Considering the widespread transmission of Coronavirus disease (COVID-19) globally, India is also facing the same crisis. As India already has inadequate waste treatment facilities, and the sudden outbreak of the COVID-19 virus has led to significant growth of Bio-medical waste (BMW), consequently safe disposal of a large quantity of waste has become a more serious concern. This study provides a comprehensive assessment of BMW of India before and during the COVID-19 pandemic. Additionally, this article highlights the gaps in the implementation of BMW rules in India. This study uses various government and non-government organizations, reports and data specifically from the Central Pollution Control Board (CPCB). The finding of the study demonstrated that most of the States/Union Territories (UTs) of India are lacking in terms of COVID-19 waste management. India has generated over 32,996 mt of COVID-19 waste between June and December 2020. During this period, Maharashtra (789.99 mt/month) is highest average generator of COVID-19 waste, followed by Kerala (459.86 mt/month), Gujarat (434.87 mt/month), Tamil Nadu (427.23 mt/month), Uttar Pradesh (371.39 mt/month), Delhi (358.83 mt/month) and West Bengal (303.15 mt/month), and others respectively. We draw attention to the fact that many gaps were identified with compliance of BMW management rules. For example, out of all 35 States/UTs, health care facilitates (HCFs), only eight states received authorization as per BMW management rules. Moreover, the government strictly restricted the practice of deep burials; however, 23 States/UTs are still using the deep burial methods for BMW disposal. The present research suggests that those States/UTs generated on an average of 100 mt/month COVID-19 waste in the last 7 months (June–December 2020) should be considered as a high priority state. These states need special attention to implement BMW rules and should upgrade their BMW treatment capacity.
Background: Despite the reduction in the maternal mortality ratio, Obstetric care service (OCS) barriers remain the significant risk factor for adverse maternal and perinatal outcomes in India. This review is relevant because it covers all three obstetric care components (ANC, child delivery, and PNC services) and identifies multiple barriers from provisioning to utilization of OCS in India. We conducted a systematic review to address the barriers in utilization and provisioning of OCS in India using a mixed-method review.
Methods: PubMed, Scopus, Web of Science, Google scholar, and Science direct databases were searched from 1st January 2000 to 30th June 2022. The methodological quality of included studies was assessed using appropriate tools. We have included 56 studies (33 quantitative, 18 qualitative, and 5 mixed method studies) after 164 full texts review. All the barriers are classified into five major themes, i.e. (i) individual and interpersonal barriers, (ii) social and cultural barriers, (iii) structural barriers, (iv) logistical barriers, and (v) organization barriers. Thematic synthesis approach was used to present the findings from included studies.
Results: Lack of knowledge and awareness, and less family support in availing the required OCS were key individual and interpersonal barriers. Negative social and cultural practices such as belief in traditional herbs/healers, dietary restrictions, and discarding colostrum were frequently reported barriers especially in rural settings. Poor economic status and high health service costs were the most reported barriers to low institutional delivery and delayed ANC services. Additionally, long distances to health facilities and poor road conditions were the most frequent logistical barriers. On the provisioning side, poor quality of treatment, shortage of drugs and equipment and non-cooperative attitude of health professionals were the most significant barriers.
Conclusion: Governments should take necessary steps to tackle the mentioned barriers and encourage women to make their own health decisions. Keywords: Obstetric care service; Barriers; Maternal Health; Systematic Review; India
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