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CHAPTER IV HEALTH

RELATED PROBLEMS AND

CAUSES

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CHAPTER IV

HEALTH RELATED PROBLEMS AND CAUSES 4. INTRODUCTION

Health is crucial issue for slum dwellers and they are facing various health

problems because of their economical, educational and environmental degraded situation.

It has been revealed dismal situation of slum dweller’s habitation and entire physical

structure of slums. In this chapter, scholar has mainly analyzed the types of diseases

spreading in the areas under study, even major health problems for these dwellers also

like 1) Government hospitals/dispensaries are far from their inhabitants, 2) women’s

pregnancy and delivery related issues and its causes, 3) Not getting nutritional food

during and after pregnancy, 4) Miscarriage and Maternal Death, 5) children’s health

problems and their high feasibility to become victim of communicable diseases etc.

Moreover, the study has also comprise the mode of treatment and place of treatment

generally using and preferring by slum dwellers. Scholar has also summarized the causes

behind the spreading of communicable diseases. Along with that, scholar has also

mentioned about some feasible steps to mitigate the health issues side by side. He has also

included some issues of women and child reproductive health and analyzes it in the study

field. Thus, in this chapter scholar has tried to depict the nature of health related problems

and its causes.

4.1 TYPES OF DISEASES:

To know about the types of diseases in selected slums, it has been asked to the

respondents about the prevalence of diseases in the members of selected household. There

are major changes of spread of the diseases in slum areas as mentioned earlier. There are

various types of diseases prevalent in slum areas such as malaria, jaundice, typhoid, small

pox and chicken pox, chronic common cold and cough, viral fever and infections,

diahorria and vomiting, skin diseases, stomach infections or food positioning etc. Some

diseases are Air borne, where as some diseases are water and food borne. Medical science

has usually distinct all diseases in three parts i.e. communicable diseases, non –

communicable diseases and contagious diseases, which is mentioned in the first chapter.

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As a matter of fact, slum areas are enlisted for easy transmission of communicable

diseases because socio, economic and cultural environment and physical structure of slum

areas are supportive cause for it. To analyze the types of diseases, scholar has put it in six

(06) category which are as under. Here scholar has distinct the types of disease and the

ratio of family members of selected households who are suffering from various diseases.

TABLE NO. 4.1 TYPES OF DISEASES

No. Types of Diseases Frequency Percent (%) 1 Water and Food Born Disease 82 27.33 2 Air – Borne Diseases 97 32.33 3 Vector Transmission Diseases 74 24.67 4 Sexual Transmission Diseases 01 00.33 5 Vertical Transmission Diseases 05 01.67 6 Non – Communicable and Other

Consequences, Anemia 71 23.67

Thus, here we see that most of the members of selected households are suffering

from Air Borne Diseases, whereas second highest numbers of family members are

suffering from vehicle transmission/water and food borne diseases. Even large number of

family members become victims of non – communicable diseases i.e. Heart diseases,

Stone, Blood Pressure, Arthritis etc. However, large numbers of cases have been reported

of cold, cough and viral fever. Subsequently high numbers of cases have been gradually

reported e.g. respiratory diseases, pheneumonia and Tuberculosis. Skin diseases are

actually considered as a contact transmission but in this study scholar has reported skin

diseases, scabies as vertical transmission because it is also infect by water and stale food

also. Even through symptoms of malnutrition, scholar got informed about Anemia.

“Prevalence of respiratory infections is found very high in Ahmedabad: As data shows in

the comparative study of Ahmedabad, Philippines and Cairo. (Sarali F, Bill. C and Ken

O: 2002)1. According to the Montgomery M. (2009)2, “ The health burdens associated

with indoor air pollution are likely to fall heavily on women, who spend much of their

time cooking and tending fires, and children who accompany them”. High considerable

numbers of cases have been reported on respiratory diseases in this study. During the

study of urban poverty, Jha S. S. (1986)3 has also reported that most of the respondents

suffered from cough, cold and fever, jaundice, stomach problems, Asthma, Typhoid and

T.B in Bombay metropolises”. But, but this is very old study, but the trends of prevalence

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of diseases are still same because the indicators behind spreading the diseases are same in

slum areas.

While data collected about the prevalence of diseases in past, 32.33% (97)

respondents has reported the air born diseases, 27.33% (82) respondents has reported

water and food borne diseases and 24.67% (74) reported vector transmitted diseases,

1.67% (05) respondents have reported vertically transmitted diseases and 19.33% (58)

respondents reported Non – Communicable diseases, other consequences and anemia in

their households. However, respondents gave multiple responses. The trends of the

prevalence of diseases during past and present seem almost similar. Because the large

number of slum dwellers was suffering from Air – born and water/food born diseases in

the past and today, the data depicts the clear picture similar to past data.

There are some root causes behind prevalence of communicable diseases. Lack of

awareness among waste disposal (Solid waste and Liquid waste) creates problems for the

health of slum dwellers. So, in this context, government should consider the waste

disposal mainly solid waste from slums. Human excreta are common cause for spreading

viruses and bacteria in slums. During the study, research scholar has observed that there

are no lavatories in many slum areas and the slum areas with common/public lavatories

are without flushing or disposable facilities. It has been scientifically proved that, on an

average a person generates 300 to 400 gram waste per day. One gram of human excreta

can contain 10,000,000 viruses, 1,000,000 Bacteria and 1,000 parasitic cysts and 100

parasitic eggs. (Basu B and Pandey D.K; 20)4. The people are unaware about the disposal

of human excreta as observed during the field work. We have seen earlier that many slum

areas are without lavatories facilities, connectivity of waste water/drainage facilities. By

this cause, they utilize the place for latrine, which would be very nearer to their residents.

Even scholar has seen that children use their street as their toilet.

It can be found that some (7) respondents from slum areas of Paldi ward, in west

zone reported that they go to beg every evening in posh areas. Therefore, to eat state food

is also a cause for vehicle transmission diseases. Moreover, place of occupation has also

impacts on the health of slum dwellers. Some respondents and their family members are

working in chemical factories and perfume (Aggarbatti) factories, which creates the large

opportunity for applying respiratory diseases. Even pollution at home, pollution on road

and pollution through factories/mills are the main cause of prevalence of respiratory

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diseases in slum areas. Thus, it can be considered as a reason behind the prevalence of

vehicle, vector and air borne transmission diseases in slum areas.

4.2 MODE OF TREATMENT:

In Indian culture, people are using different types of treatment to cure the

diseases. These treatment are homeopathic, Ayurvedic, Allopathic, other traditional

medicines and regional beliefs i.e. mantra and different kind of worship. In many

situations (places) even today people are not aware about certain types of illness and

diseases. This is because of illiteracy prevailing in most of Indian population, we have to

consider all these factors before analyzing data and scholar has done it. It has been

scientifically proved that, Allopathic is fast to cure, compared to other mode of treatment.

Therefore, it is more popular choice of slum dwellers and non – slums inhabitants. Even

Allopathic treatment is easily available. If we converse about homely remedy/traditional

medicine, large numbers of people in slums and also non slums use it during illness but it

is mostly useful during normal diseases and infections i.e. cold and cough, viral infection

etc. People are using turmeric during viral fever and common fever by cold because it is

antibiotic, during stomach pain they are using bishop and salt to cure it, using turmeric

during external wounds, and if swelling in external body part they used custard seed’s oil

to cure it etc. Thus, there are some traditional ways to cure the normal diseases and

wound of body. Homeopathy treatment is very effective during chronic diseases which

have proved by medical science. Similarly, Ayurvedic treatment is also suitable for

serious diseases but it gives slowly results. So for immidiate cure of illness, mostly people

beliefs in allopathic treatment because of immediate relief, easy availability and

economically suitable for that. Here scholar has summarized the zone – wise mode of

treatment which has taken by the respondents and their family members.

TABLEN NO 4.2 MODE OF TREATMENT

ZONE Traditional/ Home

Remedy

Ayurvedic Allopathic Homeopathy Total

North 38 04 57 02 101 South 29 05 52 01 87

Central 18 01 56 00 75 West 23 02 56 01 82 South 30 03 55 03 91 Total 138 15 276 07 436

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As table no 4.2 shows that 92% (276) respondents preferred Allopathic mode of

treatment. Whereas, 46% respondents using traditional medicine or homely remedy. Here

it is mentionable that scholar derived more than one answer from respondents. So, those

who prefer traditional or Ayurvedic mode of treatment, they may have preferred the other

mode of treatments. Only 8% respondents did not prefer Allopathic mode of treatment,

because they have faith in Ayurvedic and Homeopathic treatment. We can see in the table

that most of the respondents are prefer traditional/homely remedy and allopathic both.

Those who prefer Allopathic mode of treatment (276), out of them 39.49%

respondents are unknown about the meaning of allopathic and after getting explanation

they agreed upon their treatment of Allopathic use. Thus, the areas under study,

respondents are using Allopathic medicine. Moreover, most of the respondents are

unknown about the homeopathic and Ayurvedic treatment. Very few members of

respondents using Ayurvedic treatment, as they are unaware about it or couldn’t reached

up to it. Because many respondents were not known about Ayurvedic dispensaries, some

respondents have some suspect about curativeness of Ayurvedic medicines, Some

respondents reported that they have not trust on the Ayurvedic medicine, Some

respondents are thinking about the expenses of Ayurvedic treatment compare to the

Allopathic treatment. Whereas Allopathic treatment is easy accessible near to their

habitation and not coastly compare to other mode of treatment. In some cases of north

zone, many respondents are addressed Ayurvedic doctors as Vaidhya. Thus, here very

large numbers of respondents are having faith and preferig Allopathic mode of treatment.

4.3 PLACE OF MEDICAL TREATMENT

As we have seen earlier, slum Dwellers are generally prefer government medical

treatment, as they resides in low income settlements and their less capacity to take

treatment at private hospitals. They can’t expand more for health at private hospitals

because of several reasons. The main one is, they are facing financial crisis. Large

numbers of respondents live in economic and some of them are Below Poverty Line

(BPL). In this situation, they can not prefer the high expenditure for the health and they

mostly select public facilities for the health treatment. It is mentionable that 87.33%

respondents are found to be utilizing the Government Hospitals and dispensaries during

illness. Thus, we come to know that slum dwellers are prefer to use public medical

facilities. Whereas, some respondents are utilize only private dispensaries/hospitals,

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which is low cost or ran on philanthropic base by trust (organization). Few respondents

are going to take treatment from both the public and private hospital and dispensaries.

Here scholar has summarized zone wise situation of the above said data.

TABLE NO 4.3 PLACE OF MEDICAL TREATMENT

ZONE Governmetnt Private Trust / NGOs

Not Anywhere

TOTAL

North 57 22 00 00 79 South 57 18 00 00 75 Center 55 17 00 03 75 West 41 05 21 00 67 East 52 33 00 00 85 Total 262 95 21 03 381

As table no 4.3 shows that out of 60 respondents, 57 respondents in north zone are

going to take treatment at government hospital/dispensaries and UHC, whereas 3

respondents are using only private hospitals for medical treatment and 19 respondents are

going to both private and public general hospitals and dispensaries for medical treatment.

In south zone, 57 respondents also prefer to take treatment under government medical

premises and 3 respondents prefer only private hospitals and dispensaries. In this zone,

25% respondents prefer to take treatment under both public and private medical premises.

In central zone, 55 respondents are using government/ public medical facilities and 3

respondents are going to take treatment at private hospitals. Noteworthy, two (2)

respondents replied that we can’t expand more for health because of financial problems

and these both respondents are preferring traditional treatment /homely remedy during

illness and even one respondent answered that no one has faced the serious diseases from

our family. 15 replied that they are using government and private hospitals / dispensaries

both. In west zone, 68.33% (41) respondents replied that they are using government

hospitals and urban health center for medical treatment which is very less numbers

compare to other zone’s slums. 35% (21) respondents are using Trust’s medical

dispensaries / urban health centers and only 8.33% (5) respondents answered that they

prefer private hospitals for medical treatment in west zone. Here we can see that large

number of respondents are preferring to take treatment at trust’s hospital/community

health center because in Juna Wadaj of west zone, mainly two NGO’s i.e. Manav Sadhna

Trust and Jivan Tirth Sanstha are giving health related services and Manav Sadhna Trust

have its own Community Health Center also which comprise large network of

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Junawadaj’s slum areas. Thus, many slum dwellers are availing these health centers in

this ward. Moreover, in this zone, out of 60 respondents, 19 respondents and their family

members are not going to take treatment at Government Hospitals and Dispensaries. In

east zone, 86.67% (52) respondents and their family members are taking medical

treatment at Government hospitals/ dispensaries and Urban Health Centers. Whereas,

13.33% (8) respondents and their family members are taking treatment at only private

hospitals. It is mentionable that 25% respondents replied that they are using both the

public and private medical premises.

As per data and personal conversation, many people are not satisfied by the

treatment given in the government hospitals and urban health centers. Moreover, many

respondents are not satisfied by the doctor’s behavior as they don’t treat them well. Many

respondents have complained that there has been long queue in Government hospital/

UHC and doctors are not giving adequate time for treatment. Some respondents have also

complained that doctors do not come in time, as given hospital’s administration. They

complained that during the serious condition or major illness of their family members,

have to be in queue or sometime they or their family member have to be waiting to admit

in general ward in general hospitals. Some respondents have also complained about the

medicine given in government hospitals that it is not more effective or not immediate

relief during illness. Thus, many respondents are unsatisfied by Government’s medical

facilities still large numbers of respondents (87.33%) are taking medical treatment from

Government premises because it is cheaper than private hospitals and dispensaries.

Those, who are taking medical treatment from trusts or NGOs, treatment wise and

expanse wise they are more satisfied than other premises still during major illness or

operation / surgery time they prefer to go to public hospitals or private hospitals as

doctors recommend. It can be said that most of the slum dwellers are not prefer to go to

private hospitals/ dispensaries due to anxiousness of high expenditure.

4.4 LOCATION OF HOSPITALS AND DISPENSARIES.

In Ahmedabad city, There are 57 urban health centers, 21 dispensaries, Nursing

Homes and referral hospitals and 3 General hospitals i.e. V.S Hospital, L.G. Hospital and

Shardaben General Hospital are located (AMC: 2012)5. These all hospitals, dispensaries

and Urban Health Centers are administrated by Municipal Corporation. Urban Health

Centers are located in every selected ward. Even these UHCs are located near around the

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1 to 3 kilometer density of selected slums. So, 87% respondents are reported that they are

not facing any problems to reach at UHC/Govt. Dispensaries. Even, private dispensaries

are also located in such wards like Junawadaj, Asarwa, Girdharnagar, Kankariya, and

Maninagar, but most of the respondents prefer Urban Health Centers for medical

treatment. Whereas, 2% respondents of south zone have complain that during the need of

emergency treatment we are going to private hospital / dispensaries because Urban Health

Centers are little bit far than private hospitals / dispensaries. Somehow, 11% respondents

have complained that we have to hire a rickshaw and have to pay more than Rs. 10/- to

reach at Urban Health Centers, Government Hospitals / Dispensaries. Some respondents

complain that in emergency we have to go by walk during illness. Most of the

respondents who prefer government medical treatment, some of them have reported the

complains among the “distance of general hospitals”, such as, those who are living in

dariyapur ward (central zone), Junawadaj ward (west zone), Nikol / odhav ward (east

zone) etc are facing problems to reach general hospitals during the serious illness. It is

mentionable that General hospitals are far from these areas and to reach their, respondents

having to pay more. Whereas, it is awkward to go by bus during illness for them, so they

have to hire a rickshaw which charged more. On the other side, the respondents living in

Asarwa ward and Girdharnagar ward (North zone) and Paldi ward (west zone) have not

complain about distance because civil hospital (managed by government) is located in

north zone and nearby both selected wards, where as V.S. Hospital is also located in west

zone and nearby paldi ward. So, most of the respondents have not any problems to reach

at urban health centers but during major illness and when need to take emergency medical

treatment at General Hospitals, respondents have to face problems to reach their.

Noteworthy, Urban Health Centers are providing required medical treatment to slum

dwellers.

4.5 REASON BEHIND SPREADING DISEASES.

Slum dwellers are living in degraded condition as we have mentioned earlier.

Even physical structure of slum areas is also like dilapidated. Social atmosphere of the

slum areas are also backward means lacking awareness of many things which is required

for the development of personality of an individual. This environment is also not

motivational for dwellers to come forward socially. As we have seen that it makes the

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situation of slum areas and slum dwellers are even worst. Physical structure of slums is

highly impactful behind the spreading of different types of diseases (epidemic) in slums.

Respondents of this study gave multiple responses about the causes of spreading

diseases and illness. In central zone, the respondents of Ramlal no Khado Slum, answered

that corporation has provided facilities of toilets and made and make an arrangement to

clean it but sweepers or person doing same work are not coming to clean it. So people of

the area have to live in dirty unhealthy atmosphere. Due to insanitation in public toilets,

children are going to toilet in open places nearby slum or on the way of street, around the

dump, on the corner of the street. Whereas, dump is also not clean up daily by sweepers,

they came once in a week and dump is increasing day to day in front of the chawls.

Similarly, the respondents of sultan maholla also indicate that due to lack of dump

cleaning and littering, this situation produced mosquitoes and people are being ill. 7

respondents of sultan maholla slum have complained about over flow of drainage and

indicate it as a cause to spreading diseases. If we look upon the west zone, the

respondents of sanjay nagar na chhapra, Gora kumbhar vaas, and Parixit Nagar slum

areas of Juna wadaj ward, reveals the similar physical structure and environmental

circumstances. Respondents of these areas complain about littering and non sanitation in

their areas. They explicit that the people are throwing their solid and liquid waste on the

way of chawl, central drainage are overflowing, pile of waste are scattered everywhere in

the street, many dwellers throw the stale food in or outside of the street / chawl, and

public toilet are not clean up by sweepers, because of these situation slum dwellers are

being ill and facing the physical problems. Moreover, wide open drainage passed from

the middle of Junawadaj ward and dump is created the possibilities of epidemic.

Respondents of the selected slums of paldi ward also proclaim that “they could not get

safe drinking water; even existence of dumps scattered in slums also a major problem for

slum dwellers health. Thus, here we can see various causes for disease infections and

illness.

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(Dump in Lavatories and Hovels)

(Drainage waste in chawl)

The question must raise that, who are the responsible for the degraded situation

for slum, which become a cause of epidemic in these areas? Mainly slum dwellers are the

responsible for that because of their unawareness among health and hygiene, maintaining

personal and public lavatories, sanitation of their house and street etc. Even less education

in slums is also a cause behind the unawareness among health and sanitation. Sanitation

of street and their owned houses is their own responsibility. Afterwards, Authority has to

sensitize among the sanitation in slum areas. If slum dwellers will aware among the

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health and hygiene and authority will specially focus to sanitation in slums, dumps, public

lavatories, than the issues of epidemic will definitely mitigate in large extent.

(Worst Situation of Public Toilet)

Scholar observed many reasons and derive various answers from the respondents

of east zone of Ahmedabad city. Respondents of these wards almost gave similar answer

behind epidemic in their areas. In these ward, 93.33% respondents have indicated that due

to open canal and throwing the waste in canal and surrounding areas, mosquitoes and

vectors are raise through which slum dwellers are being ill. Noteworthy, all respondents

indicated that we have to drink water mixed by chemical and sullage. 3% respondents did

not reply about it and 3.67% are explained that due to insanitation people are facing

health related problems. 90% (27) respondents of Bhavaninagar no Tekro slum (odhav

ward) also indicates about the existence of open canal in their areas and also mention that

chemical factories are dispose the waste and chemicalized water in this canal. Even

respondents complain that “our areas are stinking by chemicals due to lots of chemical

factories established here. Whereas, 10% (3) slum respondents were unaware about the

causes of spreading epidemic.

Both the selected slums of North zone comprise similar type of physical structure

and environment. 22 (73.33%) respondents indicate about overflowing drainage and

16.67% (5) respondents have indicated the insanitation and littering in the areas, whereas

10% (3) respondents have indicated the insanitation in public toilet, dump and chawl.

Respondents gave multiple response and some of all respondents (141) have also

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indicated about non – safe drinking water. Moreover, in south zone, respondents gave

almost similar answer to both the selected slum areas i.e. Ramgiri na chhapra slum

(Maninagar ward) and Sankal Chand Mukhi ni chali (Kankaria ward). Out of all

respondents of both the areas, 13.33 % (8) respondents have not given any answer about

spreading diseases in slums which show that they are unaware about sanitation and

health. 78.33% (47) respondents replied that due to existence of dumb in front of chawl,

insanitation and littering in public toilet and street, people throwing the waste on the way

of street. Children are going for toilet and bathroom in the chawl or near by dump etc. are

the reasons behind spreading the diseases. 8.33% (5) respondents complained about non –

safe drinking water, waste water (by washing cloths and vessels), mud made by waste

water throwing by inhabitants in chawls etc are the reasons summarized by respondents.

As answers collected by scholar and as observed, most of the selected slum areas are

having similar circumstances and causes for spreading diseases as mention earlier, for

spreading the diseases and illness. Thus, scholar has traced various answers for spreading

diseases during field work.

4.6 WOMEN MARRIAGE AGE AND HEALTH

As we know that according to law, women’s marriage age is 18 years and men’s

marriage age is 21 years in India. Health factor is also pertain with the women’s marriage

and indicates the ability and disability of reproductivity. We have included those women

as respondents who are under reproductive age and who has one or more than one

children. Scholar has tried to know about women’s marriage age per households and

related health problems.

TABLE NO 4.4 WOMEN’S MARRIAGE AGE

AGE NORTH SOUTH CENTER EAST WEST TOTAL BEFORE

18 YEARS

32 (59.33%)

48 (80%)

24 (40%)

19 (31.67%)

17 (28.33%)

140 (46.67%)

AFTER 18 YEARS

28 (46.67%)

12 (20%)

36 (60%)

41 (68.33%)

43 (71.67%)

160 (53.33%)

TOTAL 60 60 60 60 60 300 (100%)

Here we can see that very few respondents and family members are having

marriage before 18 years in west zone. Highest numbers of respondents and women

members of their households from south zone were got marriage before 18 years. It is

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because of conservative beliefs for women. People are not giving importance to women

education. They think that finally she has to married and making breads. Many people

think that, why should we spend money for their education, it will never helped us in

future because after marriage she will care and manage her in-lows. Sometime, they also

think that the woman has to make bread so no need to study. In our society, most of the

families are giving importance to birth of boy child than girl child, as they think that girl

means big responsibility and expenses. This approach seems push factor to women

marriage before 18 years. In this study, scholar analyzed that large numbers of

respondents and woman of selected households are getting married before 18 years.

Whereas not even a single women out of 53.33% household are married before 18 years

which means good numbers of slum dwellers are aware about the women marriage age.

As a matter of fact, marriage before early adolescent period and physical immaturity of

reproductivity is very harmful for health of women. In this context, Scholar has tried to

make informed about women’s marriage age. But here we can see that large numbers of

women per households are having marriage before 18 years which is mentionable and we

will see its impact in next proclamation.

4.7 MATERNAL DEATH AND FORM OF DISEASES DURING

PREGNANCY:

The study noticed about the maternal death in slum areas. It is a precarious issue

in slums and mainly slums of developing countries. Direct and indirect causes can report

behind maternal death. According to WHO report, “Maternal death is the death of a

woman while pregnant or within 42 days of termination of pregnancy, irrespective of the

duration and site of the pregnancy, from any cause related to or aggravated by the

pregnancy or its management but not from accidental or incidental causes” Here scholar

has summarized Global report on maternal death and the place of India in it. As Maternal

Mortality Estimation Inter Agency Group (MMEIAG) has presented the Global report for

over 1990 to 2010, which indicated that, “Globally, an estimated 2, 87,000 maternal death

occurred in 2010. Sub – Saharan Africa (56%) and Southern Asia (29%) accounted for

85% of the global burden (2, 45, 500 maternal death) in 2010. At the country level, two

countries account for a third of global maternal death: India at 19% (56,000) and Nigeria

at 14% (40,000)”. (MMEIG Report: 2010)6. Every report of international and national

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agencies reveal the facts that maternal death rate is declining by the efforts of government

and non – government agencies.

Scholar found that, during last five years 30 women died during or termination of

pregnancy from the selected 300 households. However, the proportion of maternal death

found in slums, it does not have to be in non – slums. As explain earlier about the

proportion of maternal death, it is required to see the reasons and form of diseases during

pregnancy of women because it may expose various diseases usually found during

pregnancy, its causes and its proportion to the women resides in slums. Noteworthy, most

of the women resides in slums are not aware about health and hygiene, which bring them

to the major disease during reproductivity. Most of the slum dwellers are also unaware

about family planning such as gap between two children, contraception etc. Moreover,

living condition and degraded environment of slums compare to the non slums is also a

cause behind epidemic and transmitted diseases to pregnant women. These are all

circumstances leading slum women to the diseases (transmitted and non – transmitted)

during pregnancy.

According to the data, 88 women faced such diseases during pregnancy. Out of

these 88 women from total selected households, who faced the physical problems during

their pregnancy, 24 women were anemic, 25 women suffered from normal and viral fever,

where as 10 women were faced hysteria and epilepsy, 11 faced jaundice, 4 had blood

pressure and 6 women suffered from the reaction of medicine, 1 women faced attacks of

normal paralysis, 2 women become victims of respiratory diseases and 2 became victim

of womb infections, 3 women had pneumonia etc. thus, it has been found that in 300

households, 88 women become victim of normal to severe transmitted and non –

transmitted diseases during pregnancy. As we explained earlier due to the impact of

slums’ dismal atmosphere women have to face some diseases. Here it has been found that

many women from respondent’s households were anemic during pregnancy. It happened

sometimes that respondents did not know about the diseases from where they and other

women family members are suffered from but through conversation with them and

understanding the symptoms of diseases, it is found that women suffering from particular

diseases, such as deficiency of vitamin, calcium and hemoglobin reveals that it is

ANEMIA.

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We can analyze the three main reasons behind large number of women being

victim of different diseases, 1) unawareness about health and hygiene; even less

education is also mentionable reason, 2) lack of medial services, 3) Economic crisis.

These are the three main reasons behind unhealthiness during pregnancy. Noteworthy,

degraded condition of slums is also responsible for factor for above circumstances. Thus,

we can see the causes and proportion of women’s illness during pregnancy.

Collected by shows, 88 women from selected households become victims of

various diseases during pregnancy. Out of these 88 women, 30 women were died during

pregnancy. As per data, reasons for these deaths are, 8 women died due to jaundice, 7

women died by high fever and hysteria, 6 died by severe bleeding and hemorrhage, one

died by burning, and 7 women died during the pregnancy but the reasons are not cleared.

Through deep conversation scholar got informed about some reasons i.e. doctors did not

give proper treatment and doctor’s mistakes during the termination of pregnancy, some

women and their family members believed and prefer the sorcery and sorcerer than

doctors during illness of pregnant women and some died by the diseases (indirect causes),

but respondents are unaware about the form of diseases. Indirect causes for maternal

death included malaria, anemia and cardiovascular diseases. Thus, we see that the

numbers of women died during pregnancy and as exhibit earlier that the women are target

group, where there is high possibilities to transmit the diseases, particularly those who are

pregnant and residing in slums because of such reasons i.e. dismal condition of physical

structure of slums, high possibilities to spreading diseases, less accessibility of nutritional

food, lack of medical facilities / treatment with modern equipments and knowledge, less

awareness about health and hygiene during pregnancy etc. Many time scholars has

noticed that large amount of slum dwellers are believing in black and white magic,

sorcery and sorcerer, witch, evil eyes and other such non –realistic stuffs. Even in 21st

century, many slum dwellers preferring the women’s delivery at home by DAI (in next

chapter we have analyzed this issue).

Thus, these are the manifestation of causes behind maternal death in slum areas.

The WHO report also supports to the finding of this study in the context of maternal

death. According to the WHO report; 2005, “major causes of maternal death are; severe

bleeding/hemorrhage (25%), infections (13%), unsafe abortion (13%), eclampsia (12%),

obstructed labour (8%), other direct causes (8%) and indirect causes (20%) like malaria,

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anemia and cardiovascular diseases all of which complicate pregnancy or are aggravated

by it” (WHO; 2005)7. Our findings of this study, among maternal death is also seems

similar to this report. However, obstrutircal hemorrhage and unintended pregnancy both

are the major cause of maternal death. In this context, unsafe delivery and unsafe abortion

both are mainly considerable causes for maternal death in slums, which have been

acknowledged in this study.

4.8 ISSUE OF MISCARRIAGE.

In common medical term, “miscarriage is spontaneous loss of pregnancy before 6

month’s gestation”. Generally the term miscarriage and abortion have very thin thread

difference. When abortion can occur spontaneously, it is usually called miscarriage.

Whereas some abortions are purposely induced. There are five types of miscarriage 1)

threatened miscarriage, 2) inevitable miscarriage, 3) incomplete miscarriage, 4) complete

miscarriage, 5) Missed miscarriage(Prasad A;1998)8.

As a matter of fact, most of the miscarriages occur due to chromosomal

abnormalities. Along with that many factors are there behind miscarriage i.e. infections,

hormonal problems, uterine abnormality and incapability, incompetent cervix, life style

factors and habits such as smoking, drinking alcohol and drugs, severe kidney diseases,

chronic diseases like diabetes, typhoid, HIV/AIDS and TB, severe fever and jaundice,

malnutrition. Even external reasons like hazard at work place. These are such reasons

behind miscarriage and the study has also noticed causes behind miscarriage in slum

women. 25% (75) women had miscarriage from selected households. Out of every five

zones, 18 women from east zone, 16 women from west zone, 11 women from central

zone, 17 from North zone and 13 from south zone had miscarriage through various

causes. It is mentionable that high proportion (21) of women became victims of anemia,

and malnourishment. Whereas, other women had miscarriage due to severe fever,

jaundice, hysteria and epilepsy, uterus infection, heavy bleeding / hemorrhage, and other

chronic diseases. 5 women had miscarriage due to hazard at home and workplace.

Whereas, 9 women did not know about the reason for miscarriage. Data disclosed such

facts like 2 women had a severe fever during pregnancy; still they did not take medical

treatment. In east zone a woman had three times miscarriage but she was unknown about

the reasons. 7 women from selected households in this zone, had miscarriage after one

child birth. Some of the miscarriages have occurred due to Anemia. 7 cases are exhibit

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that women suffered from Anemia during pregnancy and addicted to drug, gutkha or

tobacco. Even it has been found that they were not going regular check up at nursing

homes. Some cases are also reported that after 2 or 3 miscarriage, slum women went to

nursing home to take treatment. Thus, scholar has observed many reasons behind women

miscarriage like anemia – malnutrition, severe communicable diseases, uterus infection,

heavy bleeding / hemorrhage, hysteria and epilepsy, respiratory diseases and some

external problems like not taking proper treatment and check ups at nursing homes,

believes in witchcrafts and sorcerer instead of going to gynecologist/Nursing home, No

trusts in modern treatment and nursing homes, less knowledge about the caring and

prescription during pregnancy etc are the responsible factors for miscarriage.

4.9 PLACE OF DELIVERY

As mentioned earlier that large numbers of slum dwellers are having economic

crisis, and by this cause high expenditure for medical treatment is not affordable for them.

So, generally they are taking treatment under the government medical premises as it is

financially affordable. Even it has been found that many women in slums are still

delivering their child through Dai which shows their unawareness. Respondents gave

multiple responses about the place of delivery. It can be seen that highest number of birth

has taken place through doctors at government nursing home. 247 women have delivered

their child at government hospitals, on the other side, only 65 respondents have delivered

their child at private nursing home which shows that vast difference between the places of

delivery. As seen earlier that, 65 respondents are delivered their child at private nursing

homes, that means economic crisis is not the hurdle for place. Majority of low income

groups in slums prefer to deliver their child at government nursing homes which has

revealed in this study. As a matter of fact, economic crisis are the major hurdle for the

slum dwellers to take treatment under the private hospitals and nursing homes. It has

found in the last chapter that most of the respondents are having very low income to

survive; in this situation it is awkward to fulfill the basic amenities of sedentary life. In

between, high expenses for health are unaffordable for them. So, the situations compel

them to take treatment at government hospitals and nursing homes. Moreover, out of all

65 cases who delivered their child at private nursing home, 22 respondents were not

satisfied by government nursing homes, some of them could not get proper and good

treatment during the last delivery at government nursing home, 17 respondents

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complained about the distance of government nursing home, 16 respondents were

compared about the treatment between government and private and prefer nursing homes,

8 respondents conceive that there are more skilled and clever doctors in private nursing

homes. Some of these respondents has availed the Chiranjivi Yojna (Scheme) of

Government and some were reported that we are able to expand money for taking

treatment at private nursing homes. 1 complex case of pregnancy was not admitted at

government nursing home and she was suggested by the government doctors to take

treatment at private nursing home. Similarly, 1 respondent could not describe any reason

behind delivering a child at private nursing home. Here we can see the tendency to deliver

a child at private nursing homes. Scholar came to know that slum women are also

recognized private nursing home, but because of low income they can not afford its

expenditure, and they are treating under government hospitals or using hospitals.

Noteworthy, large numbers of child birth (67) have taken place through Dai. Here Dai

means Traditional Birth Attendant (TBA or midwife). Dai may be skilled or unskilled

attendant, and delivery operated at home. It becomes very harmful and creates many

hazards for women, if delivery has done through unskilled attendant. But during

conversation with respondents who have delivered their children through DAI, Scholar

came to know that Dai was skilled and experience so we did not have any problems and

delivered our children safely. 22 respondents delivered their child at native place

(Village), where there were no facilities of nursing home are far from their residents. In

this situation, they preferred to appoint DaI for delivery. Many of these respondents

assume the safe delivery by Dai at home. The numbers of Delivery carried out by Dai

were 68.2% in case of Surat slum study near about two decade back (Das B; 1994)9. Even

the data of the case study of slum of India and Philippines, also revealed that 63% poor

women’s delivery has been carried out at home in urban India, which is totally

astonished. (Islam M, Montgomery M and Taneja S; 2006)10. The study definitely exhibit

the large proportions of slum dweller’s perceptions to favor of traditional birth attendant,

but the trend seems changed today in some extent and most of slum dwellers are

preferring the safe delivery by skilled attendants and doctors at government and private

nursing homes.

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4.10 ANTE NATAL CHECK UP (ANC)

Ante Natal Check up is utmost important for any pregnant women before the

termination of pregnancy because it reflects the graph of the health of pregnant women.

Ante Natal Check Up describes the chromosomal and cardiovascular infections and

diseases, uterine ability and disability, womb infections, biological deficiency and

efficiency of pregnant women for child birth etc. in the reports. So, this report is very

useful during the termination of pregnancy for the doctors and also important for case

study during emergency. According to the data, 79% respondents were going for Ante

natal Check Ups for their last delivery. Whereas, 21% respondents were not going for

Ante Natal Check Ups. Here scholar has summarized the zone wise data of respondent’s

Ante Natal Check Ups.

TABLE NO 4.5 ANTE NATAL CHECK UP

ZONE YES NO TOTAL EAST 53 07 60 WEST 41 19 60

CENTRAL 49 11 60 NORTH 44 16 60 SOUTH 50 10 60 TOTAL 237 63 300

Place of Ante Natal Check Up is pertaining to the place of women’s delivery also.

Here it is found that 42 (18%) respondents went at private nursing home for Ante Natal

Check Up, who delivered their children at the same place. Out of 247 respondents who

delivered their child at government nursing home, 195 (82%) respondents went at the

same place for ANC. However, those who did not went for ANC, 34 women were totally

unaware about the requirement of routine check ups during pregnancy and some of them

replied that they are still healthy after the delivery without any check up. These

respondents also delivered their children at home. 8 respondents were delivered their

children at home, though they were serious about the requirement of Anti Natal Check Up

but it was inaccessible for them by familier rigid and orthodox beliefs and financial crisis.

Even due to less education and unawareness of family members did not permit the

women for Ante Natal Check Up, whereas, far location of nursing home may be a casue

for not going to Anti Natal Check Up. As we have seen in other review of literature, same

findings are seen in other cities also.

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4.11 EXCLUSIVE BREAST FEEDING (EBF)

Doctors and other medical agencies strongly recommend that Exclusive Breast

Feeding and Colostrums are the significant indicators to decline the neo natal morbidity.

Exclusive Breast Feeding creates the resistance in Infants to survive. 48% (144) women

respondents reported that they practiced EBF till six months. 89 respondents replied that

they got information from the doctors and other hospital’s staffs, 36 respondents were

suggested by UHC’s health workers, 19 respondents were feeding their child till six

months by the suggestions of their family members, hospitals and social workers came for

health awareness from NGOs. Out of those respondents who practiced Exclusive Breast

Feeding to their children, some of them were suggested by elders that mother’s milk is

more worth for children’s health as far as she can feed. Noteworthy, large numbers of

respondents (46.33%) were not practiced Exclusive Breast Feed which shows the

unawareness of the respondents, even it also indicates that the hospital staff where they

deliver their child, may not be suggesting about EBF.

4.12 IMMUNIZATION

Immunization is treasure and effective technique to prevent the diseases. Vaccine is

basically given in the particular age, particular time duration and particular proportion to

child to prevent from normal to severe diseases. Completion of vaccination course is

require for any child to maintain their health. Here scholar has explicit the ideal chart for

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8% (24) respondents have partially / half immunized their children, which means only

first two dose of vaccine has been given at the time of child birth or one and half month

of birth .i.e. BCG, DPT, and POLIO – 1. These all respondents immunized their children

at the place of delivery which may be given under the recommendation and insistence of

doctors. Thus, most of the respondents are aware about the immunization. When scholar

asked about the reasons for immunization to their children, respondents similarly replied

that “through these vaccines, our children will be safe from the diseases and they will be

healthy long life”. Here it is a question of 19% (57) respondents who did not immunize

their children. Out of these, some respondents replied that our children become victim of

reaction like fever, swelling at some part of the body, nausea and many others.

As a matter of fact, adverse reaction happened in some cases after immunization.

Whereas, some respondents are connecting with income generation activities and by this

cause, they could not bring their children at the place of immunization, or they became

inaccessible when health workers went to their houses for immunized their children. It is

mentionable that health workers are going to each and every slum areas and surrounded

Anganwadis for the immunization of slum children and even once in a month, authority

celeberate mamata day (Mamata Divas –Tuesday and Thursday) at every Aanganwadies

and health workers are going their for immunization of children studying at

Aanganwadies

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Many respondents did not know about the name of vaccine, so scholar tried to

make them understand month wise immunization name. But every respondents has heard

about polio and polio vaccine due to its canvassing and advertisement full-fledged in

entire India to mitigate it. Moreover, 79% (192) respondents were immunized their

children along with 8% who were half immunized their children) at Government nursing

home, urban health centers and Aanganwadies. 14.33% (35) respondents immunized their

children at home through health workers and 6.67% (16) respondents were immunized

their children at private nursing home. As mentioned earlier, most of the respondents

have given first two does of vaccine to their children at the place of delivery (Government

and Private Nursing Homes) under the recommendation and insistence of doctors. Here it

has been found that, doctors, nurses and health workers (from UHC) are working very

seriously for the vaccination to children.

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4.13 INCOME GENERATION ACTIVITIES OF SLUM CHILDREN.

Slum dwellers are mainly facing the financial crisis which is a severe problem for

them. Even it compels them to reside in the slums with the lack of basic amenities. In this

context, income generation becomes an important part for slum dwellers. Those,

households who are severely facing the financial crisis, their children also take part to

income generation, so as to fulfill the financial requirements of the family. Here scholar

comprise this point in this study to reveal its consequences i.e.1) It has found that many

children are doing income generating activities, which directly or indirectly impact on the

health of children (that means it depends on the type of their work. If they are working in

chemical factories, there is high possibilities to spreading diseases in them) 2) In very

small age, when children started to earn and give up their education, it impacts on their

future, and when they will not be educated, they will not understand the value of

education and similarly they will not be aware about the health and family planning, 3)

Those who are going for physically hard work for earning, they will not take care about

their health, and may be possible that their family members will also not be serious about

the health of their children because money would be their priority. 4) it has found that

many children’s become addicted of tobacco and gutkha at their working place. Thus, this

topic will also helpful to know that how children of slum areas become victim of diseases.

17.67% (53) children of selected households are doing income generation activity. Out of

the, 10 children are working in factories, 20 children are doing job at tea stall, hotels,

electric and furniture shop and working as a car washer at garage, 4 children riding pandal

rickshaw (more than 12 years, so considered as adolescent), 1 girl child is working for

switch box packing at factory, 1 girl child is doing tailoring with her mother, 14 children

are working as labourers, 3 are street hawkers or vendor. Maximum children who are

doing economic works are above 12 years.

When asked about the child connection with income generation activities, most of

the respondents are replied that “we don’t want to send them for work, we wants to give

them good education and then make them able to live financially graceful life”. This

approach shows that the perceptions have changed. Whereas, some respondents replied

that “our children are still younger, which means they desire to send them for work but

age is a barrier”. Thus, we can interpreted that changes come in the slum dweller’s

approach but somehow financial crisis make them desirable to sent their children for

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income generation. In the next chapter scholar has analyzed the consequences of children

connection with income generation activities.

4.14 ADDICTION OF WOMEN AND THEIR CHILDREN.

Almost 25.67% (77) respondents are addicted by Tobacco, Brown and Gutkha.

Whereas, some of them also drunk liquor and other alcoholic beverage. However, these

respondents hesitated to answering on alcoholic addiction but scholar came to know

through the technical conversation with slum dwellers residing in the selected slum areas.

Many respondents replied that they are not addicted by alcohol, tobacco or brown, but

deep investigation and inquiries reveal the facts about the addiction of some women. As

we know that material consumption of alcoholic beverages in is harmful to health,

especially women under reproductive age and who are pregnant. Here it has been found

that 25.67% of respondents are drug and alcohol addicted.

37 children are found addicted to Tobacco/Gutkha out of those who worked for

income generation. When respondents’ asked about their children’s addiction, most of

them replied that “Children are self dependent and spend money as they wish”. (Jaate

kamaay che ane jaate vaapre che). Some respondents replied that “we don’t know either

they are addicted or not”, and some respondents knew about their children’s addiction and

by appreciating their children they said that, “through addicting tobacco they can work

energetically”, (Tamaku khai ne teone kaam karvaani sfurti rahe che). Thus, respondents

gave various answers about addiction of them and their children. Even 93% (279) almost

respondents knew about the scathing of tobacco and alcoholic addiction. They said that

addiction is cause of mouth and lung cancer; even it invites many other diseases in body.

Advertisements of television, posters and hording at hospitals and dispensaries, link

workers and doctors of Urban Health Centers (UHC) etc make them aware about the

diseases applied by addictions. Awareness comes in the slums about the harmfulness of

addiction. Along with that we must accept the fact that, there is large numbers of male

population in slums having addiction of Tobacco, Gutkha, Liquor and other drugs. Many

slum respondents reported that we tried to convince them to give up addiction but they

are not accepting. During field work, it has been found that many male inhabitants are

addicted to alcoholic beverages. Scholar came to know by conversation with respondents

that “the positive change comes gradually”.

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4.15 CONCLUSION:

During the conversation with respondents, other slum dwellers and observations

of the scholar revealed that the people of slum areas are facing many health problems

compare to the non slum areas, as mentioned in hypothesis of this study. In this chapter

scholar has summarized that how slum dwellers become victim of various diseases? Why

they can’t easily came out from the dismal condition of slum? Why they have to face such

types of medical treatment related problems. Finally scholar also analyzes the causes

behind the problems mentioned earlier. Scholar analyze that the dismal condition of

slums and unawareness and sincerity among various diseases and its consequences of

slum dwellers and authority also, are seems the basic reason of spreading diseases

(epidemic) in slums. Moreover, it has also been found that women’s recklessness and

unawareness about health and hygiene during pregnancy and selection of the place of

termination of pregnancy (delivery at home) is a cause to become victim of normal to

severe diseases during and after pregnancy. Even unawareness about Ante Natal Check

up, Immunization, Exclusive Breast Feeding, lack of proper treatment of mother and child

after pregnancy, etc leads slum women to the serious illness. It has found that children are

also going for earning before their younger age. It has also reported that children are

addicted of Tobacco, Gutkha, and Smoking etc which are the harmful of them. Parent

should be serious about their children’s health, in place of that they are also the addicted

of Tobacco, Gutkha, Smoking, alcohol etc. So, these situations lead them to the

unhealthiness. Thus, scholar has analyzed the problem related to the health and its causes

in this chapter.

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REFERENCE

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Urban Slums in Asia and the Near East: Review of Existing Literature and Data”,

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EHP Project, U.S Agency of International Development (USAID), Washington.

2. Montgomery Mark. R, 2009, “Urban Poverty and Health in Developing Country”,

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(http://www.prb.org/pdf09/64.2urbanization.pdf Access on 19th March, 2012)

3. Jha. S. S, 1986, “Structure of Urban Poverty”, Popular Prakashan, Bombay

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Evam Pradhyogiki Sanchar parishad (RVPSP), Government of India, New Delhi.

5. Patel Nilesh and Mahapatra G, 2013, “AMC DAIRY 2013”, Ahmedabad Municipal

Corporation, Ahmedabad

6. MMEIG Report: 2012, “Trends in Maternal Mortality: 1990 to 2010”, World Health

Organization,

http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Tren

ds_in_maternal_mortality_A4-1.pdf access on January 2013.

7. WHO Report, 2005, “Make Every Mother and Child Count”,

http://www.who.int/whr/2005/whr2005_en.pdf access on January 2013.

8. Das Bishwaroop, 1994, “Socio – Economic Study of Slums in Surat City, Center for

Social Study, Surat.

9. Dr. Prasad Ayodhya, 1998, “Kaumarbhritya”, Chokhamba Vidhya Bhavan,

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10. Islam M, Montgomery M and Taneja S, 2006, “Urban Health and Care Seeking

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FURTHER READINGS

11. Kar Malini, 2001, “Primary Immunization Status of Children in Slum Areas of

South Delhi: The Challenge of Reaching urban Poor”, Indian Journal of Community

Medicine, New Delhi, Vol 26, (3), 151 – 154.