Association between architectural parameters and burden of tuberculosis in three resettlement colonies of M-East Ward, Mumbai, India

Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework

An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbai's population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery.

Evaluating the risk of accessing green spaces in COVID-19 pandemic: A model for public urban green spaces (PUGS) in London

The pandemic caused by SARS-CoV-2 (COVID-19) at the beginning of 2020 has restricted the human population indoor with some allowance for recreation in green spaces for social interaction and daily exercise. Understanding and measuring the risk of COVID-19 infection during public urban green spaces (PUGS) visits is essential to reduce the spread of the virus and improve well-being. This study builds a data-fused risk assessment model to evaluate the risk of visiting the PUGS in London. Three parameters are used for risk evaluation: the number of new cases at the middle-layer super output area (MSOA) level, the accessibility of each public green space and the Indices of Multiple Deprivation at the lower-layer super output area (LSOA) level. The model assesses 1357 PUGS and identifies the risk in three levels, high, medium and low, according to the results of a two-step clustering analysis. The spatial variability of risk across the city is demonstrated in the evaluation. The evaluation of risk can provide a better metric to the decision-making at both the individual level, on deciding which green space to visit, and the borough level, on how to implement restricting measures on green space access.

COVID-19 & informal settlements: is 'Stay Home' safe?

The disproportional burden of coronavirus (COVID-19) and vulnerability to containment measures in informal settlements have been recognised; however, the role of poor housing conditions in propagating these remains neglected. Poor housing conditions makes it difficult to effectively implement social distancing measures. With increased time spent in cramped, dark and uncomfortable indoor environments, water and sanitation outside the home, and no outdoor space, higher exposure to existing health hazards and high levels of stress, with women and children being most vulnerable, are anticipated. Through this commentary paper, we reflect on these interconnections and recommend immediate measures and the long-term need for adequate housing for health and well-being.

Public Health Issue of Indoor Dilution Ventilation for Disease Prevention Versus PM2.5 in Intake Air in Auditoriums of Premier Engineering Institutes in India

Background: Dilution ventilation by enhancing fresh air intake has been prescribed to reduce airborne infection spread during the COVID-19 pandemic. This is all the more important in assembly spaces like auditoriums. Premier technology institutes have large campuses with large auditoriums for academic and cultural events in India. These institutes serve as role models for society, where gatherings are essential, but there is also the possibility of transmission of all airborne respiratory infections, including tuberculosis, into the community. The fresh air taken in should also be filtered for pollution to prevent other lung issues.

Aims: Fresh air intake and filtration have been studied in order to understand whether the outside air supplied indoors is filtered for PM2.5, which is a major ambient polluter in India.

Settings and design/methods: In this study, the Right to Information Act of 2005 has been used to obtain first-hand information from the institutes with respect to the heating, ventilation, and air conditioning (HVAC) systems in their auditoriums. Twelve of the 19 institutes fall in cities with non-attainment of ambient air quality standards.

Results: Eleven out of all those had recently integrated fresh air supply, and six replied in the negative. Only one out of all of them had appropriate filters.

Conclusion: This study highlights the need for a possible trade-off between the use of air conditioners for thermal comfort + assumed protection against PM2.5, which is the switching off of air conditioners and manually opening up windows and using fans for ventilation. Indian HVAC design for gathering spaces, especially educational institutes, needs to factor in fresh air for dilution ventilation as well as PM2.5 filtration.

Spatial distributive effects of public green space and COVID-19 infection in London

While public green spaces (PGS) are opined to be central in the pandemic recovery, higher accessibility to PGS also mean a higher risk of infection spread from the raised possibility of people encountering each other. This study explores the distributive effects of accessibility of PGS on the COVID-19 cases distribution using a geo-spatially varying network-based risk model at the borough level in London. The coupled effect of social deprivation with accessibility of the PGS was used as an adjustment factor to identify vulnerability. Results indicate that highly connected green spaces with high choice measure were associated with high risk of infection transmission. Socially deprived areas demonstrated higher possibility of infection spread even with moderate connectivity of the PGS. The study demonstrated that only applying a uniform social distancing measure without characterising the infrastructure and social conditions may lead to higher infection transmission.

Microbial, environmental and anthropogenic factors influencing the indoor microbiome of the built environment

A built environment is a human-made environment providing surroundings for human occupancy, activities, and settlement. It is supposed to safeguard humans from all undesirable and harmful pollutants; however, indoor concentrations of some pollutants are much greater than that of the outdoors. Bioaerosols infiltrate from the outdoors in addition to many indoor sources of bioaerosols including the use of various chemicals as well as activities like cooking, smoking, cleaning, or even normal movement. They are also associated with a number of serious health concerns. Various ecological factors associated with the generation, the persistence as well as the dispersal of these microbial components of indoor bioaerosols, are discussed in this review, that have not been considered all together till now. The factors like microbial taxa, environmental factors, and anthropogenic activities (human occupancy, activities, and impact of urbanization) are addressed in the review. Effects of both indoor environmental factors like architectural design, lighting, ventilation, temperature, humidity, indoor/outdoor ratio, particulate matter, indoor chemistry as well as outdoor environmental factors like geography, seasons, and meteorology on the microbial concentrations have been discussed. Efforts are underway to design selective pressures for microbes to create a healthy symbiotic built microbiome as the "right" indoor microbiome is a "healthy" indoor microbiome.

Informal urbanism in the state of uncertainty: forms of informality and urban health emergencies

Forms of informality—ranging from informal settlements to street vending and informal transport—have become integral, yet not necessarily limited to how cities of the global South work. Our aim in this paper is to explore the dynamics of informal urbanism in the face of the COVID-19 pandemic and the extent to which forms of informality can adapt in the state of uncertainty. This paper lies in the intersections of informal urbanism and urban design in relation to public health emergencies. This is an exploratory paper in nature, structured in three main sections to focus on the implications of the Coronavirus pandemic on informal settlements, street vending, and informal transport, respectively. We point to how different forms of informality work across cities and conclude by outlining some key considerations and discussing the role of urban design in addressing the capacities and challenges of informal urbanism in the state of uncertainty facing public health emergencies such as the Coronavirus pandemic.