A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Squirrels could be natural hosts of the mpox virus (MPXV) -- that causes monkeypox disease -- according to a recent study by German researchers.

The team from the Helmholtz Institute for One Health (HIOH) identified the fire-footed rope squirrel (Funisciurus pyrropus) as a likely natural reservoir of the MPXV.

The study published in the journal Nature revealed that sooty mangabeys – a primate found in West Africa -- can contract mpox by eating infected squirrels. The disease may present mild lesions, but it can also cause more severe skin lesions or even be fatal.

"Identifying the animal sources of the virus and the exposure routes that lead to inter-species transmission are key steps towards understanding spillover mechanisms and developing effective prevention measures to mitigate the risk of transmission to humans," said Livia V. Patrono, one of the senior authors at HIOH.

Squirrels Suspected MPXV Hosts

While squirrels have long been suspected as potential reservoirs for MPXV, their role was confirmed after an investigation of an mpox outbreak among wild sooty mangabeys (Cercocebus atys) in Côte d'Ivoire.

During the outbreak, reported in early 2023, nearly one-third of the primates showed clinical signs of disease, and four infants died.

The team conducted viral genome sequencing and found that the infected monkeys carried a virus that was nearly identical to an MPXV strain identified in a fire-footed rope squirrel found dead 12 weeks earlier nearby.

Further, the team analyzed fecal samples from the mangabeys. A sample collected eight weeks before the outbreak's onset contained DNA from both the virus and the rope squirrel. This provided strong evidence of interspecies transmission at that moment.

Sooty mangabeys have been previously observed catching and eating fire-footed rope squirrels, which provide a direct route for the transmission of viruses.

Mpox Continues To Spread Globally

Although mpox is no longer a public health emergency, outbreaks of clade I and clade II strains of the mpox virus are continuing in many countries around the world, especially in Africa.

Last week, Madagascar announced the country's first death from mpox, a 3-year-old girl from the island nation’s eastern city of Toamasina.

The WHO has also confirmed that two cases of the recombinant strain – combining genomic elements of clades Ib and IIb of the monkeypox virus (MPXV) – have been identified to date: one in the United Kingdom and one in India.

Mpox is an infectious disease caused by the monkeypox virus (MPXV), part of the Orthopoxvirus genus, which also includes the virus that causes smallpox.

It spreads through close physical contact, including sexual contact, and in some cases through contaminated materials or respiratory droplets.

Symptoms typically include fever, swollen lymph nodes, rash, and/or lesions.

The global health body has also urged all countries to “remain alert to the possibility of MPXV genetic recombination.” It has also urged for continued epidemiological surveillance, sequencing, vaccination of at-risk groups, and infection prevention and control measures.

An international group of scientists has created an artificial intelligence tool that can estimate a woman’s likelihood of developing breast cancer within the next four years.

The AI tool, known as the BRAIx risk score, analyzes mammogram images to generate an individualized risk assessment and flag women who may face a higher chance of developing the disease.

It may not only show the current risk but also predict the future risk, enabling early detection and treatments for a better outcome.

According to the findings published in The Lancet Digital Health journal, nearly one in 10 women ranked in the top 2 percent of risk by the AI tool were diagnosed with breast cancer within four years. This was despite previously receiving a clear screening result.

“These risk scores enable future development of personalized screening pathways to transform population breast cancer screening and save lives,” said corresponding author Helen M. L. Frazer of the University of Melbourne.

Frazer noted that identifying women who appear cancer-free but carry very high risk -- comparable to those with inherited BRCA1 or BRCA2 mutations -- will unravel both hereditary and non-hereditary causes of breast cancer.

From one-size-fits-all screening to personalization

Breast cancer screening programs have significantly lowered mortality rates -- by roughly 40-50 percent among women aged 50 to 74. However, most screening systems still apply the same approach to all women, regardless of individual risk.

Traditional screening tools use genetics, breast density, and questionnaires to estimate breast cancer risk. On the other hand, new AI-based screening tools, such as BRAIx personalizes screening by gathering information already present in breast scan images to better identify who is at higher risk.

“Our results show that conventional mammographic density is a far weaker predictor of breast cancer risk than the BRAIx risk score, even for interval cancers,” the researchers said in the paper. Interval cancers are aggressive tumors diagnosed after a negative mammogram.

The BRAIx Tool

The BRAIx risk score was developed using mammograms from nearly 400,000 women. To prove its efficacy, the AI tool was tested on data from almost 96,000 women from Australia and then confirmed in an independent Swedish population of over 4,500 women.

The findings showed that:

• The BRAIx risk score estimated breast cancer risk more accurately than the traditional risk factors, such as breast density, country of birth, and even family history.

• For the top 2 percent of women with the highest BRAIx risk score, the probability of a cancer diagnosis within 4 years was 9.7 percent -- a risk level exceeding that typically seen in women with inherited BRCA1 or BRCA2 mutations.

The BRAIx risk score can:

• Make breast screening more personalised,
• Improve early cancer detection,
• Reduce false alarms,
• Save lives without increasing costs

Global Breast Cancer Burden

Breast cancer continues to be the most common cancer among women worldwide.

A recent study published in The Lancet Oncology journal predicted that the number of new cases of the deadly disease will reach more than 3.5 million globally in 2050 -- rising by a third from 2.3 million in 2023.

Annual deaths from the disease will also rise by 44 percent -- from around 764,000 to 1.4 million.

However, not smoking, getting sufficient physical activity, lowering red meat consumption, and having a healthy weight can help prevent over a quarter of healthy years lost to illness and premature death from breast cancer.

People who survived a COVID-19 infection can be at significant risk for kidney disease, acute kidney injury, and chronic kidney disease. compared to individuals who were not infected, according to a study.

The study, published online in the journal Communications Medicine, revealed that COVID patients have

• a 2.3-times higher risk of acute kidney injury
• a 1.4-times higher risk of chronic kidney disease
• a 4.7 times higher risk of kidney failure

“While we’re in the post-pandemic era, this shows that COVID-19 history is an important variable when considering the long-term impact of the infection on kidney function and disease,” said first author Yue Zhang, who was at Pennsylvania State University, US, while conducting the study. Zhang is currently a postdoctoral scholar at Johns Hopkins Bloomberg School of Public Health.

How Was The Study Conducted?

For the study, data on over 3 million working-age adults in the United States were analyzed.

The team compared the effect of influenza, another common viral infection that affects kidney health, and people with a history of COVID infection on kidney infections.

Using a machine learning model, the individuals were followed between 180 and 540 days for the emergence of new acute or sudden kidney disease.

The results showed that:

• Both COVID and the flu can worsen kidney health
• Flu caused a mild and temporary effect
• COVID increased the risk of acute kidney injury for a longer duration
• COVID survivors developed kidney disease within a few hours to a few days
• COVID patients had a longer-term chronic and end-stage kidney disease.

How COVID Worsens Kidneys Health

The Penn State researchers explained that kidney cells express high levels of the primary protein receptors that SARS-CoV-2 uses to enter and infect cells. Kidney cells also produce specialized enzymes that help viruses enter cells.

According to Kidney Health Australia, an acute COVID infection can impact the kidneys with fevers and respiratory symptoms, and/or worsening blood sugar control.

The US National Institutes of Health stated that renal dysfunction is an increasing clinical indicator of COVID propagation.

Citing several studies, the NIH said that the most common clinical manifestation is proteinuria -- found in more than half of the COVID patients. In addition, hematuria, elevated blood urea nitrogen, and elevated serum creatinine are other common features in Covid survivors with poor kidney health.

Nasr Ghahramani, Professor of Medicine at Penn State College of Medicine, stressed the need for COVID survivors, especially those with diabetes and high blood pressure, to take "more frequent and more prolonged monitoring of their kidney function" to enable early detection and better outcomes.