. Bound by social norms that restrict their movements and tether them to spotty mobile data, women's Internet usage is limited in comparison to men, whose relatively unconstrained mobility permits them access and use of the free WiFi in the community. Additionally, interviews with a commercial WiFi provider reveals naive assumptions about women's Internet habits and gendered mobilities influencing access. The findings suggest that in certain contexts, women may remain invisible as potential customers despite their desire and ability to pay for WiFi access.

Factors Affecting the Growth of Dry Fish Industry in West Bengal : An Empirical Study

Dry fish industry is one of the most significant industries in rural India. India is exporting 200 tonnes of dry fish per year to various parts of the country as well as to Myanmar, Bangladesh, etc. Dry fish is not only consumed by humans, but it is also rampantly used in feeding poultry and broilers firms. This industry is not getting proper opportunity to sell its products not only in the Indian market, but also in the international market as the government has not focused on this market by providing financial and marketing support with licenses to this sector. Millions of poor fishermen who are engaged in the small scale dry fish industry are passing through a very tough situation for their livelihood. Unavailability of few species, absence of storage facilities, lack of rural road infrastructure, lack of facilities of preservation process, insect infestations, absence of product-standard testing facilities, etc. are the biggest issues for this sector. This study attempted to investigate multifarious factors which are affecting the growth of the dry fish industry in India. We also checked the relationship between the growth of the dry fish industry and the overall development of the rural community in India, particularly in West Bengal. The study confirmed the positive relationship between the growth of the dry fish industry and the overall development of the rural community. This study also suggested various recommendations to ensure the growth of the dry fish industry, which would also lead to the development of the rural community in India, particularly West Bengal.

Multidrug-Resistant Enterobacteriaceae Colonising the Gut of Adult Rural Population in South India

Background: Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics. Aim: Detection of multidrug resistance genes of extended spectrum β-lactamase (ESBL-CTX-M), AmpC β-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo β-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community. Methodology: Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blaCTX-M, blaCIT, blaKPC-1 and blaNDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively. Results: Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively. Conclusions: Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.

Development of a mobile groundwater desalination system for communities in rural India

The consumption of saline groundwater has contributed to a growing incidence of renal diseases, particularly in coastal communities of India. Although reverse osmosis (RO) is routinely used to remove salt from groundwater, conventional RO systems (i.e. centralized systems using spiral wound RO elements) have limited utility in these communities due to high capital and maintenances costs, and lack of infrastructure to distribute the water. Consequently, there is a need to develop an appropriate solution for groundwater treatment based on small-scale, mobile and community-led systems.In this work, we designed a mobile desalination system to provide a simple platform for water treatment and delivery of goods to rural communities. The system employs tubular RO membranes packed in a single, low-profile vessel which fits below the cargo space. The low-profile enables minimal intrusion on the space available for the transportation of goods. Pressure is delivered by a belt driven clutch pump, powered by the engine. Water is treated locally by connecting the intake to the village well while the vehicle idles.A combined numerical and experimental approach was used to optimise the module/system design, resulting in ∼20% permeate flux enhancement. Experimental results revealed that the system can produce 16 L per square meter of membrane area per hour (LMH) at a salinity level of 80 ppm from a ∼2000 ppm groundwater when it is feed at 1 m3/h at 8 bars. This indicates that a vehicle equipped with 12 m2 of tubular RO membranes can deliver 1 m3 of drinkable water by using ∼0.9 L of diesel. Assuming eight such systems could be implemented in a community to fulfil the water demands for a village with 2000 residents, a social business study revealed that a payback time of 2.5 years is achievable, even if the sale price of the water is relatively low, USD 0.18 (Rs 12, which is half of the lowest market price) per 20 L, including providing a goods transportation service at price of USD 5.25 (Rs 350) per 100 km.