Taking in to account the above facts and as per recommendations of the World Health Organization (W.H.O.) study group in 1957,that in order to get a comprehensive picture of a disease or health related matter, more and more such studies have to be carried out, Garg Narenra K.(3) and Garg Narenra K. and Sharma A.B.(4), the authors have under taken this study with the objective to find out the cultural factors and social relations in connection with illness and the social principles in medical organization and treatment. Taking in to account the above facts and as per recommendations of the World Health Organization (W.H.O.) study group in 1957,that in order to get a comprehensive picture of a disease or health related matter, more and more such studies have to be carried out, Garg Narenra K.(3) and Garg Narenra K. and Sharma A.B.(4), the authors have under taken this study with the objective to find out the cultural factors and social relations in connection with illness and the social principles in medical organization and treatment.

MATERIAL AND METHODS:

This study was undertaken in an urban slum of Nagpur city (M.S.).This being a slum area, the houses were mostly kachha. Residents of slum were taking water from public well and corporation taps, the supply was interrupted. There were very few public latrines but not in use. Majority of people belong to low socio-economic category, most of them were working as laborers. An urban health centre, govt. aaurvedic hospital/dispensary, mobile health clinic and private practitioners were situated in and around the slum that were in sufficient in fulfilling the health needs of the residents.

In this study, a broad approach "situational analysis" of operational research (5 and6)was used by interviewing the adult sampled population of both sexes belonging to all religion viz. Hindu, Muslims, Sikhs, Christians, Boddha etc. The relevant reply from the respondents was recorded in their own words and has been classified in six headings and sub headings (7).

OBSERVATIONS AND DISCUSSIONS:

The data thus collected were analyzed and interpretation was drawn accordingly.

(1).Lack of awareness:

(a).Fear of side effects of allopathic medicine-not taking in full course or in doses as per prescribed by the consulting "Chikistak", leading to resistance of drugs or desired effects were not achieved.

(b)Family Planning-

(i).Male Sterilization –lead to lack of libido etc.

(ii)Female Sterilization –-Obesity / Backache-may lead to lack of morality in the society

(iii).Cu.-T, -Backache-heavy menses etc.

(c).Nutrition –

(i).Nutrition during pregnancy--less diet otherwise baby will be heavy which may lead to difficulty in delivery, hence mother is deprived of proper nutrition and both mother and child become anemic.

Papaya causes abortion hence papaya is not offered to pregnant woman hence there are chances of Vitamin-A deficiency.

(ii).Adolescent girls take less diet to remain slim may lead to be anemic.

(iii).Ghee-Keep the mind cool, sharpen memory and increase intelligence

(iv).Egg – cholesterol which may cause heart problems/ heat up the body.

(v).Jiggery – heat up the body

(vi).Buffalo Milk – blunt intellectuality.

(vii).Diet during illnesses specifically during fever- rice is not taken because rice increases fever.

(viii). Costlier fruits provide more energy/nutrition.

(2).Religious :

(a)Fasts – in some religion fasts are advocated - too many fasts weaken the body.

(b)Family Planning –

(i)Children are gift of "God".

(ii)Every man has to be married and every couple must have a son.

(c)Diet –specifically non-vegetarian diet not advocated in some religion.

(d).Child Marriage –-marriages are fixed in heaven. - Girl must be married even before starting of menses to earn "Punya".

(e) Illnesses is because of our past sins.

(f) Measles/chicken pox is the result of "Goddess" is not pleased.

(3) Lack of motivation :

(a) To seek early health care.

(b) To take full course of medicine as per prescription of the "Chikishak".

(c) Lack of faith in one system of treatment specially"Allopathic" resulting patient frequently changes the system –from allopathic to aayurvedic / traditional unscientific system of cure viz.Jhaad-phook /Jaadoo-tona/Ganda-taaviij/ Kala-teeka to protect from evil eye etc.

(d) Rumors- specially at govt. health facilities-

(i). about quality of medicine

(ii).Lab investigations

(iii).Behavior of health personnel.

(4) Obstacles –

(a) Insufficient health facilities /situated far away.

(b) Rush or health personnel were not reaching in time particularly in govt. health facilities, patients have to wait for long time.

(d) Time inconvenient because of pre engagement of the community personnel.

(5)Traditions and Culture :

(a) First feed of new-borne – Honey/Glucose water / Some "Ghuti" etc.

(b). Initiation of breast (mother) milk to new borne after "Chhati" (8).

(d).Weaning- weaning was not done as per recommended time generally too late and food was not as per recommendations, just giving Biscuits etc.

(e).Cooking specially washing of rice too much time taken for washing rice resulting water soluble vitamins washed away.

(f). Pulses –specifically Arhar- Dhal -is consumed because it was a tradition coming from generation to generation.

(g).Men eat first –women in the last.

(h) Toilets were built for the community but remaining unused because there was tradition to go to open field for defecation, thus providing sanitation was flawed.

(6).Miscellaneous :

(a).Discrimination in bringing up of children on account of sex (9),

(b).Domestic violence.

(c).Negligence of women in health care.

(d).Indiscriminate use of drugs specially pain killers.

(e).Pressure of Peer groups for do or do not.

Modern India continues to be plagued by social and health ills like child marriage, early mother hood and domestic violence. Latest data in the state of the world's children report-2012 released by UNICEF shows that almost 22% women in India now aged between 20 and 24 years gave a birth to a child before turned 18 (10).

Almost 45 among every 1000 children are born to mothers in the 15-19 age brackets. Shockingly, around 57% of male adolescents (aged 15-19) and 53% of female adolescents thought a husband was justified in beating up their wives under certain circumstances.

Around two in four people in urban India and one in five in rural settings used improved sanitation facilities. Almost one in three newborns is borne with a low birth weight, with less than 50%children being breast fed by their mothers. A child born in a slum in urban India is as likely to die before the first birth day, to become under weight or anemic or to be married off before the18th birth day as a child in rural India. Un fortunately for the urban poor child, the situation is not as visible and gets diluted by a much rosier picture of urban life. Great inequities are found within towns and cities, where great opportunities and great deprivation exists side by side, Karin Hulshof, UNICEF representative to India (10).

According to UNICEF, more than 40%of the world's child marriages still occur in India. Worldwide, more than 60 million women between 20 and 24 years were married before they turned 18.

According to the National family health survey, about 10 millions girls are married each year before the age of 18 worldwide –one third of them live in India. Child marriage is prohibited by law in India .However ,the latest available government survey found 48%of women (aged 20 and 24) were married or in union before the age of 18 ,and almost one in five was married or in union before she turned 15 (10).

Indians enjoy a better standard of living than a decade ago but they are spending on TV sets and mobile phones rather than sanitation, a decadal census of house hold amenities and assets revealed (1). Mihir Shah, planning commissioner, member in-charge of rural development, admitted that the approach of providing sanitation was flawed. We have tried to build toilets for all without ensuring quality resulting many of them remaining un used.

As many as 92%mothers either don't know of the term "malnutrition" or are unaware of the fact that poor nutrition causes more than 50%deaths of children below five years of age in the country. Malnutrition makes people, especially women and children susceptible to various diseases (2)."Educating women is a tested solution," said Sir Michael G Marmot, chair, European review on social determinants of health and health divide. Experts feel that education will also help eradicate problems such as lack of awareness, gender bias and low access to government facilities in uplifting the living standard of people at the base of pyramid.

India's abysmally low doctor-patient ratio, one doctor for 1,953 people or a density of 0.5 doctors per 1,000 population in comparison to WHO's recommended norm of one doctor per 1000 people, coupled with acute shortage of nurses and health delivery personnel is a matter of concern (11).The Prime Minister's Office (PMO) is pushing for an early introduction and passage of the National Commission on Human Resources in Health (NCHRH) for "Building human resources for health by producing adequate number of doctors, nurses, auxillary nurse midwives, other paramedics in vital" bill in parliament. The planning commission high-level expert group (HLEG) recently suggested the setting up of a Public Health Service Cadre that would be responsible for all public health functions starting at the block level, and going up to state and national levels.

Delhi recorded one of the lowest death rates in India in2010 with four out of every 1000 people dying that year. According Union health secretary PK Pradhan, "Overall ,life expectancy in Indian is increasing with better nutrition and health care availability "Former union health secretary K Chandramouli added that "major growth in health infrastructure – more number of community health centers ,primary health centers and district hospitals is a major reason .Better emergency care services also contributed" (12).

Doctors say that more and more youth are self –medicating and overusing painkillers, unaware of the danger that it can even take their lives (13).

The study involving nearly 56,000 women with at least one child concluded that mothers who exclusively breastfed for at least six months were less likely to develop hypertension over a 14-year period than those who bottle-fed (14).

Mothers struggling to get their babies to sleep should consider cutting back on their own caffeine intake. Drinking coffee, tea, soft drinks and even eating chocolate increases the level of the stimulants in the mother's blood, which is passed on babies on breast fed, making them sleepless, restless and irritable(15). Babies cannot remove caffeine from their bodies; especially in their first two weeks of life. Ideally, new mums should not have more than 300 mg of caffeine –equivalent to three cups of coffee a day.

For many people, the key question regarding fasting is whether it's good or bad for health. Now ,a new study says that skipping meals for a couple of days (one or two days) a week could help a person live longer because it can protect the brain against Alzheimer's, Parkinson's and other degenerative brain conditions(16).

Researchers at the University Hospital in South Manchester in Britain put 115 women volunteers on one of three diets for the study. The first involved sticking to just 650 calories a day for two days of the week, including cutting out carbohydrates such as pasta, bread and potatoes and all fatty foods. For the other five days, they could eat as much as they liked, although they were encouraged to stick to healthy foods. Women on the second diet were also banned from carbohydrates for two days of the week but they did not have a specific calorie limit .They could also eat as much as they wanted the rest of the week. The third group followed a standard weight-loss diet, which involved sticking to about 1,500 calories every day and avoiding high –fat foods and alcohol. They found that women who stuck to fruit, vegetables and lean meat for two days a week while being allowed to eat as much as they liked on other days lost nearly twice as much weight than those on the full-time diet (17).

Women, better multi-taskers in comparison to their male counter parts (18), in spite of this there are reports of gender bias and even domestic violence.

The findings of the present study were more or less in accordance of the findings of different studies conducted across the globe by different authors and national and international organizations like WHO and UNICEF etc.

Popcorn –seems to be the latest "nutritional golden nugget". Scientist report popcorn, which is a 100% unprocessed grain, contains more of the highly healthy antioxidant substances called polyphenols than fruits and vegetables if it is not dipped in butter, oil or salt. The hulls of popcorn –the part that everyone hates for its tendency to be caught in the teeth –has been found to have the highest concentration of polyphenols and fiber. The levels of polyphenols rivaled those in nuts and were up to 15 times greater than whole grain tortilla chips. Joe Vinson from the university of Scranton in Pennsylvania, who has been pioneer in analyzing healthful components in chocolate, nuts and other common food items ,presented these findings at the American Chemical Society's (ACS) Scientific society on Sunday (25-03-2012) said one serving of popcorn will provide more than 70%of the daily intake of whole grain needed by an adult. The scientist further added "Popcorn may be perfect snake food .It is 100% unprocessed whole grain as against all other grains which are actually processed and diluted with other ingredients –meaning only 51% of the product is whole grain. The average person only gets about half a serving of whole grains a day and popcorn could fulfill that gap in a very pleasant way"(19). Vinon however cautioned the finding should not make people give up fruits and vegetables."Popcorn cannot replace fresh fruits and vegetables in a healthy diet. Fruits and vegetables contain vitamins and other nutrients that are critical for good health, but are missing from popcorn". Vinson explained that the same concentration principle applies to dried fruit, which holds a polyphenol edge over regular fruit. Another scientist, Jyoti Arora, head of nutrition at Artemis Health Institute, said popcorn's high content of fiber makes it nutritious and healthy. Whole grains like popcorn are high in fiber that helps in relieving constipation and leads to weight loss, better blood sugar control levels under check.

Telemedicine to boost health services – Skype, biometrics, M-health (use of mobile phones )and E-health are all set to make entry in to India's primary health centers (PHC's) and Sub health centers as the health ministry steps on the gas to go hi-tech."The overreaching goal is to develop a biometric health information system, which begins with universal vital registration, is portable and accessible to service providers and to the families themselves. Based on this foundation, a net work links all service providers, public and private laboratories and also generate figures at different levels for policy making as well as generates the alerts needed for disease surveillance" (20).

From above observations and discussions, the authors reached to the conclusion that the present efforts are succeeded in bringing awareness in the community up to some extent but still a lot have to do. There is a wide gap between the knowledge and practices of the people, sooner this gap is filled better will be the results. Hence, every effort must be made to bridge this gap. This is possible among other things by (i)unearthing the factors responsible for undesirable ,unscientific knowledge of the people by conducting more and more Knowledge ,Attitude and Practices (KAP) studies .The findings of these studies will act as pegs on which to hang new knowledge.

For bringing awareness proper use of traditional and modern medias i.e. media mix will be helpful to reach the target groups. (ii)By strengthening the democratic alliance of key players viz. the patients, people around them and service providers. So all these three frankly and freely exchange their views about fears, concern, prejudices and problems etc. and not only seek help but also extend their help in whatever form, where ever and when ever desired. Free medical camps are one of the best means for operationalisation of the strategy. These camps must organized by "Jan- Bhagidari", using medico-technical service providers. To facilitate these camps community contribute by providing volunteers and venue as well as by publicizing the events /camps (venue, time, and date/day etc.) in the catchments area. This approach also helps to reduce the stigma attached to various aspects of disease by providing health education and in early detection of cases if any. These camps can be organized at low cost and do not need any additional budget (21)). (iii) Educating women is a tested solution (2) for the treatment of all the ills of society, hence no stone left unturned to achieve this noble task of educating the women.

ACKNOWLEDGEMENT:

Authors are thankful to Dr. A. K Bansal, Ex-Professor and HOD, Dept. of Community Medicine, Govt. Medical College, Jagdalpur (Bastar) for his guidance and encouragement in preparing this manuscript.

REFERENCES:

1. Mihir Shah. Good news from census: Indians better off, but ignore sanitation; Hindustan Times, New Delhi, March 14, 2012

2. Sir Michael G Marmot : Girl's education must to tackle malnutrition ,say experts : Hindustan Times, New Delhi,February,28,2012 .

3. Garg Narendra K.: Evaluation of the impact of emesis and emesis plus purgation therapy; Research J Pharmacology and Pharmacodynamics:2 (2) March-April;2010:201-202.

4. Garg Narendra K and Sharma A.B. : Epidemiological profile of patients attending a tertiary care hospital, Muktsar, Punjab (India); Research J Pharmacology and Pharmacodynamics:3 (6) November-December;2011:311-317.

5. Park J.E. : Text Book of Preventive and Social Medicine (Treatise on Community Health) 1^st Edition (1970) ; M/S Banarsi Das Bhanot, Jabalpur,India:p.p.542-598.

6. Bansal, A.K. and Govila, A.K. ; Quality of services under ICDS in a rural block : India :J of Ravishankar University : Vol.10,No. B (Science) 1997: pp 71-81.

7. Bansal, A.K. and Chandorkar, R.K.; Immunization status of tribal and non tribal children of Raipur district ,Madhya Pradesh; Tribal Health Bulletin (ICMR) 1997 Vol.3 :No.2 pp12-14.

8. Bansal, A.K. and Chandorkar, R.K.; Knowledge, belief and practice :a study of tribal mothers about feeding of infants : Tribal Health Bulletin (ICMR) 1993 Vol.2 :No.3and6 pp1-2

9. Karin Hulshof: 22% of mothers under 18, finds UNICEF study; The Times of India, New Delhi:02-03-2012;pp10.

10. Bansal A.K., Ashok K Agarwal and Govila A.K.; Status of the girl child amongst tribes and non tribes in the un-reached rural India: J of Ravishankar University : Vol.11-12,No. B (Science) 1998-99: pp 31-36.

11. PMO pushing to ramp up poor doc-patient ratio: The Times of India, New Delhi; 08-03-201 2: pp10.

12. Delhi death rate among lowest; Sunday Times of India, New Delhi: 12-02-2012; pp06.

13. Painkiller abuse drills holes in teen's stomach; The Times of India, New Delhi; 20-03-2012..

14. Breast feeding cuts blood pressure risk in women; The Times of India, December 28, 2011; pp13.

15. Mom's caffeine spikes breast milk; Sunday Hindustan Times, New Delhi, and February 26, 2012: pp16.

16. Fasting once or twice a week could help you live longer; The Times of India, New Delhi, February 27. 2012 : pp11.

17. Want to cut flab? Try strict diet for just two days /week; Sunday Times of India, New Delhi.

18. (18)Barbara Schneider et. al. :Women, Better Multi-Taskers; Sunday Hindustan Times, New Delhi, December 04,2011:pp16.

19. "Popcorn is healthier than fruits" packs more punch than veggies with higher antioxidant content : Study ;The Times of India, New Delhi :28-03-2012; pp-12.

20. Telemedicine to boost health services; The Times of India, New Delhi :19-03-2012 :pp06..

21. Bansal A.K. and Garg Narendra K.: Information, Education and Communication in context of Reproductive and Child health including H.I.V./AIDS; J. of Ravishankar Uni.vol.14:No.B (Science)2001; pp.28-34.

Received on 23.03.2012

Modified on 18.04.2012

Accepted on 26.04.2012

Research J. Pharmacology and Pharmacodynamics. 4(5): September –October, 2012, 267-271