Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

Background: Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups. Methods: We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores. Results: Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08). Conclusion: Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for healthcare provision strategies to take account of both sectors

Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: A mixed methods study

Background: Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. Methods: The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Results: Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. Conclusions: In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour

Comparison of aerosol products retrieved from AERONET, MICROTOPS and MODIS over a tropical urban city, Pune, India

Aerosol Optical Depth (AOD) measurements from Aerosol Robotic NETwork (AERONET; level 2.0), Microtops - II sun-photometer and MODerate Resolution Imaging Spectroradiometer (MODIS) (Terra and Aqua; level 2, collection 5, dark target) were compared and used to characterize aerosols over Pune, India. AODs from Microtops and MODIS were compared with those measured by AERONET to evaluate the measurement quality. To the best of our knowledge, this is the first systematic comparison of MODIS aerosol products over Pune, India. The results of the analysis show that during 2008-10, 68 to 84 of the MODIS AODs fell within an expected error, as defined by the MODIS science team, and thus the retrievals from this system are validated and accepted. In addition, during pre-monsoon periods MODIS retrievals are better-matched with ground-based measurements. On the seasonal scale, MODIS retrievals corroborate well with ground-based measurements, with correlation coefficients ranging from 0.62 to 0.93. Despite an overall satellite-ground agreement, MODIS tends to under-estimate AOD during winter, and this may be due to improper assumptions of surface reflectance and the incorrect selection of aerosol types. AERONET retrieved single scattering albedo (SSA) values in winter (0.82-0.86), suggesting the dominance of absorbing aerosols, slightly increased (0.87-0.89) in pre-monsoon season, indicating more scattering type of aerosols. These values are about 8.9-1.1 lower than those of the assumed SSA values in the MODIS algorithm

Generalised Decision Level Ensemble Method for Classifying Multi-media Data

In recent decades, multimedia data have been commonly generated and used in various domains, such as in healthcare and social media due to their ability of capturing rich information. But as they are unstructured and separated, how to fuse and integrate multimedia datasets and then learn from them eectively have been a main challenge to machine learning. We present a novel generalised decision level ensemble method (GDLEM) that combines the multimedia datasets at decision level. After extracting features from each of multimedia datasets separately, the method trains models independently on each media dataset and then employs a generalised selection function to choose the appropriate models to construct a heterogeneous ensemble. The selection function is dened as a weighted combination of two criteria: the accuracy of individual models and the diversity among the models. The framework is tested on multimedia data and compared with other heterogeneous ensembles. The results show that the GDLEM is more exible and eective

Dark matter-baryons separation at the lowest mass scale: the Bullet Group

We report on the X-ray observation of a strong lensing selected group, SL2S J08544-0121, with a total mass of $2.4 \pm 0.6 \times 10^{14}$ $\rm{M_\odot}$ which revealed a separation of $124\pm20$ kpc between the X-ray emitting collisional gas and the collisionless galaxies and dark matter (DM), traced by strong lensing. This source allows to put an order of magnitude estimate to the upper limit to the interaction cross section of DM of 10 cm$^2$ g$^{-1}$. It is the lowest mass object found to date showing a DM-baryons separation and it reveals that the detection of bullet-like objects is not rare and confined to mergers of massive objects opening the possibility of a statistical detection of DM-baryons separation with future surveys.Comment: 5 pages, 3 figures. Accepted for publication in MNRAS Letters. Typos correcte