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  • Title: Measuring the interactions of the determinants of health.
    Author: Mukhopadhyay SP, Seal SC, Mitra J, Das KK.
    Journal: Indian J Public Health; 1993; 37(4):114-24. PubMed ID: 8076999.
    Abstract:
    Considering environmental sanitation and health care services as most important determinants of health, this study was undertaken to know their impacts in an urban slum area of Calcutta. The families were studied in-depth and detail in relation to their health status in the form of morbidities and utilisation of preventive and promotive services. The health service impact was mainly assessed through comparative study between these who availed the services and to these who did not. Similarly, environmental sanitation services impact on health was measured through comparing the slum group with those who lived in Pucca houses. The criteria of priority decision on determinants was attempted through analysis of cost of these services and comparing their beneficial effects on health. The study was undertaken in urban slums of Calcutta and at the Urban Health Center, Chetla (UHC), a field practice area of the All India Institute of Hygiene and Public Health, Calcutta. The first community received only health care services but no environmental sanitation services, the second one received only environmental services but no health care services, the third community had both health care and environmental services, and the fourth had none. Each of the 4 groups consisted of 80 families. Those who took advantage of the UHC health care services were compared to those who did not. Similarly, the impact of environmental sanitation services on health was measured through comparing the group who lived in pucca houses (multistoried flats). 2 groups each in pucca houses and slums primarily used UHC comprehensive health care services, while the groups who did not take advantage of UHC services used hospitals (88% in pucca houses and 96% in slums) and private practitioners (24% in pucca houses and 11% in slums). The incidence of sickness per 100 persons in 2 residential areas was significantly higher among slum dwellers in all ages and sex groups (79% for males [p 0.05], 83.5% for females, and 81.1% for children) as compared to those residing in pucca houses (59.8%, 54%, and 57.2%, respectively). For all ages taken together, females suffered comparatively more than males among slum dwellers, whereas this was the reverse among pucca house residents. The incidence rates were significantly lower among beneficiaries of UHC than among those who did not use the services except for the age group 5 years. The sickness rate was around 63% for all ages vs. around 74% of those not using UHC. Analysis of variance substantiated that both type of residence and utilization of UHC had a significant impact (p 0.01) on the morbidity rates and the average duration of sickness per person, but the effects of utilization of services was not more than 3 times that of residence.
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