Urban Slum Of Kolkata Research Articles

Anaemia and its Determinants Among Pregnant Women: A Study in Urban Slums of Kolkata Metro City

Anemia among pregnant women remains a significant public health concern, particularly in urban slum areas where access to healthcare and proper nutrition is often limited. Iron deficiency anemia is a pervasive issue, particularly impacting pregnant women and adolescent girls, considered by the World Health Organization with hemoglobin levels below 11 g/dl. On a global scale, as of 2019, 37% of pregnant women and 30% of women aged 15 to 49 experience anemia. NFHS-5 data reveals that the prevalence of anemia among pregnant women in urban areas of India stands at 45.7%. This study explores the multifaceted factors influencing the prevalence of anemia among pregnant women residing in the urban slums of Kolkata, India. The study adopted a mixed-methods approach, combining quantitative surveys and qualitative interviews to comprehensively assess the determinants of anemia among pregnant women in the Urban slums of Kolkata. Quantitative data collection involves structured surveys administered to pregnant women, focusing on socio-demographic characteristics, dietary habits, access to healthcare services, and knowledge of anemia prevention and management. Qualitative interviews delve deeper into the experiences and perceptions of pregnant women regarding anemia, exploring cultural beliefs, social norms, and barriers to accessing healthcare services. Additionally, healthcare providers and community health workers contribute insights into the challenges faced in addressing anemia in urban slum settings. Preliminary findings suggest that several interconnected factors contribute to the high prevalence of anemia among pregnant women in urban slum areas of Kolkata. These include inadequate antenatal care, limited availability of iron-rich foods, poor sanitation and hygiene practices, cultural beliefs surrounding pregnancy and nutrition, and socio-economic constraints. The study underscores the importance of multi-sectoral interventions aimed at addressing the complex determinants of anemia among pregnant women in urban slums. Effective strategies may involve improving access to antenatal care services, promoting nutrition education and supplementation, enhancing sanitation infrastructure, and fostering community engagement to challenge harmful cultural norms. By elucidating the nuanced factors influencing anemia in this vulnerable population, this research seeks to inform targeted interventions and policies aimed at improving maternal and child health outcomes in urban slum areas of Kolkata and similar settings worldwide.

Nutritional status and morbidity pattern among school children in an urban slum of Kolkata, India

Background: Sickness and morbidity rates in Indian school going children are among the highest in the world. Poor health and sickness absenteeism results in school dropouts and it is more among the female children as compared to male children. Present study was conducted to study the nutritional status and morbidity pattern among children attending the school health clinics in an urban area of West Bengal India. Methods: A cross-sectional study was conducted in the field practice area of urban health centres (UHC) of AIIH and PH Kolkata, West Bengal. Children enrolled in class 1-10 were included in the study by using systematic random sampling technique. Data was collected by using semi-structured questionnaire, clinical history and physical examination was done. Results: Out of total 254 students, 129 (50.8%) were boys and 125 (49.2%) were girls. Dental caries and skin diseases like ringworm infection, cuts and fungal infection were most common types of morbidity found in school children. Dental caries and skin diseases both were more common in girls as compared to the boys. Underweight was found in more than 70% of the children and their BMI was significantly low as compare to the ICMR standard. Conclusions: The proportion of malnutrition is very high in the school children of the field practice area of UHC Chetla and there is need to create opportunities to increase the family income and awareness programme to increase the nutritive values of foods prepared at household level.

Age-Appropriate Feeding Practices and Nutritional Status of Slum-Dwelling Young Children in Kolkata during COVID-19 Pandemic

Introduction: COVID-19 pandemic was postulated to affect the infant and young child feeding (IYCF) practices and their nutritional status. This study was planned to assess IYCF practices and nutritional status of infant and young children residing in slum areas and their association with selected background characteristics. Materials and Methods: A community-based, cross-sectional study was conducted in slums of Kolkata Municipal Corporation among 161 mother–child dyads from October to December 2020. After obtaining informed consent, mothers were interviewed to collect information about their socioeconomic status, hardship faced during pandemic, and IYCF practices of their children using indicators proposed by the World Health Organization and Government of India. Weight and height were measured using the standard operating protocol. The proportion was used to express descriptive statistics. Binary logistic regression models were used for calculating the adjusted odds ratio (AOR) using PSPP (v 1.20). Results: Only 64 (39.8%) children received age-appropriate feeding; 73 (45.3%) had single/multiple anthropometric failure(s). Reduction of family income was reported by 142 (88.2%) respondents. Children aged 6–8 months (AOR = 17.08, 6.43–45.42) were more likely to not have appropriate feeding. Association of female gender (AOR = 2.00, 1.01–4.00), maternal education less than middle class (AOR = 2.58, 1.22–5.46), and lack of appropriate feeding (AOR = 2.57, 1.08–6.12) were statistically significant with the presence of anthropometric failure. Conclusions: The study revealed a dismal scenario of child feeding and nutritional status of young children in the urban slums of Kolkata. Pandemic and imposed restrictions hit the families hard by reducing income and increasing food-related costs.

‘Bhavishya Shakti: Empowering the Future’: establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India

BackgroundMalnutrition is a global emergency, creating an overlapping burden on individual, public and economic health. The double burden of malnutrition affects approximately 2.3 billion adults worldwide. Following 3 years of...

Prevalence of undernutrition and effectiveness of a community-based nutritional support programme to reverse stunting among children under five years of age in an urban slum in Kolkata, India: findings of a one-year longitudinal study

Background Stunting, defined as z-score height-for-age (HAZ) < -2, is an important contributor to the burden of childhood undernutrition among slum-dwelling residents in India’s metropolitan areas. Calcutta Rescue (CR) is a non-governmental organisation that provides medical care and nutritional support to slum-dwellers in Kolkata, India. CR undertook a study in Liluah Bhagar, an urban slum, to 1) establish the prevalence of undernutrition among children under five years of age, 2) evaluate the impact of a pilot nutritional support programme on growth patterns of a consecutively selected group of stunted children, and 3) identify socio-economic predictors of stunting. Methods For the prevalence assessment (April-June 2018), we conducted anthropometric measurements using standardised World Health Organization (WHO) growth measurements for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WFH). For the longitudinal study, we recruited stunted children and collected anthropomorphic data every three months for one year (December 2018-December 2019). Results The prevalence assessment of 116 children revealed 59% of stunting, 44% underweight and 12% of wasting. Follow-up of 42 stunted children in a pilot nutritional programme improved stunting over time (b =0.07, 95% CI 0.05 to 0.039, P<0.001), with a trend towards clinical improvement at one year. Linear mixed model analysis revealed household income was a negative predictor of stunting (b =-0.38, 95% CI -0.66 to -0.09, P=0.010). Conclusions This study highlights the burden of undernutrition in marginalised slum-dwelling children in India and the benefits of a pragmatic, education-focused nutritional intervention programme. Further studies are required to determine what predictors other than income are associated with stunting to then determine what interventions are likely to effect long-lasting and sustainable changes to growth in this vulnerable population.

Assessment of Perception of Family Planning among Mothers in an Urban Slum Area in Kolkata, India

Introduction: Women in India are not fully educated on contraception usage. In 2017, a central family planning initiative called Mission Pariwar Vikas was launched by the Ministry of Health and Family Welfare (MoHFW). Aim: This study was conducted among mothers in an urban slum in Kolkata to establish their unmet family planning needs, as well as different factors associated with it. Materials and Methods: A cross-sectional community-based study was conducted from February 2019 to May 2019 among mothers residing at an urban field practice area (Dhapa UHTC, Kolkata). All mothers of under-five children present in the slum were included in the study (n=246). Pre-designed, pre-tested, semi-structured schedule with both open and closed-ended questions were used. Results: The majority of the mothers were Muslim, of whom 37.8% were below 18 years of age. Among the mothers, 46.3% were adolescent mothers (<18 years). Around 78% mothers desired two children. Around 70.7% mothers were using some form of contraceptives at the time of the study. Out of 246 subjects, unmet family planning needs were found in 72 (29.3%) subjects. Significant association was found between unmet family planning needs and age, education level, socio-economic status, knowledge of the ideal age of marriage, and the number of children desired. Conclusion: The study revealed the unmet needs for contraception in an urban slum. However, the practice assessed by the study was actually reported practice and therefore, recall bias might be present. Further studies are recommended in other areas and different settings in order to extrapolate the study findings.

Unmet Need of Family Planning in Urban Slum of minority community in Kolkata: Is it any different?

Introduction: India may boast of introducing a national programme for fertility control earlier than most countries had conceived it. But in the same breath we are yet to concede the fact that the ultimate objectives of such dreams remained largely unfulfilled. Unmet need for contraceptioncontinues to haunt us as being an unresolved riddle. The experts have been concerned about it and the dire necessity to address the problem was vouched in various National Programmes. Methodology-This cross sectional study was conducted among the parous Muslim women residing in an urban slum of Kolkata with the objective of estimating the prevalence and finding out the reasons responsible for unmet need in the community. Results- The prevalence of unmet need was 20.0%. It varied significantly betweenage groups below (35%) and above (13.3%) 24 years, between BPL (31.4%) and APL (6.7%) and between Joint (25.5%) and nuclear (5.6%) families. The AOR for joint families was 4.522 (95% C.I. 0.482 - 42.438). There was a statistically insignificant difference in the problem between the groups of women who had less than or equal to two children (19.6%) and those who had more than that (21.1%). But the difference that women with adequate spacing had the problem in greater numbers (44.4%) compared to those who did not (10.5%), was statistically significant. The commonest principal reason cited by the respondents was fear of side effects of the methods (38.5%). Conclusion- More in-depth qualitative enquiries are required to find out the reason of such contraceptive behavior of the minority community living in slums.

The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India

BackgroundEmpirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India’s slums.MethodsThe study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through individual face-to-face in-depth interviews with a semi-structured questionnaire.ResultsThe data analysis shows six categories of reasons underlying women’s preferences for informal healers, which are presented in the form of the following themes: cultural competency of care, easy communication, gender-induced affordability, avoidance of social stigma and labelling, living with the burden of cultural expectations and geographical and cognitive distance of formal health care. In case of men ease of access, quality of treatment and expected outcome of therapies are the three themes that emerged as the reasons behind their preferences for formal care.ConclusionOur results suggest that both men and women utilise formal and informal care, but with different motives and expectations, leading to contrasting health-seeking outcomes. These gender-induced contrasts relate to a preference for socio-cultural (women) versus technological (men) therapies and long (women) versus fast (men) treatment, and are linked to their different societal and familial roles. The role of women in following and maintaining socio-cultural norms leads them to focus on care that involves long discussions mixed with socio-cultural traits that help avoid economic and social sanctions, while the role of men as bread earners requires them to look for care that ensures a fast and complete recovery so as to avoid financial pressures.

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India.

One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Incentives, information and malnutrition: Evidence from an experiment in India

This study provides one of the first pieces of evidence comparing the effectiveness of different performance pay contracts among caregivers to improve child health. We carry out a cluster randomized controlled trial in urban slums of Kolkata, India covering 209 childcare centers to test three separate performance pay treatments in addition to providing information on the demand-side. We promise low or high absolute performance incentives to public sector caregivers where each bonus is based on improvements in health of 3–6 year old children under their care. We also test for the impact of relative incentives where the bonus depends upon a worker’s performance relative to her peers. All mothers in the treatment arms are also provided nutritional information. High absolute incentives to workers combined with nutritional information to mothers works to reduce severe malnutrition by 5 percentage points over three months. Relative incentives and low absolute incentives show no significant improvements in child health on average.

Domestic Violence against Women – An Unsolved Issue: A Community Based Study in an Urban Slum of Kolkata, India

Domestic Violence against Women – An Unsolved Issue: A Community Based Study in an Urban Slum of Kolkata, India

A Study of Morbidity And Nutritional Profile Among Under Five Children in An Urban Slum, Kolkata

Child health is prime concern of any country. Under five age morbidity profile has a far reaching consequence on future development of country. Malnutrition is the one of the leading cause of morbidity and mortality in children of under five in developing countries The Objectives of the present study were to evaluate the morbidity profile of under-5children in urban slum in Kolkata and to identify the risk factors associated with it. It was a cross-sectional, population based, descriptive study conducted in urban slums of Rajabajar, Kolkata. Total 122 under 5 children of both sex were studied during the 3 month study period (Dec 2013- Feb 2014). Among the 122 under 5 children 54.1% was male sex. Prevalence of under-five morbidity was 52.45% among children aged 1 to 5 yrs of urban slum of Rajabazar, Kolkata. Acute respiratory infection was most common (51.56) followed by loose stool (15.62%).Prevalence of malnutrition was 23.77 %. Children were mostly from lower socio-economic class (class V)- 59%.Immunisation status was up to date among 84.4% children. Keywords: ICD 10 code, morbidity, nutritional status, slum, under-5children (3) Most of the childhood illnesses are caused by acute respiratory infections, diarrhea, measles, malaria, malnutrition or a combination of these conditions (4). Each year 27 million children born in India.10% of them do not survive up to 5 years. India contributes 25% of over 6.9 million under 5 death world wise every year. under- 5 mortality rate in 2012 was 56/1000 live birth. Infant mortality rate 41 per thousand live birth in 2012.Prevalence of morbidity is about 42% to 48%. (5) With this background we carried our study in an urban slum. The Objectives of our study were to evaluate the morbidity profile of under-5children in urban slum in Kolkata and to identify the risk factors associated with it.

Variation in blood pressure among adolescent schoolchildren in an urban slum of Kolkata, West Bengal

BackgroundHigh blood pressure in childhood is a potential risk factor for cardiovascular and cerebrovascular diseases. The roots of essential hypertension in adults may be initiated in childhood. This study was...

A preliminary investigation of the barriers to clean water access in the urban slums of Kolkata, India

Introduction: Safe drinking water is scarce in Kolkata. Inadequate knowledge and poor practices of storing and cleaning drinking water can cause severe effects on the health of the population. There is a need to understand the current trend of attitudes and practices of individuals living in urban slums to reduce water-borne diseases and mortality. This limited convenience sample study attempted to explore and identify areas for further study regarding the barriers of clean water access in urban slums of Kolkata, India. Methods: This pilot cross-sectional study was conducted in Kolkata, India during July 2014. Five urban slums were selected based on proximity and cooperation from the community. A sample of 50 women was taken, representing the five slums, with a sample of 10 women taken from each slum. Results: The majority (80%) of the participants said they regularly have enough water available to meet the needs of their household. Fifty-two percent of subjects received their water for drinking from a tap, hand pump, or time pump. Thirty percent had water pumped into their homes, and 18% purchased their water from a water truck. Fourteen percent said they did not treat their water because it was too time consuming, 40% said it was too much work, and 34% said it was not needed. Ninety percent said they felt it was important to clean their water, almost half (48%) thought their water was not clean, but only 42% used some method to clean their water. Many subjects (68%) stated they knew how to clean their water, but 66% were unaware that visible dirt is not an indicator of illness-causing bacteria in water. Conclusions: More focus should be directed towards improving awareness and knowledge and changing attitudes, motivation, and perceived susceptibility to disease from water within slum communities in Kolkata, India.

Gender Preference among Married Women in Kolkata Metropolitan Slum of India

Preference for Male baby reflects underlying socioeconomic and cultural patterns and prevailing inequity between genders in many societies in India. A cross-sectional population based study was conducted in the urban slum of Kolkata in eastern India on socio-demographic variables of gender preference among 122 married women using a predesigned, pretested, semi-structured data collection tool. Maximum participants were less than 35 years - 25-34 years (50%) and 15-24 years (45.08%); Female children were predominant; one-third (33.16%) were born between 25-34 age of mothers followed by 10.56 percent from 15-24 age. Among respondents, majority were Hindu (78.68%); from Joint family (54.10%); Unreserved caste (56.57%); Primary school literates (60.65%). Female children were more among Hindus (54.55%), in nuclear families (53.88%), among middle and secondary level of literate mothers (58.23%). Gender had no significant role in treatment seeking behavior though male children had significantly more completion of immunization. In the continuation of education male children received significant advantages. Majority (58.20%) responded with two as the ideal family size; yet all the participants with single living daughter desired another child, preferably a son though 10 percent desired a daughter. Among the participants having one living son and no daughter, looked-for another child (16%), another son (36%) and rest (48%) a daughter. The study identified male gender baby preference among married women related with socio-demographic variables.

Evaluation of Physical Growth Status of Boys from Low Income Families of Slums of Kolkata

In the context of scanty nutritional data on urban slum children, the present study is conducted to assess the nutritional standard of 9 – 12 years boys from urban slums of Kolkata. Mean height var...

Campylobacter jejuniin Hospitalized Patients with Diarrhea, Kolkata, India

To the Editor: Campylobacter spp. infection is the leading cause of bacterial enteritis worldwide. The epidemiology of Campylobacter infection in developing countries differs substantially from that in industrialized countries. In many studies from the United States and other industrialized countries, Campylobacter spp. are among the most common bacterial causes of diarrhea (1), with an incidence of ≈10% in persons with diarrhea. Reports from developing countries also suggest that C. jejuni and C. coli have been isolated mostly from patients with diarrheal illness (2). We investigated for the prevalence of Campylobacter infection in patients hospitalized with diarrhea at the Infectious Disease Hospital in Kolkata, India, and their resistance patterns to different antimicrobial drugs. During January 2008–December 2010, we screened 3,186 fecal samples on brain–heart infusion agar with 5% defibrinated sheep blood and antimicrobial drugs (bacitracin, cycloheximide, colistin sulfate, cephazoline sodium, novobiocin) and incubated under microaerophillic environment (5% O2, 10% CO2, and 85% N2) at 37°C for 48 h. Each isolate was tested by Gram staining, cytochrome oxidase, and hippurate hydrolysis for presumptive identification and species-specific PCR (3) to identify 5 species from Campylobacter genus. The overall isolation rate of Campylobacter spp. was ≈7% (222/3,186). Sole infection with Campylobacter spp. accounted for only 40% of cases; others were mixed infection. C. jejuni was the predominant species (78%), with C. coli, C. fetus, C. lari, and C. upsaliensis isolated less frequently. Campylobacter infection prevailed throughout the year, with no seasonality. The C. jejuni isolation rate was significantly higher (10.0%; p<0.001) for children <5 years of age who had diarrhea than for persons in other age groups (3.7%). Although we used the culture method, which is the standard for screening fecal samples, some molecular methods, such as PCR and real-time PCR, are now used for screening Campylobacter spp. from fecal samples on the Indian subcontinent (4,5). The results from molecular methods are showing more infection with Campylobacter spp. and high mixed infection cases and suggest the usefulness of molecular methods in combination with cultures. Macrolides and fluoroquinolones generally are the first- and second-line choices, respectively, of antimicrobial drugs for treating Campylobacter enteritis. Since the late 1980s, resistance to these drugs has complicated treatment. In India, resistance of Campylobacter spp. to several antimicrobial drugs has been reported since the early 1990s (6). Fluoroquinolone resistance was not reported in 1994 but reached 79% during 2001–2006 (2). Likewise, ciprofloxacin resistance in Campylobacter spp. increased markedly in Dhaka, Bangladesh, during 2005–2008 (7) and in Karachi, Pakistan, during 1992–2002 (8). We tested 142 C. jejuni isolates for antimicrobial susceptibility by disk diffusion method on Muller-Hinton agar with 5% sheep blood and incubated them at 37°C in microaerophillic environment for 48 h before obtaining results. All tested strains were resistant to trimethoprim–sulfamethoxazole, and most (97%) were resistant to quinolone (nalidixic acid) and fluoroquinolones (norfloxacin, ciprofloxacin, and ofloxacin) (Figure). Approximately 26.1% and 17.6% of the isolates were resistant to ampicillin and tetracycline, respectively. Susceptibility to erythromycin, azithromycin, gentamicin, furazolidone, and chloramphenicol was very high (>97%) in most isolates. Multidrug resistance was frequent among many of the isolates: ampicillin, nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and trimethoprim–sulfamethoxazole (19%); tetracycline, nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and trimethoprim–sulfamethoxazole (10.2%); and tetracycline, ampicillin, nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and trimethoprim–sulfamethoxazole (6.8%). These results indicate that macrolides may be useful for treating campylobacteriosis in this region. Figure Antimicrobial drug susceptibility profile of 142 Campylobacter jejuni isolates, Kolkata, India, 2008–2010. Black bars, resistant; gray bars, intermediate resistance; white bars, susceptible. AMP, ampicillin; NAL, nalidixic acid; NOR, norfloxacin; ... The resistance patterns are influenced by various factors, possibly including pressure exerted by use of antimicrobial drugs. Various reports have stated that introduction of fluoroquinolones for use in veterinary practice has been associated with a dramatic rise in Campylobacter strains showing resistance to these drugs (9). Increasing antimicrobial drug resistance limits the number of therapeutic options, which makes empirical treatment more difficult. Therefore, constant monitoring of Campylobacter susceptibility to antimicrobial agents is essential. We could not detect any allele of plasmid-mediated quinolone resistance genes (qnr) among C. jejuni isolates and the different class of mobile genetic elements that generally carry the antimicrobial resistance gene cassettes. However, we found that most of the C. jejuni isolates had a mutation in the quinolone-resistance determining region of gyrA (Thr-86 to Ile), which led the isolates to become resistant for quinolone and fluoroquinolones. Recent microbiome analysis of the gut of a malnourished child residing in an urban slum in Kolkata showed 35 times more Campylobacter bacteria than in healthy child in the same setting (10). This finding suggests that intestinal inflammation may directly influence malabsorption of nutrients. Hence, it is essential to examine the effect of Campylobacter infection in the developing world in the context of many recent developments in the human gut microbiome.

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India.

Diarrhoeal management practices are unsatisfactory in India especially in the slum areas. Dearth of information regarding physicians' diarrhoea-related knowledge and practice in India necessitated this cross-sectional study of allopathic practitioners in the slums of Kolkata, to assess the distribution and interrelationship between physicians' characteristics, knowledge and practice regarding diarrhoea. A total of 264 randomly selected consenting practitioners were interviewed using a field-tested questionnaire. Nineteen percent had good overall knowledge, 49% and 80% prescribed antibiotics to diarrhoea and cholera patients, respectively, and 55% advised stool examination for every case. Qualified and Government physicians had better knowledge regarding diarrhoea [MBBS: odds ratio (OR) 5·96, P < 0·001; postgraduates: OR 9·33, P < 0·001; Government physicians: OR 11·49, P < 0·0001] and were less likely to prescribe antibiotics for all diarrhoea cases (MBBS: OR 0·30, P = 0·002; postgraduates: OR 0·20, P < 0·001; Government physicians OR 0·24, P < 0·029). Better knowledge was associated with a lower likelihood of prescribing antibiotics for diarrhoea (OR 0·72, P < 0·001), cholera (OR 0·78, P = 0·027) and investigative procedure (OR 0·85, P = 0·028). In the slums of Kolkata, diarrhoea-related knowledge and practice were poor with the exception of qualified physicians, hence an improvement in the knowledge of pharmacists and unqualified practitioners is necessary for the overall improvement of diarrhoeal management in these slums.

Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India

Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

Vibrio cholerae/mimicus in fecal microbiota of healthy children in a cholera endemic urban slum setting in Kolkata, India

During a double-blind, randomized, placebo-controlled probiotic trial among 3758 children residing in an urban slum in Kolkata, India, Vibrio cholerae/mimicus was detected in fecal microbiota of healthy children. The importance of this finding in the local, regional and global transmission of cholera is discussed.