As per the Census data dated 2011, the slum dwellers population in Mumbai was the highest among all other major metropolitan cities of India, at around ************. Hyderabad and Delhi followed it. A total of about ** million people were estimated to be living in slums across the country.

Abstract

The National Family Health Surveys (NFHS) programme, initiated in the early 1990s, has emerged as a nationally important source of data on population, health, and nutrition for India and its states. The 2005-06 National Family Health Survey (NFHS-3), the third in the series of these national surveys, was preceded by NFHS-1 in 1992-93 and NFHS-2 in 1998-99. Like NFHS-1 and NFHS-2, NFHS-3 was designed to provide estimates of important indicators on family welfare, maternal and child health, and nutrition. In addition, NFHS-3 provides information on several new and emerging issues, including family life education, safe injections, perinatal mortality, adolescent reproductive health, high-risk sexual behaviour, tuberculosis, and malaria. Further, unlike the earlier surveys in which only ever-married women age 15-49 were eligible for individual interviews, NFHS-3 interviewed all women age 15-49 and all men age 15-54. Information on nutritional status, including the prevalence of anaemia, is provided in NFHS3 for women age 15-49, men age 15-54, and young children.

A special feature of NFHS-3 is the inclusion of testing of the adult population for HIV. NFHS-3 is the first nationwide community-based survey in India to provide an estimate of HIV prevalence in the general population. Specifically, NFHS-3 provides estimates of HIV prevalence among women age 15-49 and men age 15-54 for all of India, and separately for Uttar Pradesh and for Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Tamil Nadu, five out of the six states classified by the National AIDS Control Organization (NACO) as high HIV prevalence states. No estimate of HIV prevalence is being provided for Nagaland, the sixth high HIV prevalence state, due to strong local opposition to the collection of blood samples.

NFHS-3 covered all 29 states in India, which comprise more than 99 percent of India's population. NFHS-3 is designed to provide estimates of key indicators for India as a whole and, with the exception of HIV prevalence, for all 29 states by urban-rural residence. Additionally, NFHS-3 provides estimates for the slum and non-slum populations of eight cities, namely Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur. NFHS-3 was conducted under the stewardship of the Ministry of Health and Family Welfare (MOHFW), Government of India, and is the result of the collaborative efforts of a large number of organizations. The International Institute for Population Sciences (IIPS), Mumbai, was designated by MOHFW as the nodal agency for the project. Funding for NFHS-3 was provided by the United States Agency for International Development (USAID), DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW. Macro International, USA, provided technical assistance at all stages of the NFHS-3 project. NACO and the National AIDS Research Institute (NARI) provided technical assistance for the HIV component of NFHS-3. Eighteen Research Organizations, including six Population Research Centres, shouldered the responsibility of conducting the survey in the different states of India and producing electronic data files.

The survey used a uniform sample design, questionnaires (translated into 18 Indian languages), field procedures, and procedures for biomarker measurements throughout the country to facilitate comparability across the states and to ensure the highest possible data quality. The contents of the questionnaires were decided through an extensive collaborative process in early 2005. Based on provisional data, two national-level fact sheets and 29 state fact sheets that provide estimates of more than 50 key indicators of population, health, family welfare, and nutrition have already been released. The basic objective of releasing fact sheets within a very short period after the completion of data collection was to provide immediate feedback to planners and programme managers on key process indicators.

Geographic coverage

• National (29 states )
• Regional (for HIV Prevalence : Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Tamil Nadu)
• Local (population and health indicators for slum and non-slum populations for eight cities, namely Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur)

Analysis unit

• Household
• Women age 15-49
• Men age 15-59

Universe

The population covered by the 2005 DHS is defined as the universe of all ever-married women age 15-49, NFHS-3 included never married women age 15-49 and both ever-married and never married men age 15-54 as eligible respondents.

Kind of data

Sample survey data

Sampling procedure

SAMPLE SIZE

Since a large number of the key indicators to be estimated from NFHS-3 refer to ever-married women in the reproductive ages of 15-49, the target sample size for each state in NFHS-3 was estimated in terms of the number of ever-married women in the reproductive ages to be interviewed.

The initial target sample size was 4,000 completed interviews with ever-married women in states with a 2001 population of more than 30 million, 3,000 completed interviews with ever-married women in states with a 2001 population between 5 and 30 million, and 1,500 completed interviews with ever-married women in states with a population of less than 5 million. In addition, because of sample-size adjustments required to meet the need for HIV prevalence estimates for the high HIV prevalence states and Uttar Pradesh and for slum and non-slum estimates in eight selected cities, the sample size in some states was higher than that fixed by the above criteria. The target sample was increased for Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, Tamil Nadu, and Uttar Pradesh to permit the calculation of reliable HIV prevalence estimates for each of these states. The sample size in Andhra Pradesh, Delhi, Maharashtra, Tamil Nadu, Madhya Pradesh, and West Bengal was increased to allow separate estimates for slum and non-slum populations in the cities of Chennai, Delhi, Hyderabad, Indore, Kolkata, Mumbai, Meerut, and Nagpur.

The target sample size for HIV tests was estimated on the basis of the assumed HIV prevalence rate, the design effect of the sample, and the acceptable level of precision. With an assumed level of HIV prevalence of 1.25 percent and a 15 percent relative standard error, the estimated sample size was 6,400 HIV tests each for men and women in each of the high HIV prevalence states. At the national level, the assumed level of HIV prevalence of less than 1 percent (0.92 percent) and less than a 5 percent relative standard error yielded a target of 125,000 HIV tests at the national level.

Blood was collected for HIV testing from all consenting ever-married and never married women age 15-49 and men age 15-54 in all sample households in Andhra Pradesh, Karnataka, Maharashtra, Manipur, Tamil Nadu, and Uttar Pradesh. All women age 15-49 and men age 15-54 in the sample households were eligible for interviewing in all of these states plus Nagaland. In the remaining 22 states, all ever-married and never married women age 15-49 in sample households were eligible to be interviewed. In those 22 states, men age 15-54 were eligible to be interviewed in only a subsample of households. HIV tests for women and men were carried out in only a subsample of the households that were selected for men's interviews in those 22 states. The reason for this sample design is that the required number of HIV tests is determined by the need to calculate HIV prevalence at the national level and for some states, whereas the number of individual interviews is determined by the need to provide state level estimates for attitudinal and behavioural indicators in every state. For statistical reasons, it is not possible to estimate HIV prevalence in every state from NFHS-3 as the number of tests required for estimating HIV prevalence reliably in low HIV prevalence states would have been very large.

SAMPLE DESIGN

The urban and rural samples within each state were drawn separately and, to the extent possible, unless oversampling was required to permit separate estimates for urban slum and non-slum areas, the sample within each state was allocated proportionally to the size of the state's urban and rural populations. A uniform sample design was adopted in all states. In each state, the rural sample was selected in two stages, with the selection of Primary Sampling Units (PSUs), which are villages, with probability proportional to population size (PPS) at the first stage, followed by the random selection of households within each PSU in the second stage. In urban areas, a three-stage procedure was followed. In the first stage, wards were selected with PPS sampling. In the next stage, one census enumeration block (CEB) was randomly selected from each sample ward. In the final stage, households were randomly selected within each selected CEB.

SAMPLE SELECTION IN RURAL AREAS

In rural areas, the 2001 Census list of villages served as the sampling frame. The list was stratified by a number of variables. The first level of stratification was geographic, with districts being subdivided into contiguous regions. Within each of these regions, villages were further stratified using selected variables from the following list: village size, percentage of males working in the nonagricultural sector, percentage of the population belonging to scheduled castes or scheduled tribes, and female literacy. In addition to these variables, an external estimate of HIV prevalence, i.e., 'High', 'Medium' or 'Low', as estimated for all the districts in high HIV prevalence states, was used for stratification in high HIV prevalence states. Female literacy was used for implicit stratification (i.e., villages were

ObjectiveA focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum’s residents.MethodsSix focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators—quantity, access, price, reliability, and equity—were collected via a structured survey of 521 households selected using population-based random sampling.ResultsIn addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts—on household economy, employment, education, quality of life, social cohesion, and people’s sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes.ConclusionsDeficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household “water poverty” that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.

BackgroundThe burden of Non-Communicable Diseases (NCDs) in urban informal settlements across Lower and Middle Income Countries is increasing. In recognition, there has been interest in fine-tuning policies on NCDs to meet the unique needs of people living in these settlements. To inform such policy efforts, we studied the care-seeking journeys of people living in urban informal settlements for two NCDs—diabetes and hypertension. The study was done in the Mumbai Metropolitan Region, India.MethodsThis qualitative study was based on interviews with patients having diabetes and hypertension, supplemented by interactions with the general community, private doctors, and public sector staff. We conducted a total of 47 interviews and 6 Focus Group Discussions. We synthesized data thematically and used the qualitative software NVivo Version 10.3 to aid the process. In this paper, we report on themes that we, as a team, interpreted as striking and policy-relevant features of peoples’ journeys.ResultsPeople recounted having long and convoluted care-seeking journeys for the two NCDs we studied. There were several delays in diagnosis and treatment initiation. Most people’s first point of contact for medical care were local physicians with a non-allopathic degree, who were not always able to diagnose the two NCDs. People reported seeking care from a multitude of healthcare providers (public and private), and repeatedly switched providers. Their stories often comprised multiple points of diagnosis, re-diagnosis, treatment initiation, and treatment adjustments. Advice from neighbors, friends, and family played an essential role in shaping the care-seeking process. Trade-offs between saving costs and obtaining relief from symptoms were made constantly.ConclusionOur paper attempts to bring the voices of people to the forefront of policies on NCDs. People’s convoluted journeys with numerous switches between providers indicate the need for trusted “first-contact” points for NCD care. Integrating care across providers—public and private—in urban informal settlements—can go a long way in streamlining the NCD care-seeking process and making care more affordable for people. Educating the community on NCD prevention, screening, and treatment adherence; and establishing local support mechanisms (such as patient groups) may also help optimize people’s care-seeking pathways.

In 2022, ****** was home to the highest number of millionaires, followed by India’s capital New Delhi, and the IT capital - Bengaluru. This comes as no surprise since all three cities have the largest share of high net worth households along with a booming economic outlook. Overall, India had around *** billionaires as of March 2023, and ranked third globally in terms of its ultra-net-worth individuals. A growing wealth gap Despite this, India also has a very high wealth inequality with millions of people living below the poverty line. In fact, according to the last census, the state of Maharashtra (with Mumbai as its capital city) had the highest number of slums across the country with over *** million households. Furthermore, according to a 2015 study on the geography of the super-rich, Bangalore was ranked first in terms of the inequality between its rich and poor, with the wealth of the city’s billionaires being ******* times that of the average per capita GDP in the city. Mumbai came second in this listing, while Delhi was ranked fifth. It's a rich man's world As of 2018, the richest ** percent of Indians owned **** percent of the country’s wealth. The Indian economy was also seen to be one of the fastest growing economies across the world. This indicates the level of unequal distribution of wealth in the country. This is a matter of grave concern and has several implications in terms of the country’s development and progress.