Demographical and Epidemiological Contribution to Cancer Incidence in Delhi and Its Trends from 1991-2015

INTRODUCTION

Cancer incidences are rising worldwide, and India ranked third globally in cancer incidence as of 2020, according to estimates from GLOBOCAN. The three components that contributed to changes in cancer incidence include cancer-related risk factors, population size, and population structure. The present study aim is to derive the contribution of these factors to cancer incidence and to evaluate their trend from 1991 to 2015.

METHODS

The Data were extracted from the Delhi population-based cancer registry published reports. This longstanding registry covers nearly 100% of the Delhi population. The secular trends of cancer incidence from 1991-2015 were assessed for all sites combined as well as top-five cancer sites among males and females. Joinpoint regression and Riskdiff software were performed to assess the trend among the components of cancer incidence change.

RESULTS

Both males and females exhibited nearly equal age-standardised incidence rates over 25 years. Albeit, an overall trend in age-standardised rate was not significant for both sexes (0.68% for males and -0.16% for females) when considering all cancer sites combined. Lung, prostate, oral, and gallbladder cancer exhibits a significant rising trend in the age-standardised rates in males while in females only breast and endometrial cancer showed a rising trend. The cancer counts surged by 252% in males and 208.5% in females from 1991 to 2015. The population size component contributed a 180% increase in males and a 170% increase in females, respectively. The site-specific risk changes were more than 100% for the prostate, oral, and gallbladder cancers in males and endometrial cancer in females. The population structure (aging) contributed to rising cancer incidence varying from 35% to 60% in both genders.

CONCLUSION

A significant contribution to new cancer cases was observed due to a demographical shift in both population size and structure, in addition to plausible cancer-specific risk factors. This transformation could surge a potential burden on the Delhi healthcare system. Persistent endeavours are essential to expand and enhance the existing cancer care infrastructure to meet the rising demand driven by aging and population growth. Implementing a stringent population policy can help to mitigate the impact of population growth on cancer incidence.

First record of Apanteles hemara (N.) on Leucinodes orbonalis Guenée and biodiversity of Hymenoptera parasitoids on Brinjal

The brinjal fruit and shoot borer (BFSB), Leucinodes orbonalis Guenée (Lepidoptera: Crambidae), is a very detrimental pest that causes significant economic losses to brinjal crop worldwide. Infested brinjal fruits were collected from vegetable fields located at the ICAR-Indian Agricultural Research Institute (ICAR-IARI), New Delhi, India, during two consecutive seasons (2021-2022). The larvae of the pest were brought to the laboratory and reared under controlled conditions of 25 ± 0.5 °C and 70 ± 5% relative humidity, for the emergence of parasitoids. In addition, the survey of Hymenoptera parasitoids in brinjal was conducted utilizing a sweep net and yellow pan trap over the course of two seasons. The results reveal that five parasitoid species were emerged from L. orbonalis viz., Apanteles hemara Nixon, 1965, Bracon greeni Ashmead 1896 (Hymenoptera: Braconidae), Goryphus nursei (Cameron, 1907), Trathala flavoorbitalis (Cameron, 1907) (Hymenoptera: Ichneumonidae) and Spalangia gemina Boucek 1963 (Hymenoptera: Spalangiidae). Out of these, A. hemara and S. gemina were documented as new occurrences in Delhi. Additionally, A. hemara was recorded for the first time as a parasite on L. orbonalis. Trathala flavoorbitalis was observed during both seasons and exhibited higher parasitism reaching 15.55% and 18.46% in July and August 2022, respectively. However, the average parasitism (%) recorded by A. hemara, B. greeni, G. nursei, T. flavoorbitalis and S. gemina was 3.10%, 1.76%, 1.10%, 9.28% and 1.20% respectively. Furthermore, the findings showed a significant (p ≤ 0.01) strongly positive correlation between fruit infestation (%) by L. orbonalis and parasitism (%). The survey indicates the presence of a broad group (19 families and 60 species) of Hymenoptera parasitoids in the brinjal crop ecosystem in Delhi which could be valuable in biological control. In light of these results, this study revealed that A. hemara and other parasitoids identified in this study alongside T. flavoorbitalis would be ideal biocontrol agents within the integrated pest management (IPM) program of BFSB in Delhi.

BREATH-Net: a novel deep learning framework for NO2 prediction using bi-directional encoder with transformer

Air pollution poses a significant challenge in numerous urban regions, negatively affecting human well-being. Nitrogen dioxide (NO2) is a prevalent atmospheric pollutant that can potentially exacerbate respiratory ailments and cardiovascular disorders and contribute to cancer development. The present study introduces a novel approach for monitoring and predicting Delhi's nitrogen dioxide concentrations by leveraging satellite data and ground data from the Sentinel 5P satellite and monitoring stations. The research gathers satellite and monitoring data over 3 years for evaluation. Exploratory data analysis (EDA) methods are employed to comprehensively understand the data and discern any discernible patterns and trends in nitrogen dioxide levels. The data subsequently undergoes pre-processing and scaling utilizing appropriate techniques, such as MinMaxScaler, to optimize the model's performance. The proposed forecasting model uses a hybrid architecture of the Transformer and BiLSTM models called BREATH-Net. BiLSTM models exhibit a strong aptitude for effectively managing sequential data by adeptly capturing dependencies in both the forward and backward directions. Conversely, transformers excel in capturing extensive relationships over extended distances in temporal data. The results of this study will illustrate the proposed model's efficacy in predicting the levels of NO2 in Delhi. If effectively executed, this model can significantly enhance strategies for controlling urban air quality. The findings of this research show a significant improvement of RMSE = 9.06 compared to other state-of-the-art models. This study's primary objective is to contribute to mitigating respiratory health issues resulting from air pollution through satellite data and deep learning methodologies.

Examining factors influencing the severity of motorized two-wheeler crashes in Delhi

Failure to meet road safety targets has necessitated urgent actions from stakeholders worldwide, especially in developing countries like India. Road safety of motorized two-wheelers (MTWs), one of India's most preferred travel modes for urban commutes, is in danger and witnessing threatening figures of fatalities and injuries. Most of the studies in the domain of MTW safety were conducted in developed countries, with very limited research in countries having a significant proportion of MTWs. The present work investigates police-reported crash data to identify the contributory factors of motorized two-wheeler crash severity. Data from MTW crash-prone areas were selected from Delhi, which is leading in road traffic fatalities among the million-plus urban cities in India. A binary logistic regression model was developed using the data for 2016-2018 period. The model results show that the odds of fatal motorized two-wheeler crashes increase when the following circumstances apply: crash occurs on underpasses; involves bus, truck, heavy motor vehicle (lorry, crane) as the striking vehicle; when hit-and-run type of crash occurs and when older age-group (> = 55) riders are involved. Finally, based on the findings, countermeasures were suggested to facilitate policymakers and traffic enforcement agencies, in improving the road safety situation of MTW users.

The warming city: the increasing risk of summer fires in Delhi

Rising temperatures are mainly associated with wildfires, but the incidence of fire may also increase in the urban context. Yet, fire in Delhi, India, as elsewhere in the towns and cities of the Global South, remains largely invisible, despite the nearly 11 million people each year who are burnt severely enough to require medical attention. This paper focuses on whether summer temperatures in Delhi are rising and whether higher temperatures and lower humidity contribute to a greater number of fires in urban areas. The data strongly suggest a relationship between the warming city, a growing number of summer fires, and mounting temperatures around the world. Delhi, however, is only one example of an urban reality that is common to much of the Global South. Similar questions about the incidence of fire and whether the number is increasing need to be asked of other towns and cities that share the same vulnerabilities.

Study of aggression and its factors among school going adolescents of Delhi, India

Background

Adolescence is an important developmental phase of life associated with various ideas and emotions filled with energy, many times spent in the form of aggressive behavior. Mental Health, as an important part of healthy well-being, cannot be ignored, and hence it becomes imperative to study aggression and associated factors among adolescents.

Objective

To determine the prevalence of aggression among school-going adolescents and to study factors associated with aggression amongst study participants.

Materials and Methods

A cross-sectional study was conducted using a self-administered semi-structured questionnaire having questions regarding socio-demographic data, details of friends, history of substance use etc. and the Buss and Perry Aggression Questionnaire (BPAQ). Data were analyzed using appropriate statistical tests. Ethical clearance was obtained from the Institutional Ethics Committee of Safdarjung Hospital, and informed written consent was taken from participants.

Results

The study involved a total of 463 school-going adolescents with a mean age of 13.78 ± 2.06 years. More than half (50.5%) of the participants were found to be aggressive. Male gender, history of family member ever jailed, parent's argument in front of them, ever tried cigarette/smoking, being involved in some fight and provocation by friends for aggression were the factors found to be significantly associated with aggression.

Conclusion

The prevalence of aggression among school-going adolescents of Delhi was quite high. There is a need to make the students aware about aggression and how to deal with it. A holistic approach may be adopted in which all authorities and stakeholders must work together to provide safer and nurturing environment to all students.

Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India

INTRODUCTION

India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi.

METHODS

A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULTS

The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75-22.54)], females [AOR: 1.57 (95% CI: 1.04-2.37)], and middle class [AOR: 2.23 (95% CI: 1.45-3.43)].

CONCLUSION

Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.

A novel approach for forecasting PM2.5 pollution in Delhi using CATALYST

Air pollution is one of the main environmental issues in densely populated urban areas like Delhi. Predictions of the PM2.5 concentration must be accurate for pollution reduction strategies and policy actions to succeed. This research article presents a novel approach for forecasting PM2.5 pollution in Delhi by combining a pre-trained CNN model with a transformer-based model called CATALYST (Convolutional and Transformer model for Air Quality Forecasting). This proposed strategy uses a mixture of the two models. To derive attributes of the PM2.5 timeline of data, a pre-existing CNN model is utilized to transform the data into visual representations, which are analyzed subsequently. The CATALYST model is trained to predict future PM2.5 pollution levels using a sliding window training approach on extracted features. The model is utilized for analyzing temporal dependencies in PM2.5 time-series data. This model incorporates the advancements in the transformer-based architecture initially designed for natural language processing applications. CATALYST combines positional encoding with the Transformer architecture to capture intricate patterns and variations resulting from diverse meteorological, geographical, and anthropogenic factors. In addition, an innovative approach is suggested for building input-output couples, intending to address the problem of missing or partial data in environmental time-series datasets while ensuring that all training data blocks are comprehensive. On a PM2.5 dataset, we analyze the proposed CATALYST model and compare its performance with other standard time-series forecasting approaches, such as ARIMA and LSTM. The outcomes of the experiments demonstrate that the suggested model works better than conventional methods and is a potential strategy for accurately forecasting PM2.5 pollution. The applicability of CATALYST to real-world scenarios can be tested by running more experiments on real-world datasets. This can help develop efficient pollution mitigation measures, impacting public health and environmental sustainability.

Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India

Introduction

The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery.

Methods

The costs in 2019-20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used.

Results

The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility.

Conclusion

Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.

Estimated risk of cardiovascular events and long-term complications: The projected future of diabetes patients in Delhi from the DEDICOM-II survey

PROBLEM

Despite high prevalence and ethnic susceptibility, limited published estimates are available on long term complication risks among known diabetes patients in India. Hence, we undertook evaluation of the cardiovascular risk of known diabetes patients from Delhi.

METHODS

The community-survey was conducted using a probability-proportionate-to-size(systematic) 2-stage cluster design. Thirty areas were selected for a house-to-house survey to recruit 25 to 30 subjects (known diabetes ≥1 year; 35-65 years of age) per area. Scores from the UKPDS 2.1, UKPDS 2.0, Framingham, ASCVD, WHO, NHS and SCORE studies were used for 10-year risk calculation.

RESULTS

We enrolled 843 subjects of which 800 consented for blood sampling. The mean age of the subjects was 53.0(52.1-54.0) years, the mean duration since diagnosis was 7.1(6.7-7.5) years, with 49.8 % women. 61.8 % were hypertensive, 81.5 % were dyslipidaemic and 53.3 % had poor glycaemic control. Although variable, risk engines estimates were consensual in projecting a high ten-year Coronary-Heart-Disease risk of 10-16 %, a stroke risk of 3.7-5.0 %, and a 5.0-5.7% risk of cardiovascular fatality. These risks were 1.5-3 times the 'risk at target levels' suggesting mitigability. Only 9.3 %, 16.0 %, and 30.0 % were taking aspirin, lipid lowering drugs and antihypertensives respectively.

CONCLUSION

The study highlights the impending impact of, and the scope for improvement in the cardiovascular risk profile of diabetes patients in Delhi, including the use of cardioprotective medications. It strengthens the case for developing and testing potential interventions for improvement.

A stepped wedge cluster randomized trial to evaluate the effectiveness of a community leader-driven kit-based diabetes self-management education approach in improving diabetes control and care: study protocol for the DElhi Diabetes INTervention Trial (DEDINTT)

INTRODUCTION

Diabetes self-management education (DSME) helps patients self-manage their condition and improve outcomes/quality of life. However, access to DSME is limited, particularly in low-income areas. This study aims to develop a DSME training kit (EK-DIN), understand barriers to implementation, and evaluate the effectiveness and sustainability of community leader (CL)-based rollout using a stepped wedge cluster randomized trial format.

METHODS AND ANALYSIS

The mixed methods study will begin with a qualitative study to evaluate the facilitators and barriers towards CL-based DSME. The in-depth interview notes will be transcribed for thematic analysis. These results will be utilized for a stakeholder's workshop to develop the EK-DIN kit, a patient-interfacing app, and an implementation plan. Rollout will be conducted in 30 clusters in Delhi, preselected by the DEDICOM-II survey in 5 steps (6 clusters every 3 months: 2 each from each socio-economic category; randomly selected per sequence). A CL from each cluster will be trained in using the EK-DIN kit/app over 1 month. The trained CL will conduct DSME sessions among the cluster residents using the EK-DIN kits provided fortnightly for 3 months. Compliance and blood parameters data will be collected at baseline, 3 months after the intervention, and every quarter thereafter till completion. Change in HbA1c before and after the intervention will be evaluated as the primary outcome using the swCRTdesign package for R version 4.0.2 and the swSummary function. The sustainability of the effects will be evaluated using the change in quarterly parameters after intervention completion.

DISCUSSION

A positive result will set the template for a generalizable public health intervention with proven community effectiveness, sustainability, cost-effectiveness, and positive quality-of-life impact. While a negative result will require the testing of alternative approaches, it would still add substantially to existing knowledge on the subject. Given the diverse socio-cultural setting in which the trial is being proposed and the high power of the study, the results (positive or negative) should be widely applicable and have policy implications.

TRIAL REGISTRATION

CTRI/2023/07/054963. Date of Registration: 7th July 2023.

Assessment of meteorological parameters on air pollution variability over Delhi

In this study, the relationships between meteorological parameters (relative humidity, wind speed, temperature, planetary boundary layer, and rainfall) and air pollutants (particulate matter and gaseous pollutants) have been evaluated during a 3-year period from 2019 to 2021. Diffusion and dispersion of air contaminants were significantly influenced by meteorology over the capital city. The results of correlation matrix and principal component analysis (PCA) suggest a season's specific influence of meteorological parameters on atmospheric pollutants' concentration. Temperature has the strongest negative impact on pollutants' concentration, and all the other studied meteorological parameters negatively (reduced) as well as positively (increased) impacted the air pollutants' concentration. A two-way process was involved during the interaction of pollutants with relative humidity and wind speed. Due to enhanced moisture-holding capacity during non-monsoon summers, particles get larger and settle down on the ground via dry deposition processes. Winter's decreased moisture-holding capacity causes water vapour coupled with air contaminants to remain suspended and further deteriorate the quality of the air. High wind speed helps in the dispersion and dilution but a high wind speed associated with dust particles may increase the pollutants' level downwind side. The PM2.5/PM10 variation revealed that the accumulation effect of relative humidity on PM2.5 was more intense than PM10. Daily average location-specific rainfall data revealed that moderate to high rainfall has a potential wet scavenging impact on both particulate matters and gaseous pollutants.

To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India

BACKGROUND

In India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors.

METHODS

This study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them.

RESULTS

Out of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females.

CONCLUSION

The occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.7 Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.

Willingness to Quit and Associated Factors Among Tobacco Users Attending Outpatient Departments of a Tertiary Care Hospital in Delhi, India

Background

Tobacco use has become a modern-day epidemic which significantly impacts health, socioeconomic status, and environmental sustainability. The readiness to quit or stop using tobacco is a crucial first step in changing one's behavior. Hence, the current study sought to assess the prevalence of willingness to quit and associated factors among tobacco users.

Methods

This study was conducted on 425 tobacco users selected using multi-stage random sampling from the outpatient departments (OPDs) of a tertiary care hospital in Delhi, India. A pre-designed, interviewer-administered questionnaire was used to elicit information. Logistic regression was performed to assess the effect of independent factors on the willingness to quit.

Findings

The mean age of the study participants was 39.37 years (S.D.=±12.99). The majority of the participants were male (400, 94.1%), and 25 (6.9%) were female. Overall, the prevalence of willingness to quit in the current study was 70% among the study participants. The results of the multivariable analysis showed that those belonging to urban areas, tobacco users with a duration of≤10 years, and those who received advice from a doctor to quit had a significantly higher willingness to quit than their counterparts. However, age, gender, marital status, education, religion, age of initiation of tobacco use, and nicotine dependence were not found to have a statistically significant relationship with the willingness to quit tobacco products.

Conclusion

Willingness to quit was high among the study participants. The data in this study suggested that belonging to urban areas, duration of tobacco use, and doctor's advice to quit are important factors which need to be considered when framing future tobacco cessation programs.

Assessment of urban air quality from Twitter communication using self-attention network and a multilayer classification model

Social media platforms are one of the prominent new-age methods used by public for spreading awareness or drawing attention on an issue or concern. This study demonstrates how the twitter responses of public can be used for qualitative monitoring of air pollution in an urban area. Tweets discussing about air quality in Delhi, India, were extracted during 2019-2020 using a machine learning technique based on self-attention network. These tweets were cleaned, sorted, and classified into 3-class quality viz. poor air quality, good air quality, and noise or neutral tweets. The present study used a multilayer classification model with first layer as an embedding layer and second layer as bi-directional long-short term memory (BiLSTM) layer. A method was then devised for estimating PM_2.5 concentration from the tweets using 'spaCy' similarity analysis of classified tweets and data extracted from Continuous Ambient Air Quality Monitoring Stations (CAAQMS) in Delhi for the study period. The accuracy of this estimation was found to be high (80-99%) for extreme air quality conditions (extremely good or severe) and lower during moderate variations in air quality. Application of this methodology depended on perceivable changes in air quality, twitter engagement, and environmental consciousness among public.

Prevalence of chronic obstructive pulmonary disease among auto rickshaw drivers of East Delhi: A cross-sectional study

Background

Recent industrialisation and urbanisation and introduction of vehicles running on fossil fuels have led to an increase in pollution especially in major cities. This has given rise to various diseases like acute and chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD), Cardiovascular Diseases, Cerebrovascular Diseases and so on leading to significant mortality and morbidity. Auto rickshaw drivers are subjected to the environmental pollutants and their ill effects.

Objectives

Current study was done with the objective of finding the prevalence of COPD among them.

Methods

A community based cross sectional study was conducted in 2019 in Kalyanpuri circle of East Delhi in 409 auto rickshaw drivers in a total of ten Three-Seater Rickshaw (TSR) stands which were chosen by simple random sampling. Consecutive auto rickshaw drivers were chosen from each stand. Data was collected using a questionnaire, and spirometry was conducted using a handheld portable spirometer with adjusted values as per S K Chhabra's formula for Indian Males. Data analysis was done on SPSS by applying chi-square tests.

Results

Mean age of study subjects was 39±7.54 years (Age group 22 to 59 years). The prevalence of COPD was found to be 13.7% based on spirometry as per GOLD criteria. Statistically significant association was found with the age of the study subjects and hour years of driving. No significant association found with the smoking status.

Conclusion

The prevalence of COPD was found to be higher among the study subjects. Since they belong to unorganized sector, relevant policies are required for promoting the health status among them.

Understanding the shared working spaces: a Geography of Co-working supply in Delhi

The present paper investigates the location pattern of co-working spaces in Delhi which is absent in the existing body of knowledge. Delhi is a political, administrative, educational, scientific and innovation capital that accommodates many co-working spaces in India. We developed Ordinary least squares (OLS) and geographically weighted regression (GWR) models to understand the associations of co-working spaces of digital labourers with other urban socio-economic, services and lifestyle variables in Delhi using secondary data for 117 coworking locations in 280 municipal wards of NCT-Delhi. Model diagnostic suggested that the GWR model provides additional information regarding geographical distribution of coworking spaces, and density of bars, median house rent, fitness centres, metro train stations, restaurants, cinemas, cafés, and creative enterprises are statistically significant parameters to estimate them. The importance of coworking spaces has increased in the post-disaster period, so this study informs public policies to benefit people and companies who choose coworking routes, and recommends urban planners, developers, and real-estate professionals to consider the proximity of creative industries in planning and developing coworking spaces in the future. Also, in the post COVID-19 period, to increase local jobs and long-term place sustainability, a localised policy intervention for coworking spaces in Delhi is highly recommended.

Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives

Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)_2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach.

Methods

The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM_2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM_2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software.

Results

Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM_2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the 'moderately polluted' south-west region of Delhi with relatively lower PM_2.5 concentrations.

Interpretation & conclusions

Acute respiratory ER visits of patients were related to regional PM_2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study provides support for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

Diurnal and Seasonal Variation of Atmospheric Particulate Matter and Trace Gases in Industrial Area of Delhi: A Study

The diurnal and seasonal variation of PM₁₀, SO₂, NO₂, NH₃ and water-soluble compounds were studied in Naraina industrial area; Delhi from January to December, 2017. It was observed that annual average concentrations of PM_10, SO₂, NO₂, NH_3, SO₄^2-, NO₃^-, NH₄⁺,Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl^- and F^- in the day time were 227 ± 91, 9 ± 5, 59 ± 22, 65 ± 15, 17.45 ± 5.14, 17.60 ± 4.94, 8.66 ± 2.94, 4.05 ± 1.08, 3.46 ± 0.91, 10.38 ± 4.48, 3.15 ± 0.99, 43.06 ± 5.20 and 0.50 ± 0.12 µg m^-3, respectively and night time were 320 ± 127, 14 ± 7, 82 ± 25, 83 ± 20, 22.64 ± 5.22, 21.66 ± 5.0, 11.81 ± 3.47, 3.29 ± 0.87, 3.02 ± 1.19, 7.55 ± 3.16, 2.49 ± 0.95, 31.86 ± 4.70 and 0.37 ± 0.12 µg m^-3, respectively. PM₁₀ and sometimes NO₂ concentrations exceeded the Indian National Ambient Air Quality Standards. SO₂, and NH₃ concentrations were within the standard. The selected parameters varied from season to season. In the night time, selected parameters concentrations were high in comparison to day time might be due to formation of inorganic secondary particulate matters and low wind speed in the ambient air.

"DOST" Model to Link and Support Drug Resistant TB Patients From Private Sector: An Experience From Delhi, India

Background

The National TB Elimination Programme (NTEP) has quite successfully involved private sector for referral of presumptive drug resistant TB (DR-TB) patients for molecular testing and referral for DR-TB management. There was a challenge as all the referred patients were not reaching to the facilities. A “DOST” intervention model was implemented to strengthen the patient care pathway. We conducted this study to describe the patient care cascade, the clinico-demographic characteristics of patients linked to the treatment and to estimate the mean turn-around time for drug resistant TB care services.

Methods

It is a cross-sectional study conducted at New Delhi during the period July 2019-December 2020 under programmatic settings.

Results

A total of 9,331 patients were subjected to CB-NAAT test and 382 (4%) were found to be resistant for rifampicin and 231 (76%) were initiated on treatment in the public sector under NTEP.

Conclusion

The DOST intervention model developed to link the DR-TB patients from private sector to the public sector DR-TB centers is found to be efficient and effective.

Association between Acute Exposure to PM2.5 Chemical Species and Mortality in Megacity Delhi, India

The association between daily all-cause mortality and short-term fine particulate matter (PM_2.5) exposure is well established in the literature. However, association between acute exposure to PM_2.5 chemical species and mortality is not well known, especially in developing countries like India. Here we examined associations between mortality and acute exposure to PM_2.5 mass concentration and their 15 chemical components using data from 2013 to 2016 in megacity Delhi using a semiparametric quasi-Poisson regression model, adjusting for mean temperature, relative humidity, and long-term time trend as the major potential confounders. Mortality estimates were further checked for effect modification by sex, age group, and season. The subspecies of NO₃^-, NH₄NO₃, Cr, NH₄⁺, EC, and OC showed a higher mortality impact than the total PM_2.5 mass. Males were at higher risk from NO₃^-, SO₄^2-, and their NH₄⁺ compounds along with carcinogen Cr, whereas female group was at higher risk from EC and OC. Among all age groups, the elderly above 65 years were the most vulnerable group prone to mortality effects from maximum species. The major mortality risk from all hazardous species arose from their winter exposures. Our study provides the first evidence of association between acute exposure to PM_2.5 chemical species and mortality anywhere in India and recommends similar studies in other regions so that sectoral mitigation emitting the most toxic species can be prioritized to maximize the health benefits.

A novel seasonal index-based machine learning approach for air pollution forecasting

Novel machine learning models (MLMs) using the seasonal indexing approach that captures the variation in air quality caused due to meteorological changes have been used to provide short-term, real-time forecasts of PM_2.5 concentration for one of the most polluted air quality control regions (AQCR) in the capital city of Delhi. Two MLMs-multi-linear regression and random forest-have been developed for using time series data for 1-h and 24-h average PM_2.5 concentration. Short-term, real-time forecasts have been made using the developed models. Various model performance evaluation indices indicate satisfactory model performance. R² values for the hourly and daily models varied between 0.95 and 0.72 and between 0.76 and 0.68 for the 1st to 5th h/day, respectively. The lagged values of PM_2.5 concentration (persistence) and the hourly and daily indices are the most influential variables for the forecasts for immediate time steps. In contrast, seasonal indices become more important with the forecasting time horizon. The developed models can be used for making short-term, real-time air quality forecasts and issuing a warning when the pollution levels go beyond acceptable limits.

SARS-CoV-2 Lineage Tracking, and Evolving Trends Seen during Three Consecutive Peaks of Infection in Delhi, India: a Clinico-Genomic Study

Since its advent, the pandemic has caused havoc in multiple waves due partly to amplified transmissibility and immune escape to vaccines. Delhi, India also witnessed brutal multiple peaks causing exponential rise in cases. Here we had retrospectively investigated clade variation, emergence of new lineages and varied clinical characteristics during those three peaks in order to understand the trajectory of the ongoing pandemic. In this study, a total of 123,378 samples were collected for a time span of 14 months (1 June 2020 to 3 August 2021) encompassing three different peaks in Delhi. A subset of 747 samples was processed for sequencing. Complete clinical and demographic details of all the enrolled cases were also collected. We detected 26 lineages across three peaks nonuniformly from 612 quality passed samples. The first peak was driven by diverse early variants, while the second one by B.1.36 and B.1.617.2, unlike third peak caused entirely by B.1.617.2. A total of 18,316 mutations with median of 34 were reported. Majority of mutations were present in less than 1% of samples. Differences in clinical characteristics across three peaks was also reported. To be ahead of the frequently changing course of the ongoing pandemic, it is of utmost importance that novel lineages be tracked continuously. Prioritized sequencing of sudden local outburst and community hot spots must be done to swiftly detect a novel mutation/lineage of potential clinical importance. IMPORTANCE Genome surveillance of the Delhi data provides a more detailed picture of diverse circulating lineages. The added value that the current study provides by clinical details of the patients is of importance. We looked at the shifting patterns of lineages, clinical characteristics and mutation types and mutation load during each successive infection surge in Delhi. The importance of widespread genomic surveillance cannot be stressed enough to timely detect new variants so that appropriate policies can be immediately implemented upon to help control the infection spread. The entire idea of genomic surveillance is to arm us with the clues as to how the novel mutations and/or variants can prove to be more transmissible and/or fatal. In India, the densely populated cities have an added concern of the huge burden that even the milder variants of the virus combined with co-morbidity can have on the community/primary health care centers.

Meteorology governs the variation of Delhi's high particulate-bound chloride levels

A significant number of past studies have reported Delhi to witness some of the highest levels of particulate-bound chloride compared to anywhere else in the world. The present study employs long-term, highly time-resolved chloride measurements at the IIT Delhi campus from February 2020 to April 2021. The present work sheds light on the dependence of high chloride levels in Delhi on the winds from the northwest direction. The study makes use of linear regression models and stepped linear models to quantify the role of meteorological variables in driving the seasonal variation of chloride in Delhi. The results indicate that ∼85-88% of the variation in chloride concentration observed in Delhi can be attributed to meteorological parameters, mainly temperature (T), relative humidity (RH), and percentage of wind incoming from the northwest (%NW). The results also suggest that the primary chloride emissions remain relatively consistent year-round, and are regionally transported from Delhi's northwest. The results of this study provide valuable insights in understanding the nature of the sources and the variability associated with the chloride levels in Delhi and thus provide a basis for future emission control strategies.

Profile of atmospheric particulate PAHs near busy roadway in tropical megacity, India

Objective: This study focuses on the profile of ambient particulate polycyclic aromatic hydrocarbons (PAHs), their seasonal distribution, source identification and human health risk assessment due to inhalation exposure of ambient PAHs in Delhi, India.Materials and Methods: Two sampling sites were chosen, one at roadway (MH) and other at urban background (JNU) site in Delhi. Determination of PAHs was carried with the help of HPLC with UV detector. Principal component analysis and Molecular diagnostic ratios were used for the source apportionment of PAHs. Health risks associated with inhalation of particulate PAHs were assessed using benzo(a)pyrene equivalent concentration and incremental lifetime cancer risk (ILCR) approach.Results: The results showed that the average mass concentration of Σ₁₆ PAHs near roadway (67.8 ± 40.2 ng m^-3) is significantly higher than urban background site (56 ± 30 ng m^-3). Moreover, source apportionment study indicated that major PAH-emission sources in Delhi NCR are traffic and coal combustion. ILCR values at both the sites fall in the range of 10^-2-10^-4 that corresponds to the priority risk level (10^-3) and higher than the acceptable risk level (10^-6).conclusions: The high PAHs concentration at MH site was due to it's nearness to busy traffic area. Thus, the spatial variations in PAHs were influenced by local emission sources. The high PAHs level during the winter season can be due to their higher emissions from local heating sources, shift of gas/particle partitioning toward the particulate phase at low temperature and reduced photochemical degradation of some PAHs in winter. The low level of PAHs in monsoon season can be attributed to their wet scavenging and higher percentage in vapor phase. PCA showed that the emissions from vehicles predominate at MH site; whereas, coal combustion and traffic both are the significant PAHs sources at JNU site. Health risk assessment revealed that the highest exposure risks occur at busy traffic site, thereby indicating a significantly higher health risk to the population of Delhi.

Identification of air pollution hotspots in urban areas - An innovative approach using monitored concentrations data

Critical assessment of spatio-temporal variations in pollution levels is a crucial step for identifying and prioritizing air pollution hotspots (APH) in urban areas. There is no universally accepted methodology for defining and delineating air pollution hotspot which can be source-specific, pollutant-specific and time-specific. The present research article is an attempt to develop a protocol for identifying APH for any pollutant within a city where-in three criteria-based innovative methodology has been derived. The three criteria are frequency of exceedance (% of days), scale of exceedance and consistency in exceedance (consecutive number of days) to the specified standards that need to be met continuously for at least three years. The suggested methodology has been applied on a three-year database (2018-2021) of 37 continuous ambient air quality stations to identify PM_2.5 specific APH. The analysis indicates 11 APH in April, 9 in May, 2 in June and almost the entire city during the October-February months. Given prioritization of implementation of control actions, the identified APH during summer has been further physically examined to map source activity types and their suitability for ambient air quality monitoring stations as per the guidelines. The APH can be the priority areas for the implementation of control actions by urban local bodies. The management of air pollution at these priority areas would be more effective instead of city-scale management practice, which is difficult to implement and monitor.

Socio-demographic profile of suicidal hanging deaths in Delhi and the National Capital Region - a retrospective study

The aim of this retrospective socio-demographic analysis is to identify those at higher risk of suicidal hanging in the region of Delhi and the National Capital Region. All deaths due to suicidal hanging from January 2016 to December 2019 reported in the Vardhman Mahavir Medical College and Safdarjung Hospital were included. Suicidal hanging accounted for 2.67% of total autopsied cases; 21-30 years old represented 42.62% of the victims. Male:female ratio was 1.7:1 and 38.37% of cases were from the adjoining areas of Vasant Kunj and Vasant Vihar. Therefore, a preventive strategy should focus concern on young adults, the male sex, and areas of Vasant Kunj and Vasant Vihar.

Contaminants of concern (CoCs) pivotal in assessing the fate of MSW incineration bottom ash (MIBA): First results from India and analogy between several countries

Present study characterizes municipal solid waste incineration bottom ash (MIBA) from three incineration plants in Delhi with an intent to serve the dual objectives: a) assessing the disposal/reuse options for Delhi MIBA, b) evaluating variability in results across the countries (including India) and assessing if is significant enough to influence the fate of MIBA of varied origin. A review on leaching studies of MIBA (50 research papers) was conducted which aided in achieving both the objectives. Delhi MIBA samples were analysed for chemical composition. The two commonly adopted leaching tests i.e., TCLP and EN 12457-2, were conducted and the results were checked against regulatory threshold levels (RTLs) to achieve the first objective. Leaching concentration of the contaminants was compared with the compiled literature and RTLs to accomplish the second objective. The compendium of literature most importantly revealed the physicochemical parameters which are pivotal in determining the fate of MIBA but have been missing from many studies. Ten such parameters were identified: Cr, Cu, Mo, Sb, Cl^-,SO₄^2-, Cd, Pb, Ni and Zn and are referred as contaminants of concern (CoCs). Delhi MIBA was found suitable for disposal to non-hazardous waste landfills and unsuitable for unrestricted reuse. CoCs identified in Delhi MIBA were identical to those observed in literature (except Cd, Pb and Zn). The variability in leaching concentration of CoCs, observed from comparative assessment of results, spanned nearly 2 to 3 log₁₀ magnitudes for Cu, Cr, Pb, Sb and Zn while 1 to 2 log₁₀ magnitudes for Mo, Cl^-andSO₄^2-.

Changes in air quality in Mexico City, London and Delhi in response to various stages and levels of lockdowns and easing of restrictions during COVID-19 pandemic

The impacts of COVID-19 lockdown restrictions have provided a valuable global experiment into the extent of improvements in air quality possible with reductions in vehicle movements. Mexico City, London and Delhi all share the problem of air quality failing WHO guideline limits, each with unique situations and influencing factors. We determine, discuss and compare the air quality changes across these cities during the COVID-19, to understand how the findings may support future improvements in their air quality and associated health of citizens. We analysed ground-level PM₁₀, PM_2.5, NO₂, O₃ and CO changes in each city for the period 1st January to August 31, 2020 under different phases of lockdown, with respect to daily average concentrations over the same period for 2017 to 2019. We found major reductions in PM₁₀, PM_2.5, NO₂ and CO across the three cities for the lockdown phases and increases in O₃ in London and Mexico City but not Delhi. The differences were due to the O₃ production criteria across the cities, for Delhi production depends on the VOC-limited photochemical regime. Levels of reductions were commensurate with the degree of lockdown. In Mexico City, the greatest reduction in measured concentration was in CO in the initial lockdown phase (40%), in London the greatest decrease was for NO₂ in the later part of the lockdown (49%), and in Delhi the greatest decrease was in PM₁₀, and PM_2.5 in the initial lockdown phase (61% and 50%, respectively). Reduction in pollutant concentrations agreed with reductions in vehicle movements. In the initial lockdown phase vehicle movements reduced by up to 59% in Mexico City and 63% in London. The cities demonstrated a range of air quality changes in their differing geographical areas and land use types. Local meteorology and pollution events, such as forest fires, also impacted the results.

Effects of ambient air pollution on emergency room visits of children for acute respiratory symptoms in Delhi, India

The present study explored the association between daily ambient air pollution and daily emergency room (ER) visits due to acute respiratory symptoms in children of Delhi. The daily counts of ER visits (ERV) of children (≤15 years) having acute respiratory symptoms were obtained from two hospitals of Delhi for 21 months. Simultaneously, data on daily concentrations of particulate matter (PM₁₀ and PM_2.5), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), and ozone (O₃) and weather variables were provided by the Delhi Pollution Control Committee. K-means clustering with time-series approach and multi-pollutant generalized additive models with Poisson link function was used to estimate the 0-6-day lagged change in daily ER visits with the change in multiple pollutants levels. Out of 1,32,029 children screened, 19,120 eligible children having acute respiratory symptoms for ≤2 weeks and residing in Delhi for the past 4 weeks were enrolled. There was a 29% and 21% increase in ERVs among children on high and moderate level pollution cluster days, respectively, compared to low pollution cluster days on the same day and previous 1-6 days of exposure to air pollutants. There was percentage increase (95% CI) 1.50% (0.76, 2.25) in ERVs for acute respiratory symptoms for 10 μg/m³ increase of NO₂ on previous day 1, 46.78% (21.01, 78.05) for 10 μg/m³ of CO on previous day 3, and 13.15% (9.95, 16.45) for 10 μg/m³ of SO₂ on same day of exposure. An increase in the daily ER visits of children for acute respiratory symptoms was observed after increase in daily ambient air pollution levels in Delhi.

Impact of COVID-19 induced lockdown and unlock down phases on the ambient air quality of Delhi, capital city of India

The present study deals with the impact of the pandemic outbreak of COVID-19 on the ambient air quality in the capital city of India. Real-time data were collected from eight continuous ambient air quality monitoring stations measuring important air quality parameters (NO₂, PM₁₀ and PM_2.5). Results revealed that the city's air quality had improved significantly during the lockdown period due to COVID-19 outbreak. The concentration of gaseous and particulate matter during the lockdown period (March-May 2020) declined significantly compared with the preceding years' data from the same timeframe. However, the ambient air quality deteriorates with the onset of unlocking phases and post-monsoon season (October 2020). Higher concentration of NO₂, PM₁₀ and PM_2.5 were recorded at industrial (S1 and S2) and hotspot (S4 and S5) sites. The lowest concentrations of studied pollutants were observed during the first phase of lockdown (March 24 - May 14, 2020). The present study, once again, establishes the direct effect of anthropogenic activities and deteriorating ambient air quality of Delhi.

Exploring short term spatio-temporal pattern of PM2.5 and PM10 and their relationship with meteorological parameters during COVID-19 in Delhi

Present study aims to examine the impact of lockdown on spatio-temporal concentration of PM2.5 and PM10 - categorized and recorded based on its levels during pre-lockdown, lockdown and unlock phases while noting the relationship of these levels with meteorological parameters (temperature, wind speed, relative humidity, rainfall, pressure, sun hour and cloud cover) in Delhi. To aid the study, a comparison was made with the last two years (2018 to 2019), covering the same periods of pre-lockdown, lockdown and unlock phases of 2020. Correlation analysis, linear regression (LR) was used to examine the impact of meteorological parameters on particulate matter (PM) concentrations in Delhi, India. The findings showed that (i) substantial decline of PM concentration in Delhi during lockdown period, (ii) there were substantial seasonal variation of particulate matter concentration in city and (iii) meteorological parameters have close associations with PM concentrations. The findings will help planners and policy makers to understand the impact of air pollutants and meteorological parameters on infectious disease and to adopt effective strategies for future.

Impact of urbanization processes on availability of ecosystem services in National Capital Region of Delhi (1992-2010)

The Southern and Eastern National Capital Region of Delhi is experiencing diversified and expanding urbanization as in million-plus cities of the area the urban sprawl activities are more frequent than the urban densification activities. The progressing sprawl of residential and construction sites is transforming the regional ecosystems and hampering the generation of ecosystem services of fundamental importance, i.e. the benefits and services that we get directly or indirectly from the ecosystem functioning. The Costanza et al., (2014) approach shows that the ecosystem services value has decreased at US$ 56 ha^-1 year^-1 (0.09% per year) and absolute and cumulative losses are estimated US$ 285.4 ha^-1 year^-1 and US$ 502.8 ha^-1 year^-1, respectively. The ecosystem service values assessment shows that the ecosystem services like climate regulation and recreation have increased but food production, genetic resources, water supply, soil formation, raw materials and waste treatment have decreased over the time. The use of alternative ecosystem value coefficient shows that the estimated value of the ecosystem service value changed from a low of 0.005% for 1% change in the value of the forest coefficient, to a high of 0.749% for a 1% change in the value of the agricultural land coefficient. For each land use/land cover category, the sensitivity analysis reflects the inelasticity or robustness of the estimated ecosystem value with respect to the value coefficient. Overall, prioritizing the conservation and enrichment of natural and man-made ecosystems of critical value will lead to sustainable development of urban ecosystems.

Impact of Environmental Indicators on the COVID-19 Pandemic in Delhi, India

Currently, there is a massive debate on whether meteorological and air quality parameters play a crucial role in the transmission of COVID-19 across the globe. With this background, this study aims to evaluate the impact of air pollutants (PM2.5, PM10, CO, NO, NO2, and O3) and meteorological parameters (temperature, humidity, wind speed, and rainfall) on the spread and mortality due to the COVID-19 outbreak in Delhi from 14 Mar 2020 to 3 May 2021. The Spearman's rank correlation method employed on secondary data shows a significant correlation between the COVID-19 incidences and the PM2.5, PM10, CO, NO, NO2, and O3 concentrations. Amongst the four meteorological parameters, temperature is strongly correlated with COVID-19 infections and deaths during the three phases, i.e., pre-lockdown (14 March 2020 to 24 March 2020) (r = 0.79), lockdown (25 March 2020 to 31 May 2020) (r = 0.87), and unlock (1 June 2020 to 3 May 2021) (r = -0.75), explaining the variability of about 20-30% in the lockdown period and 18-19% in the unlock period. NO2 explained the maximum variability of 10% and 7% in the total confirmed cases and deaths among the air pollutants, respectively. A generalized linear model could explain 80% and 71% of the variability in confirmed cases and deaths during the lockdown and 82% and 81% variability in the unlock phase, respectively. These findings suggest that these factors may contribute to the transmission of the COVID-19 and its associated deaths. The study results would enhance the ongoing research related to the influence of environmental factors. They would be helpful for policymakers in managing the outbreak of COVID-19 in Delhi, India.

Variation in chemical composition and sources of PM2.5 during the COVID-19 lockdown in Delhi

The Government of India (GOI) announced a nationwide lockdown starting 25th March 2020 to contain the spread of COVID-19, leading to an unprecedented decline in anthropogenic activities and, in turn, improvements in ambient air quality. This is the first study to focus on highly time-resolved chemical speciation and source apportionment of PM_2.5 to assess the impact of the lockdown and subsequent relaxations on the sources of ambient PM_2.5 in Delhi, India. The elemental, organic, and black carbon fractions of PM_2.5 were measured at the IIT Delhi campus from February 2020 to May 2020. We report source apportionment results using positive matrix factorization (PMF) of organic and elemental fractions of PM_2.5 during the different phases of the lockdown. The resolved sources such as vehicular emissions, domestic coal combustion, and semi-volatile oxygenated organic aerosol (SVOOA) were found to decrease by 96%, 95%, and 86%, respectively, during lockdown phase-1 as compared to pre-lockdown. An unforeseen rise in O₃ concentrations with declining NO_x levels was observed, similar to other parts of the globe, leading to the low-volatility oxygenated organic aerosols (LVOOA) increasing to almost double the pre-lockdown concentrations during the last phase of the lockdown. The effect of the lockdown was found to be less pronounced on other resolved sources like secondary chloride, power plants, dust-related, hydrocarbon-like organic aerosols (HOA), and biomass burning related emissions, which were also swayed by the changing meteorological conditions during the four lockdown phases. The results presented in this study provide a basis for future emission control strategies, quantifying the extent to which constraining certain anthropogenic activities can ameliorate the ambient air. These results have direct relevance to not only Delhi but the entire Indo-Gangetic plain (IGP), citing similar geographical and meteorological conditions common to the region along with overlapping regional emission sources. SUMMARY OF MAIN FINDINGS: We identify sources like vehicular emissions, domestic coal combustion, and semi-volatile oxygenated organic aerosol (SVOOA) to be severely impacted by the lockdown, whereas ozone levels and, in turn, low-volatility oxygenated organic aerosols (LVOOA) rise by more than 95% compared to the pre-lockdown concentrations during the last phase of the lockdown. However, other sources resolved in this study, like secondary chloride, power plants, dust-related, hydrocarbon-like organic aerosols (HOA), and biomass burning related emissions, were mainly driven by the changes in the meteorological conditions rather than the lockdown.

Cholera outbreak investigation, Bhadola, Delhi, India, April-May 2018

BACKGROUND

In the Gangetic plains of India, including Delhi, cholera is endemic. On 10 May 2018, staff at the north Delhi district surveillance unit identified a laboratory-confirmed cholera outbreak when five people tested positive for Vibrio cholerae O1 Ogawa serotype in Bhadola. We investigated to identify risk factors and recommend prevention measures.

METHODS

We defined a case as ≥3 loose stools within 24 h in a Bhadola resident during 1 April-29 May 2018. We searched for cases house-to-house. In a 1 : 1 unmatched case control study, a control was defined as an absence of loose stools in a Bhadola resident during 1 April-29 May 2018. We selected cases and controls randomly. We tested stool samples for Vibrio cholerae by culture. We tested drinking water for fecal contamination. Using multivariable logistic regression we calculated adjusted ORs (aORs) with 95% CIs.

RESULTS

We identified 129 cases; the median age was 14.5 y, 52% were females, 27% were hospitalized and there were no deaths. Symptoms were abdominal pain (54%), vomiting (44%) and fever (29%). Among 90 cases and controls, the odds of illness were higher for drinking untreated municipal water (aOR=2.3; 95% CI 1.0 to 6.2) and not knowing about diarrhea transmission (aOR=4.9; 95% CI 1.0 to 21.1). Of 12 stool samples, 6 (50%) tested positive for Vibrio cholerae O1 Ogawa serotype. Of 15 water samples, 8 (53%) showed growth of fecal coliforms.

CONCLUSIONS

This laboratory-confirmed cholera outbreak associated with drinking untreated municipal water and lack of knowledge of diarrhea transmission triggered public health action in Bhadola, Delhi.

Long-term exposure to indoor air pollution and risk of tuberculosis

Indoor air pollution (IAP) is a recognized risk factor for various diseases. This paper examines the role of indoor solid fuel exposure in the risk of mycobacterium tuberculosis (TB) in Delhi Metropolitan, India. Using a cross-sectional design, subjects were screened for a history of active TB and lifelong exposure to IAP sources, such as solid fuel burning and kerosene. The TB prevalence rate in the study area was 1117 per 100 000 population. Every year, increase in solid fuel exposure was associated with a three percent higher likelihood of a history of active TB. Subjects exposed to solid fuel and kerosene use for both heating home and cooking showed significant associations with TB. Age, household expenditure (a proxy of income), lung function, and smoking also showed significant associations with TB. Smokers and solid fuel-exposed subjects were four times more likely to have a history of active TB than non-smoker and unexposed subjects. These finding calls strategies to mitigate solid fuel exposure, such as use of clean cookstove and ventilation, to mitigate the risk of TB which aligns with the United Nations' goal of "End TB by 2030."

Cycling in one of the most polluted cities in the world: Exposure to noise and air pollution and potential adverse health impacts in Delhi

Background

In India, many cities struggle with extreme levels of air pollution and noise. Delhi, in particular, has the notorious reputation of being one of the most polluted cities in the world. Cyclists constitute a particularly exposed population, since they cycle among motor vehicles without any protection. This paper modeled the cyclists’ exposure to nitrogen dioxide (NO₂) and noise in Delhi, India.

Methods

Using primary data collected on 1,229 kms of roads in Delhi, Generalized Additive Mixed Models with Auto-Regressive terms (GAMMAR) are constructed for noise exposure, NO₂ exposure and NO₂ inhalation doses.

Results

Results show that cyclists are exposed to 47 µg/m³ of NO₂ and 3.3 dB(A) more when cycling on a primary road than on a residential street. Using WHO guideline values for noise and air pollution, we assessed how many minutes of inhaling doses and noise doses become potentially harmful to cyclists’ health in Delhi. Such thresholds are quickly exceeded: after cycling one hour in an area with moderate predicted values of noise and air pollution, the noise dose and inhaled dose of NO₂ will reach 212% and 403 µg on residential streets, and 459% and 482 µg on primary roads, respectively.

Conclusion

Policy makers should take these results into account to minimize cyclists’ exposure, especially for the most deprived people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00272-2.

2-D simulation of atmospheric boundary layer in and around Delhi to determine air pollution scenarios during winter morning

In this paper, a 2-D turbulent closure model, based on the pollutant mass conservation equation, is adopted to estimate the local and background pollutants in the predominant wind direction for the stable atmosphere during winter mornings. The background concentration of pollutants can severely affect the regional pollution level, and its monitoring is a challenging task. Here, the turbulent closure model is employed across three cities in India, viz., Patiala, Delhi, and Agra, to estimate SO₂ and NO_x concentration along the predominant wind direction to demonstrate the potential of numerical models. The direction of the prevailing wind in this area during January 2003 was NNW (330°). Patiala is followed by Delhi and then Agra in the predominant wind direction. The sensitivity analysis of surface temperature on pollutant concentration reveals that concentration would increase by its square as temperature dips. So, during low or no horizontal wind, pollution episodes will be inevitable. Thus, the pollution hotspots are also identified in these three cities. Delhi had a high pollution load. So, the impact of local pollution in Delhi, through dispersion, was found significant in Agra. NO_x hot spots (exceed the 30 μg/m³ limit) are found all across Delhi, except IGI Airport and two other locations. However, no SO₂ hotspot (exceed the 60 μg/m³ limit) is found in Delhi. The proposed model output is verified with the WRF-CFD model results. Compared to the WRF-CFD model, the proposed model has overestimated NO_x and SO₂ concentration maximum by 14.4% and 23.5%, respectively. The overestimation occurred primarily due to ignoring atmospheric chemical reactions (e.g., acid condensation, etc.) for which the atmospheric factors were not so conducive.

Prevalence of anaemia among school going adolescent girls attending Test, Treat and Talk (T-3) camp under Anaemia Mukt Bharat in Delhi

Background

Adolescent period is signalized by marked physical activity and rapid growth spurt; therefore, they need additional nutritional supplements and are at utmost risk of developing nutritional anaemia. Anaemia play a major role in affecting the adolescents especially girls. On September 2019, Ministry of Health and Family welfare, Govt. of India directed to all state and district health authority to conduct Test, Treat and Talk (T-3) anaemia camps for celebration of nutrition month (Poshan Maah) in all government schools and colleges. The present study aimed to assess prevalence of anaemia and factors associated with it among school going adolescent girls attending T-3 camp in Delhi.

Methods

A cross-sectional study was conducted among 203 adolescent girls in government girls' school in central district of Delhi. Hb estimation was done by HemoCue 201 and data regarding socio-demographic details, deworming, dietary preferences were collected. Clinical examination and anthropometric measurements were done by resident doctors. Data was analysed using STATA vs. 13.

Results

The prevalence of anaemia was found to be 59% with mean (±SD) Hb of 11.3 gm/dl (±1.55) among 203 participants. The majority (48%, n = 119) of anaemic girls had mild degree of anaemia. Among 203 girls, 65% participants were of age 14-15 years with mean (±SD) age of 14.6 years (±1.18). There was a significant relationship between anaemia and diet, deworming status, and BMI (P < 0.05).

Conclusion

The study revealed that anaemia was highly prevalent among adolescent girls. Among anaemic girls, majority had mild anaemia. Factors like vegetarian diet, underweight, deworming and presence of pallor were found to be associated with anaemia. There is need to conduct T-3 camps at regular interval in all schools to curb the problem of adolescent anaemia.

COVID-19 lockdown: a rare opportunity to establish baseline pollution level of air pollutants in a megacity, India

This paper analyses air quality data from megacity Delhi, India, during different periods related to the COVID-19, including pre-lockdown, lockdown and unlocked (post-lockdown) (2018-2020) to determine what baseline levels of air pollutants might be and the level of impact that could be anticipated under the COVID-19 lockdown emission scenario. The results show that air quality improved significantly during the lockdown phases, with the most significant changes occurring in the transportation and industrially dominated areas. A pronounced decline in PM_{2.5 and} PM₁₀ up to 63% and 58%, respectively, was observed during the lockdown compared to the pre-lockdown period in 2020. When compared to 2018 and 2019, they were lower by up to 51% and 61%, respectively, dropping by 56% during unlock. Some pollutants (NOx and CO) dropped significantly during lockdown, while SO₂ and O₃ declined only slightly. Moreover, when compared between the different phases of lockdown, the maximum decline for most of the pollutants and air quality index occurred during the lockdown phase 1; thus, this period was used to report the COVID-19 baseline threshold values (CBT; threshold value is the upper limit of baseline variation). Of the various statistical methods used median + 2 median absolute deviation (mMAD) was most suitable, indicating CBT values of 143 and 75 ug/m³ for PM₁₀ and PM_2.5, respectively. This results although preliminary, but it gives a positive indication that temporary lockdown can be considered as a boon to mitigate the damage we have done to the environment. Also, this baseline levels can be helpful as a first line of information to set future target limits or to develop effiective management policies for achieving better air quality in urban centres like Delhi.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13762-021-03142-3.

Assistive technology for visual impairment and trainers at schools for the blind in Delhi

The aim of the study was to assess the availability of assistive technology (AT) for visual impairment and trainers in schools for the blind in Delhi. A cross-sectional study was conducted in 22 of the 24 schools in Delhi. The headteacher of each school was asked about availability of 52 ATs divided into writing, reading, math, sciences, sports, mobility, and daily living, using a questionnaire. Information on availability of trainers was also collected. Of the 52 ATs, the most frequently available were Braille slate with stylus and abacus (>90% of schools), followed by Taylor frame, long cane and talking watch (80% to 90% of schools). Only 11 of 52 AT devices were available in 60% or more of the schools. Tactile-based ATs were more available than vision-based ATs. In the 22 schools, 63 trainers for reading & writing were available (80% of posts), 18 for sciences (59%), 25 for math (70%), and 11 for mobility (50% of posts). Except Braille slate and stylus, there is a huge shortage of AT in these schools. The educational needs and performance of students could be helped by developing and using a list of priority Assistive Products for example, the WHO AP list.

Liposomal amphotericin B-induced reversible ototoxicity in a patient with disseminated histoplasmosis

Amphotericin B (AmB) is a polyene antifungal agent used widely for systemic fungal infections. Infusion-related side effects, nephrotoxicity, and dyselectrolytemia are well-known adverse effects with the use of this drug. Liposomal preparation of AmB has less adverse events. However, ototoxicity due to AmB is scarcely mentioned in the literature. We report a case of disseminated histoplasmosis who was treated with liposomal amphotericin B (LAmB) and developed hearing loss during the treatment, which recovered after discontinuing the drug. This is a rare adverse effect of LAmB and reported only once from India, to the best of our knowledge.

Exceedances and trends of particulate matter (PM2.5) in five Indian megacities

Fine particulate matter (PM_2.5) is the leading environmental risk factor that requires regular monitoring and analysis for effective air quality management. This work presents the variability, trend, and exceedance analysis of PM_2.5 measured at US Embassy and Consulate in five Indian megacities (Chennai, Kolkata, Hyderabad, Mumbai, and New Delhi) for six years (2014-2019). Among all cities, Delhi is found to be the most polluted city followed by Kolkata, Mumbai, Hyderabad, and Chennai. The trend analysis for six years for five megacities suggests a statistically significant decreasing trend ranging from 1.5 to 4.19 μg/m³ (2%-8%) per year. Distinct diurnal, seasonal, and monthly variations are observed in the five cities due to the different site locations and local meteorology. All cities show the highest and lowest concentrations in the winter and monsoon months respectively except for Chennai which observed the lowest levels in April. All the cities consistently show morning peaks (~08: 00-10:00 h) and the lowest level in late afternoon hours (~15:00-16:00 h). We found that the PM_2.5 levels in the cities exceed WHO standards and Indian NAAQS for 50% and 33% of days in a year except for Chennai. Delhi is found to have more than 200 days of exceedances in a year and experiences an average 15 number of episodes per year when the level exceeds the Indian NAAQS. The trends in the exceedance with a varying threshold (20-380 μg/m³) suggest that not only is the annual mean PM_2.5 decreasing in Delhi but also the number of exceedances is decreasing. This decrease can be attributed to the recent policies and regulations implemented in Delhi and other cities for the abatement of air pollution. However, stricter compliance of the National Clean Air Program (NCAP) policies can further accelerate the reduction of the pollution levels.

Oral cancer incidence trends in Delhi (1990-2014): An alarming scenario

Background:

Oral cancer ranks in the top three of all cancers in India, which accounts for over 30% of all cancers reported in the country, and oral cancer control is quickly becoming a global health priority. We have conducted an age period analysis of oral cancer incidence trends using the Population-Based Cancer Registry (PBCR) data in Delhi over a 24-year period (1990–2014) to address the trends of one of the leading cancer sites in Delhi.

Materials and Methods:

The data of oral cancer proportion and incidence for the year 1990–2014 were taken from Delhi PBCR which records cancer cases from more than 180 government and 250 private facilities. The data were segregated by sex, age, and anatomical site and were analyzed to calculate age-specific incidence rates and expressed in cases per 100,000 persons/year.

Results:

The highest incidence for both genders was seen in the age group 50–59 years and the lowest incidence for both genders was in youngest age group (<20 years) for all the years from 1990 to 2014. The relative proportion of oral cancer among all types of cancer in Delhi has shown alarming rise from the year 2003 onward.

Concusion:

Increasing relative proportion of oral cancer can be implicated in increased consumption of gutkha chewers in the last decade of the 20^th Century. As access to health-care services and cancer-related awareness is highly variable in India, more in-depth analysis of the incidence of oral cancer in rural regions will be required.

Prevalence and risk factors of soil-transmitted helminth infections in school age children (6-14 years) - A cross-sectional study in an urban resettlement colony of Delhi

Background

Soil-transmitted helminth (STH) infections have adverse physical and mental effect, especially in preschool (3-6 years) and school-age children (6-14 years). They are associated with socio-behavioral factors of poverty and poor personal and community hygiene.

Objectives

To determine the prevalence, intensity, and the type of helminths infection harbored by the school age children (6-14 years) and to examine the relationship between STH infection and their potential risk factors and associated variables.

Methods

This cross-sectional study was conducted from January to December 2016 among 250 school age children residing in an urban resettlement colony of East Delhi. Data were collected using a semistructured interview schedule. Stool sample was tested using the Kato Katz technique. Data were analyzed in SPSS software version 16, and multivariable regression analysis was done to calculate the odds of various risk factors.

Results

The prevalence of STH was found to be 54.8%, and majority (85.3%) of Ascaris and all Trichuris infections were of light intensity. Multivariable logistic regression analysis confirmed that children having poor handwashing behavior in school, irregular handwashing before eating, having pica, and lack of de-worming had higher odds of having STH infection.

Conclusion

The prevalence of STH in the study area is substantially high, and the findings suggest that besides mass de-worming strategy, behavior change, and improvement in hygiene are required to control STH.

Assessment of cold chain equipments and their management in government health facilities in a District of Delhi: A cross-sectional descriptive study

Background

Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013.

Objectives

The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi.

Methods

The assessment was done during December 2017-March 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection.

Results

Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management.

Conclusion

There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.

Diurnal and temporal changes in air pollution during COVID-19 strict lockdown over different regions of India

Lockdown measures to contain COVID-19 pandemic has resulted in a considerable change in air pollution worldwide. We estimate the temporal and diurnal changes of the six criteria air pollutants, including particulate matter (PM2.5 and PM10) and gaseous pollutants (NO2, O3, CO, and SO2) during lockdown (25th March - 3rd May 2020) across regions of India using the observations from 134 real-time monitoring sites of Central Pollution Control Board (CPCB). Significant reduction in PM2.5, PM10, NO2, and CO has been found in all the regions during the lockdown. SO2 showed mixed behavior, with a slight increase at some sites but a comparatively significant decrease at other locations. O3 also showed a mixed variation with a mild increase in IGP and a decrease in the South. The absolute decrease in PM2.5, PM10, and NO2 was observed during peak morning traffic hours (08-10 Hrs) and late evening (20-24 Hrs), but the percentage reduction is almost constant throughout the day. A significant decrease in day-time O3 has been found over Indo Gangetic plain (IGP) and central India, whereas night-time O3 has increased over IGP due to less O3 loss. The most significant reduction (∼40-60%) was found in PM2.5 and PM10. The highest decrease in PM was found for the north-west and IGP followed by South and central regions. A considerable reduction (∼30-70%) in NO2 was found except for a few sites in the central region. A similar pattern was observed for CO having a ∼20-40% reduction. The reduction observed for PM2.5, PM10, NO2, and enhancement in O3 was proportional to the population density. Delhi's air quality has improved with a significant reduction in primary pollutants, however, an increase in O3 was observed. The changes reported during the lockdown are combined effect of changes in the emissions, meteorology, and atmospheric chemistry that requires detailed investigations.

Socioclinical profile of patients seeking treatment for cancer in a Teaching hospital in east Delhi, India

Background

Prevalence of cancer in urban India is seeing a discernible increase due to lifestyle modifications and adverse environmental exposures. The pattern of cancer incidence varies from one region to another within a large country like India.

Aim and Objectives

This study was conducted to understand the socioclinical profile of the patients attending a tertiary care hospital in east Delhi for the treatment of cancer.

Methods

Patients above the age of 18 years, who had been diagnosed with cancer, were recruited for our study and their socioclinical details were elicited. After 3 months they were reassessed and their treatment and side-effect profile were studied.

Results

Majority of our patients were diagnosed with cancers of the oral cavity and were married men in age group of 40-60 years, residing in the National Capital Region. Patients diagnosed with breast cancer were more likely to receive chemotherapy and suffer from side effects of treatment like nausea, anorexia, and loss of weight.

Conclusion

Physicians need to be aware of these complications and should incorporate a proper counselling mechanism before treatment is started in such patients. Family physicians play a defining role in the palliative management since he remains a trusted face in his community and can provide professional and psychotherapeutic support.

Social stigma among tuberculosis patients attending DOTS centers in Delhi

Background:

Every year >9 million people suffer from tuberculosis (TB) and India accounts for >25% of global TB burden. Tuberculosis patients experience both psychological and social suffering. Amongst the problems met by tuberculosis patients, social stigma has been increasingly recognized. This study was done to assess social stigma and associated factors among the tuberculosis patients attending Directly Observed Treatment Short-course (DOTS) centers in South East Delhi.

Material and Methods:

It was a cross-sectional study carried out among tuberculosis patients availing treatment from DOTS centers of South East Delhi. Out of 48 DOTS centers in South East Delhi, 6 centers were selected on the basis of population proportion to size. A total of 270 TB patients were interviewed using a semi-structured, pretested questionnaire consisting of stigma-based questions. Fisher exact and Chi-square test applied.

Results:

The mean age of patients was 31.5 years (SD ± 11.5) with age ranging from 18 to 77 years. Males were higher (57.4%) compared to females (42.6%). 123 (45.5%) perceived stigma with family/friends and 92/158 (58.2%) perceived stigma at workplace. Young patients (<30 years), males faced more stigma at workplace and lower socioeconomic class faced higher stigma with family and friends (P < 0.05).

Conclusion:

There is still higher stigmatization faced by patients with TB at family/friends and at workplace. Motivation by friends/family and support at workplace has been crucial in achieving successful treatment outcomes.