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!

Malaria is widely known as a mosquito-borne disease that causes fever, chills, and body aches. But what many people don’t realize is that in severe cases, it can also affect the heart.

Malaria is caused by parasites belonging to the Plasmodium genus. It may cause complications beyond the bloodstream. In some cases, this may happen in severe malaria, where either the diagnosis or treatment is late.

How Malaria Infection Affects The Heart

Speaking to HealthandMe, Dr. Ravi Prakash, Senior Consultant Cardiology, PSRI Hospital, Delhi, noted that malaria affects different parts of the body, depending on the severity and the patient's immunity.

"In severe malaria cases, the parasite that causes malaria infects the red blood cells, making them sticky. When these stick together, the cells block the flow of blood in smaller blood vessels, limiting oxygenation of important organs, including the heart," Dr Prakash explained.

The condition may then result in myocarditis, arrhythmias, or heart failure. Although these complications rarely affect the heart, they require prompt medical intervention.

Further, Dr. Rakesh Pandit, Senior Consultant & HOD, Internal Medicine, Aakash Healthcare, highlighted that malaria can put stress on the heart either directly or indirectly.

It can lead to inflammation of the heart and result in chest pains, fatigue, or arrhythmia.

"Patients suffering from severe malaria may develop tachycardia or, in worst-case scenarios, experience heart blockage," Dr. Pandit told HealthandMe.

The Role of Anemia

Furthermore, malaria infection may limit the blood flow to the heart by increasing the stickiness of the blood, thus blocking small blood vessels.

"Anemia associated with malaria can increase the load on the patient's heart," Dr Pandit said.

Fever, dehydration, and hypoxia further increase cardiac stress in malaria patients, who may end up having their pre-existing heart conditions unmasked.

Malaria: Early Signs Of Heart Damage?

Early detection is important. Besides classic malaria symptoms such as fever, sweats, shivers, headaches, and tiredness, any unusual symptoms such as chest pains, difficulty breathing, rapid heartbeats, or excessive weakness must be considered carefully.

"These could be signs of organ damage caused by the disease, which means early diagnosis and treatment are vital. Blood tests will be conducted to identify malaria parasites in your body," Dr. Prakash said.

Malaria And Heart: Who Is At More Risk

Some individuals are more susceptible to contracting malaria, which increases their chances of developing complications from the disease.

These include

• children,
• pregnant women,
• the elderly,
• immunocompromised patients.

"People who have underlying diseases may develop heart-related problems due to the malaria infection," Dr Prakash said.

Moreover, travelers to malaria-endemic areas without adequate protection from the disease are also likely to be affected.

How To Prevent?

The best method to avoid contracting malaria is to take preventive measures.

• Individuals must protect themselves from mosquito bites.
• Applying insect repellents, sleeping under mosquito nets, and covering your arms and legs when you go out are effective ways to shield yourself from being bitten.
• Proper hygiene and sanitation practices are necessary to prevent mosquitoes from reproducing.
• Having a good general health status is another preventive measure. Your immune system must be able to combat invading agents.

Malaria is usually understood as a fever illness, with symptoms such as chills, sweating, body ache, weakness, and in severe cases, anemia or organ complications. But for women, especially in malaria-prone regions, its impact can be more layered.

It can disturb the body’s hormonal rhythm, worsen fatigue, complicate menstrual symptoms, and create confusion between infection-related pain and period-related discomfort. That is why malaria should not be seen only as a seasonal mosquito-borne disease, but also as a health concern that can affect women’s reproductive and menstrual well-being.

India has made strong progress against malaria. According to the Government of India, reported malaria cases fell from 11.6 lakh in 2015 to 2.27 lakh in 2023, a reduction of roughly 80%. Malaria-related deaths also declined from 384 to 83 in the same period, a fall of about 78%. This shows that prevention, testing, surveillance, and treatment have improved significantly.

At the same time, malaria has not disappeared. The risk remains higher in endemic, tribal, forested, and hard-to-reach areas, where mosquito exposure, delayed testing, limited access to care, and anemia can make the illness more difficult to manage.

How Malaria Dents Menstrual Health

The connection begins with the body’s stress response. Malaria infection does not remain limited to the bloodstream. Research on hormones in malaria shows that the infection can affect host metabolism and create hormonal imbalances, with changes influenced by parasite type, disease severity, immune response, age, sex, nutrition, and stage of infection.

The research notes that malaria can dysregulate the hypothalamic-pituitary-adrenal, thyroid, and gonadal axes, which are central to stress, metabolism, and reproductive hormone regulation.

For menstrual health, this matters because periods are not controlled by the uterus alone. They depend on coordination between the brain, ovaries, and hormones such as estrogen and progesterone. When the body is fighting malaria, that rhythm can be disturbed.

Fever, inflammation, poor appetite, weakness, anemia, and high physical stress can make periods late, lighter, heavier, or more exhausting than usual. In some women, premenstrual symptoms such as body ache, fatigue, abdominal discomfort, and mood changes may also feel worse because malaria itself produces overlapping symptoms.

There is also a direct hormonal pathway to consider. Cortisol, often called the stress hormone, is reported to rise in both P. falciparum and P. vivax malaria. High cortisol can affect immune function and may also disturb the wider hormonal balance on which regular ovulation and menstruation depend.

The same research notes that lower estradiol has been reported in severe falciparum malaria, while progesterone levels have also been reported to be lower in patients with P. falciparum malaria.

These findings do not mean every woman with malaria will have menstrual changes, but they do show that malaria can interfere with the hormonal systems linked to reproductive health.

Link Between Malaria And Anemia in Women

Anemia is another important link. Malaria can destroy red blood cells and contribute to severe anemia. Menstruation, especially heavy bleeding, can also lower iron stores. When both happen together, the result can be extreme tiredness, dizziness, breathlessness, paleness, poor concentration, and slower recovery.

This is particularly relevant in India, where anemia among women is already a major public health concern. A woman recovering from malaria who also has heavy periods should not dismiss prolonged weakness as “normal period fatigue.”

Malaria: Delayed Symptoms In Women

One reason diagnosis can be delayed is that malaria symptoms are often nonspecific. WHO lists fever, headache, and chills as common early symptoms, and says early testing is important because symptoms may initially resemble many other fever illnesses. In women, body ache, fatigue, abdominal discomfort, and weakness may be mistaken for PMS, a painful period, viral fever, or early pregnancy unless malaria is actively considered.

The risk is even more serious during pregnancy, including early pregnancy when a woman may not yet know she is pregnant. WHO states that malaria during pregnancy can cause premature delivery or low birth weight, and it is also noted that pregnancy reduces immunity to malaria, increasing the risk of severe anemia and illness.

The practical message is simple: if fever with chills, severe body ache, vomiting, unusual weakness, dizziness, or headache appears around the time of a period, it should not automatically be treated as PMS or “period weakness,” especially after travel to or residence in a malaria-prone area.

A malaria test should be done promptly, and treatment should be taken only under medical supervision.

Malaria can affect menstrual health by placing stress on the body’s blood, hormones, immunity, and energy reserves. For women, recognizing this connection can help prevent delayed diagnosis and support faster recovery.

When it comes to gas, bloating, and "acidity," it is easy to think that these are simply a case of IBS or nervousness about eating. However, gastric cancer is one of the most frequent causes of cancer-related deaths in the world, including in India, where it is a common form of gastrointestinal cancer. In some cases of early gastric cancer, the symptoms are so similar to other digestive troubles that it could prove fatal to ignore the warning signs.

In an interaction with Health and Me, Dr Rakesh Kumar Sharma, Senior Consultant Medical Oncologist at M | O | C Cancer Care & Research Centre, Gurugram, spoke about the symptoms of stomach cancer and how it can often be confused with IBS.

Why is IBS confused with stomach cancer?

IBS is a functional gastrointestinal condition, which means the patient’s gut may seem fine, but it is not functioning properly. Common complaints in IBS include abdominal pain, bloating, diarrhoea, and constipation. Patients may notice a pattern in which their symptoms come and go over several months and may even associate them with food triggers or emotional stress.

However, IBS does not cause ulcers, bleeding, or intestinal damage, and patients have no greater likelihood of developing cancer when evaluated properly. This means that since many symptoms of IBS, inflammation, and cancers can overlap, there is a risk of diagnosing something serious as “just IBS."

What are the symptoms of stomach cancer?

Stomach cancer commonly begins in the inner lining of the stomach and usually presents with non-specific and subtle symptoms in its early stages. Common complaints include continuous indigestion and heartburn that fail to respond to common anti-acidity medication. Early satiety is another common complaint, whereby patients feel full too soon during meals, along with upper abdominal discomfort and heaviness. Other common symptoms include bloating, nausea, and gradual loss of appetite over weeks.

It is important to differentiate early-stage gastric cancer from simple acidity and IBS, since the latter conditions usually show periodic improvement and respond to common medications. However, if the above symptoms persist for two to three weeks without relief despite basic management, further evaluation may be required, especially in middle-aged and older patients.

Stomach cancer symptoms to never miss

There are certain symptoms that should never be overlooked and are regarded as red flags requiring prompt investigation for possible stomach cancer:

1. Sudden weight loss and poor appetite
2. Concurrent vomiting and regurgitation
3. Dysphagia or difficulty swallowing
4. Melena or hematochezia
5. Anaemia (reduced haemoglobin level), tiredness, and weakness due to chronic blood loss
6. Ongoing or progressive upper abdominal pain or a lump in the upper part of the abdomen

Any of these require immediate attention, regardless of an IBS diagnosis.

Who is at an increased risk?

Persistent infection by the bacterium Helicobacter pylori is the most well-established risk factor for the development of stomach cancer, primarily lower stomach cancers. H. pylori infections affect about half the global population and may lead to chronic inflammation, ulcers, and eventually precancerous changes in the stomach lining. High dietary consumption of salt, pickled or smoked foods, and processed meats increases the risk, especially when there is an existing H. pylori infection.

Smoking and alcohol abuse independently contribute to an increased risk of gastric cancer, along with obesity and specific genetic or familial risk factors. There are higher rates of gastric cancer in some parts of India, with the majority of cases being detected at later stages of the disease. This emphasises the importance of early detection and evaluation in populations with a high burden of gastric cancer.

When should you be alarmed?

You do not have to worry about every episode of acid reflux, but you should never dismiss anything unusual that occurs in your body. You need to consult your doctor if your indigestion, epigastric pain, early satiety, and bloating persist for two to three weeks even after conventional treatment. You experience alarming symptoms such as weight loss, vomiting, dysphagia, black stools, and anaemia