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The emergence of novel coronavirus disease 2019 (COVID-19) pandemic provides unique challenges for health system. While on the one hand, the government has to struggle with the strategies for control of COVID-19, on the other hand, other routine health services also need to be managed. Second, the infrastructure needs to be augmented to meet the potential epidemic surge of cases. Third, economic welfare and household income need to be guaranteed. All of these have complicated the routine ways in which the governments have dealt with various trade-offs to determine the health and public policies. In this paper, we outline key economic principles for the government to consider for policymaking, during, and after the COVID-19 pandemic. The pandemic rightfully places long due attention of policymakers for investing in health sector. The policy entrepreneurs and public health community should not miss this once-in-a-lifetime “policy window” to raise the level of advocacy for appropriate investment in health sector.

Background: Anemia is a common morbidity in elderly persons (aged 60 years or above). In India, in recent years, the number of old age homes (OAHs) and the residents living in them has increased significantly. Objective: The aim of this study was to estimate the prevalence of anemia among elderly persons living in OAHs. Methods: This was a cross-sectional study among individuals living in OAH in Delhi, India. Using combination of location and type of OAH, 28 clusters of almost equal sizes were created, of which 13 clusters were randomly selected, and all elderly persons living therein were selected for the study. Sociodemographic profile was recorded using a self-designed, semistructured interview schedule. Hemoglobin (Hb) was estimated using HemoCue Hb 201+ system. Binary Logistic regression was used to assess the socioeconomic determinants of anemia. Results: The study included 334 elderly persons, with a mean (standard deviation [SD]) age of 75.2 (8.6) years and mean (SD) Hb of 11.6 (1.7) g/dL. The mean (SD) Hb in men was 12.1 (1.7) g/dL compared to 10.9 (1.5) g/dL among women (P < 0.0001). The overall prevalence of anemia was 68.7% (95% confidence interval 63.9, 73.4); among those who were anemic, 47.4% had mild anemia, 47.0% had moderate anemia, and 5.6% had severe anemia. The prevalence of mild anemia was 45% in men compared to 24.8% in women. The odds of anemia among ≥80 years was 2 times that among 60–69 years (P < 0.029). Conclusions: The prevalence of anemia among elderly persons in OAHs is high in Delhi, India and increased with age.

Background: Iron supplementation during pregnancy in programmatic settings has failed to produce desired results. Formulation of iron supplementation may have a role in compliance and hematological parameters. Objective: We did this study to compare the compliance to iron supplementation, change in mean hemoglobin and serum ferritin level after iron supplementation in capsule form and tablet form during pregnancy. Materials and Methods: In this single-blinded (investigator blinded), active comparator, randomized controlled trial we enrolled pregnant women (aged ≥18 years) from May to November 2014 during second trimester to receive iron supplementation either as capsule (ferrous fumarate) or tablet (ferrous sulphate) during entire pregnancy. The outcome was compliance (good compliance ≥ 90%) to iron supplementation assessed by pill count and change in mean hemoglobin and serum ferritin. Statistical significance was tested using Chi-square test and Student's t test. Results: We enrolled and randomized 204 pregnant women for iron supplementation; capsule form (n = 100) and tablet form (n = 104). Out of which 52 (25.5%) women (23 in capsule arm and 29 in tablet arm) were lost to follow up. As compared to tablet arm, the capsule arm had higher good compliance (22% vs 16.8%), increase in mean hemoglobin (0.79 vs 0.44 gm/dL) and increase in mean serum ferritin (2.50 vs -2.14 ng/mL), but the difference was not statistically significant. Conclusion: Pregnant women who received either of the formulation reported a low compliance. Iron supplementation in capsule formulation resulted in more increase in blood hemoglobin level, though clinically insignificant.

Background: Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. Objective: To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. Methods: Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. Results: Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference −0.16; 95% CI: −0.26, −0.06) and ID (risk difference −0.20; 95% CI: −0.32, −0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 μg/L; 95% CI: −0.12, 1.37), serum TfR levels (mean difference −0.23 mg/dL; 95% CI: −0.85, 0.38), and IDA (risk difference −0.08; 95% CI: −0.28, 0.11). Conclusion: DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

Anthropometric changes take place with increasing age. Progressive loss of height makes it difficult to use height for calculation of body mass index in nutritional screening of elderly persons. There is a need to find other alternative methods which could be used as proxy measurements of height in them. To assess the relationship of height and arm span and among elderly persons. A community-based cross-sectional study was conducted among elderly persons in urban colony of Delhi. Height and arm span of persons aged 60 years and above (n = 711) were measured according to standard methods. Correlation between arm span and height was calculated. The mean arm span was seen to be more than the mean height in all age-groups and both sexes. There was a linear relationship between height and arm-span in all age-groups. There was a strong correlation between arm span and height in all age groups. Arm span could be used instead of height as an alternative in the conventional body mass index in elderly persons.

Background: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. Objectives: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. Methods: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. Results: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). Conclusion: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.

Background: Gender differences can be in any stage in the life cycle including before birth (feticide/sex selective abortions) which have been objectively documented. This study tries to identify the gender differentials among the children which is a basic step in cascade process of female discrimination in the society. Objective: To study the gender differentials among children under 6 years in households of rural Ballabgarh, Haryana in terms of nutrition, health care seeking, social aspects and to see whether they differ by socio economic status. Methods: Two hundred households were selected purposively from four villages (50 households each) by multi stage sampling during Mar – June 2010. Pre tested interview schedule was used to assess gender differences in nutrition (breast feeding, 'z' score); in health care seeking and in social aspects (Expenditure on birth related ceremonies and toys and dresses). Differences are measured in means or proportions. Determinants of Gender differentials were identified by logistic regression. Results: Girls were breast fed for five months lesser than boys (P < 0.02). Even though occurrences of common childhood illnesses were equal between the two, expenditures incurred to treat these illnesses were more among the boys (Boys Vs girls: Rs 181.3 Vs Rs 123.9). Proportion of illnesses treated from health facilities located outside the villages was higher among the boys [boys (22.2%), girls (11.4%)]. Expenditures incurred during birth related social ceremonies were higher for boys (Rs 20311 and Rs 2487.5 respectively for boys and girls). Conclusion: In this patriarchal society, socio cultural norms have produced the gender gap which can have adverse impact on health of the female children.

Background: Daily requirement of iodine increases during pregnancy making pregnant women a high-risk group for iodine deficiency disorders. The limited available literature shows that even in iodine sufficient population, pregnant women are iodine deficient. Objective: The objective of this study is to assess the current iodine nutrition status among pregnant women in Ballabgarh, district Faridabad, Haryana. Materials and Methods: Pregnant women were recruited from antenatal clinic (ANC) of subdistrict hospital (SDH), Ballabgarh, Haryana. Consecutive sampling strategy was followed to recruit pregnant women, and women of all trimesters were included in the study. Urinary iodine estimation was done using simple microplate method, and salt iodine was estimated using iodometric titration. The study was approved by Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Results: Out of the total 1031 pregnant women, 90.9% were using adequately iodized salt. Median (interquartile range [IQR]) salt consumption by the pregnant women was 8.3 (6.7, 11.1) g/day. Median (IQR) urinary iodine concentration (UIC) for the pregnant women was 260 (199, 323) μg/L. Only 13.5% of pregnant women had insufficient iodine intake (UIC 90% adequately iodized salt coverage in the study population.

Anemia is major public health problem affecting 1.6 billion people worldwide. The poor compliance of iron supplementation remains main contributor for high prevalence of anemia. The current paper reviewed the effectiveness of direct observation of oral iron supplementation on anemia. A systematic search was performed through electronic databases and local libraries. Search strategies used subject headings and key words “directly observed” and “iron supplementation.” Searches were sought through April 2014. A total of 14 articles were included in the study. Findings were presented in three categories. First, all of those reported an improvement in compliance of iron supplementation. Second, reduction in the prevalence of anemia was reported by all and third, all except one reported increased blood hemoglobin level. Directly observed an iron supplementation is an effective approach for prevention and management of anemia in vulnerable groups. However, larger trials are needed before concluding that scaling up directly observed iron supplementation through community health volunteers would be beneficial.

The existing technologies in Light Emitting Diode (LED) lighting sometimes cause flicker at frequencies that may have adverse health effects. Although, not always obvious to the human eye, it can make a difference in certain circumstances. Moreover, the flicker rate of many LED lights available in the market is much greater than conventional lights. This flicker has the potential to exert harmful effects on health. The various adverse effects of flicker include eye strain, fatigue, headache, migraine, blurred vision as well as photo epilepsy in sensitive individuals. In order to resolve the problem of high flicker, the foremost step is to develop a global standard for measuring flicker and then to have regulations for acceptable flicker limit. With the growing concern over LED flicker rate, many global lighting standards and specification communities have developed or are in the process of developing flicker measurement standards. In India, currently, there is no regulatory body to check the LED quality parameters with regard to flicker rate. Despite the fact that LED lighting products with high flicker rate carry a risk of flicker-induced health problems, a wide range of such products have penetrated the Indian market. The aim of this article was to summarise the information from the available literature about different types of flicker, methods to quantify flicker and potential health impact of flicker.

Background: Rural areas pose challenges for motivating villagers to donate blood. We organized a blood donation camp in a rural setting by engaging multiple stakeholders. We examined the factors that influenced blood donation. Methods: Local level stakeholders were involved in planning of the camp. Mobilization of donors was attempted through intensive awareness generation activities utilizing multiple channels. A list of willing blood donors was prepared. Results: Out of 152 willing donors, 88 reported to donation camp, and after screening, 67 donated the blood. Most of the willing donors were males (89.8%), and the mean standard deviation age was 31.9 (9.4) years. Deferral rate was 23.8%. Involvement of local stakeholders can result in creating a pool of donors in rural area which can mitigate the existing gap between demand and supply of blood in India.

Introduction: There are few data on heart failure (HF) burden and none available on the community prevalence of HF in India. We conducted a study aimed at determining the HF prevalence in a rural community as well as tertiary hospital care setting in North India. We also reviewed the existing literature regarding the estimated and projected prevalence of HF in India. Methodology: All adults (>20 years) with chronic breathlessness in six villages under a primary health care center in Northern India were identified and evaluated with standardized questionnaire and physical examination by trained health care workers. HF was diagnosed by standardized criteria and a transthoracic echocardiogram was performed in all subjects. In the hospital study, 500 consecutive patients presenting to our tertiary referral hospital were evaluated for the diagnosis of HF. For the systematic review, all published studies addressing HF or the burden of risk factors in India were identified. Projections for the absolute HF burden were made using local data and global studies of HF incidence, morbidity, and mortality. Results: Among the surveyed rural adult population of 10,163 patients, chronic breathlessness was present in 128 (1.3%). HF was present in 9% (n = 12), of which 67% (n = 8) had preserved left ventricular (LV) systolic function and 33% (n = 4) had LV systolic dysfunction. Therefore, the prevalence of HF in this general community was 1.2/1000. All patients with HF and preserved ejection fraction had poorly controlled hypertension. In the hospital study, of 500 consecutive patients, 20.4% had HF. Rheumatic heart disease (52%) was the most common cause followed by ischemic heart disease (17%). The mean age of presentation was 39 ± 16 years. The prevalence of HF in the outpatient department patients was 22.5% below 30 years and 14.9% above 50 years, reflecting the young population of HF. For the estimates concerning HF burden in India, projections were made using both age-specific extrapolations from developing countries and data regarding development of HF in the presence of risk factors. The estimated prevalence of HF is about 1% of the total population or about 8–10 million individuals. The estimated mortality attributable to HF is about 0.1–0.16 million individuals per year. Conclusions: While our hospital data are consistent with the HF burden and etiology expected in a government tertiary hospital setting, our community-based study is the first of its kind reported from India. The community study demonstrates a surprisingly low prevalence of symptomatic HF in the surveyed villages. This could be partially explained by the rural farming-based community setting but is also likely due to under-reporting of symptoms. Our review of the projected national estimates suggests an alarming burden of HF in India despite a younger population than the developed nations. A significant proportion of this burden may be preventable with better screening and early and adequate treatment of the risk factors.

Background: Though nonalcoholic fatty liver disease (NAFLD) is increasingly becoming prevalent in the Indian population, knowledge regarding the burden and risk factors of NAFLD is limited, more so from rural areas. This study was thus conducted to estimate the prevalence of NAFLD among adults in a rural community of Haryana, India and to measure the association of diet, physical activity, and other selected risk factors with NAFLD. Materials and Methods: The present study was conducted in a rural community of Haryana, India among resident adults ≥35 years of age. Eight out of 28 villages were selected by probability proportion to size sampling. The number of eligible and consenting participants randomly selected from each village was 27. Out of 216 participants thus recruited, 184 participants reported for undergoing ultrasonography (USG) of the liver, anthropometry, blood pressure recording, and blood sample collection. Finally, 176 participants were analyzed. Results: Prevalence of NAFLD was 30.7%. There was no significant difference in the calorie intake and average total physical activity between participants with and without NAFLD. On multivariate analysis, hypertension [adjusted odds ratio (OR): 2.3, 95% confidence interval (CI): 1.1-5.0, P 0.03] and an increased waist circumference (adjusted OR: 4.9, 95% CI: 1.5-7.0, P < 0.001) were independently associated with NAFLD. A normal high-density lipoprotein (HDL) level was protective against NAFLD (adjusted OR: 0.4, 95% CI: 0.2-0.8, P 0.001). Conclusions: The high prevalence of NAFLD is already a public health problem, even in the rural parts of India. Urgent public health interventions are required to prevent its development by controlling the cardiometabolic risk factors associated with it.

Background: Preeclampsia in pregnancy has been shown to be associated with low serum calcium level. Though the evidence is abundant, it is equivocal. Objectives: The study aimed to estimate the dietary calcium intake and serum calcium status among pregnant women, and to document the association of the dietary calcium intake and serum calcium status with incidence of preeclampsia in the 3rd trimester of pregnancy. Materials and Methods: A community-based cross-sectional study was conducted in the Health and Demographic Surveillance System (HDSS) site, Ballabgarh, Haryana, India. All pregnant women between 28 weeks and 36 weeks of gestation were interviewed. A semi-structured interview schedule and a 24-h dietary recall questionnaire were administered to assess the dietary calcium intake. AutoAnalyser (Biolis 24i) was used for measuring serum calcium. Results: We enrolled 217 pregnant women. The mean [standard deviation (SD)] dietary calcium intake was 858 (377) mg/day. The mean (SD) serum calcium level was 9.6 mg/dL (0.56). Incidence of preeclampsia was 13.4%. Preeclampsia was not associated with hypocalcemia [odds ratio (OR) = 1.2 95% confidence interval (CI); 0.27-3.98]. Conclusion: The majority of pregnant women had inadequate dietary calcium intake. The prevalence of hypocalcemia was low. Low serum calcium level was not associated with preeclampsia. Calcium supplementation may not reduce preeclampsia in this population.

Iodine Deficiency Disorders (IDD) constitute the single largest cause of preventable brain damage worldwide. In India the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from it. Of these, an estimated 350 million people are at higher risk of IDDs as they consume salt with inadequate iodine. Every year nine million pregnant women and eight million newborns are at risk of IDD in India.On September 13, 2000, the Government of India lifted the ban at the national level on the sale of non-iodized salt (India Gazette 2000). Scientists, civil society, international agencies and other stakeholders joined ranks to fight against this retrograde step by the government of India. The four pronged approach to fight the removal of ban on non- iodized salt comprised of writing advocacy documents, meeting with stakeholders, media campaign and tracking of Universal Salt Iodization (USI) in states by state iodine status surveys.But effective advocacy and media campaign were hampered by lack of scientific data substantiating the magnitude of Iodine Deficiency disorders (IDD) in India. To address this lacuna, state level Iodine status surveys were planned in seven states of India and were executed over next five years in collaboration with various national and international stakeholders.State level IDD surveys were carried out in seven states (Kerala, Tamil Nadu, Orissa, Rajasthan, Bihar, Goa and Jharkhand) from 2000 to 2006 by International Council for Control of Iodine Deficiency Disorders (ICCIDD) in collaboration with state medical colleges, Micronutrient Initiative (MI) and UNICEF. The surveys were carried as per the recommended guidelines of WHO/UNICEF/ICCIDD and used 30 cluster into 40 children sampling methodology. Children in the age group of 6-12 years, women in the household, retail shop keepers and other community stakeholders constituted the study population. All three indicators viz. Total Goiter Rate (TGR), Urinary Iodine (UI) concentration and iodine content of salt (household and retail shop) were studied. TGR ranged from 0.9% in Jharkhand to 14.7% in Goa. The median urinary iodine excretion ranged from 76 µg/L in Goa to 173.2 µg/L in Jharkhand. The household level consumption of adequately iodized salt ( ≥ 15 ppm) ranged from 18.2% in Tamil Nadu to 91.9% in Goa. These state level IDD surveys are the only sub-national (state) level IDD surveys in India where all three indicators viz. iodized salt coverage, urinary iodine and TGR were assessed concurrently.These surveys provided valuable reliable scientific data to back up the need of urgency to re-instate the ban and aided in convincing wider scientific community and policy makers regarding the need for the same. These surveys also aided in capacity building at state level which will provide necessary impetus to sustain USI. The ban on sale of non-iodized salt was finally re-instated in May, 2005.Purpose of the study : To understand the complex policy environment in which National Health Programmes in India are operating.Basic Procedures : A case study approach applying the criteria of policy formulation and policy implementation to National Iodine Deficiency Disorders Control Programme (NIDDCP).Main Findings : The major limiting factor in the implementation of NIDDCP was that the community perceptions about IDD and iodized salt and their interests and beliefs (Values) were not explicitly considered as part of the implementation process. Addressing the values through sustained advocacy, development of partnerships among stakeholders, supply and demand side interventions and more research based on the programme needs helped in achieving sustainability in elimination of IDD.Conclusion : In formulating National Health Programmes in a policy environment, scientific inputs, political will and institutional structure for decision making are necessary but not sufficient. Pro-active recognition values of key stakeholders, continuous and dynamic generation of scientific information and development of partnerships are critical for sustainability of the National Health Programmes.

Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC

Background: Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. Materials and Methods: Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. Results: The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. Conclusions: The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

Background: The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

Iodine deficiency disorders (IDD) has been documented since around 5,000 years. However, geological factors like frequent glaciations, flooding, and changing of course of rivers has led to iodine deficiency in soil. As a result everyone remains at risk of IDD, if optimum intake of iodine is not sustained. Evolution of the IDD control program in India has been a dynamic process. The model of IDD control program in India provides important lessons for successful implementation of a national health program. In formulating National Health Programs; policy environment, scientific inputs, political will, and institutional structure for decision making are necessary but not sufficient. Continuous and dynamic generation of reliable and representative state and national level data, proactive recognition of values of key stakeholders and addressing them through sustained advocacy, development of partnerships among stakeholders, institutional continuity, and mentorship are critical for achieving sustainability of results.

Background: Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. Materials and Methods: The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. Results: The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. Conclusion: IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.

Background: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. Objectives: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Materials and Methods: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. Results: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. Conclusion: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.

Background: Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons. Objectives: To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India. Materials and Methods: This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days. Results: One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29 - 3.54) was found to be significantly associated with mortality in the age group ΃70 years. Conclusions: This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ΃70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.

While many may argue as to who deserves the most credit for the discovery of modern anaesthesia, events in the late 18 th and early 19 th centuries led to the introduction and development of modern anaesthetic techniques. English physicist and chemist Humphry Davy [1778-1829] first became aware of the sedative and analgesic properties of nitrous oxide in 1795. Although he never experimented with the drug during a surgical procedure, he was the first to suggest that it would be beneficial in relieving pain during surgical procedures. The mind-altering properties of nitrous oxide and ether were often abused for recreational purposes, and the term ′ether frolics′ was coined to describe such use. While physician William Crawford Williamson Long [1815-1878] first used ether during general surgery, medical student William Edward Clarke [1819-1898] was the first to use ether for dental extraction in 1842. Dr. Long neglected to publicize his findings until 1849, thereby denying himself much of the credit he deserved. Dentist Horace Wells [1815-1848] successfully used nitrous oxide for dental procedures, but a public demonstration which he held in January 1845 turned out to be a fiasco. Medical student William Thomas Green Morton [1819-1868] was the first to publicly demonstrate the effectiveness of ether for general surgery on October 16, 1846. This article seeks to give rightful credit to each of these individuals for their unique contributions to the discovery of modern anaesthesia.

In India there is an increasing trend in hypertension prevalence among the general population. Studies have shown that tribal populations in India are also experiencing this burden.The aim was to estimate the pooled prevalence of primary hypertension among adult tribal populations of India.A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals for studies published between 1981 and 2011. Two authors independently reviewed the studies, did quality assessment and extracted data in pre-coded spread-sheets. Pooled estimates of prevalence of hypertension were calculated using DerSimonian-Laird random effects model. Subgroup and sensitivity analyses and meta-regression were performed.Twenty studies or 53 subpopulations with 64 674 subjects were included in final review. The pooled estimate of hypertension prevalence was 16.1% (95% CI: 13.5, 19.2). There was significant heterogeneity among the studies (I2 = 99% and Q = 4624.0, df = 53, p

The environmental radiation release from Fukushima nuclear power following tsunami in Japan has once again highlighted the omnipotent risk of radiation injury in the today’s world. India is at a real risk from radiation fallout both due to nuclear power plant accidents and nuclear warfare threat. The risk from nuclear radiation accident in India is further increased by the region being endemic for iodine deficiency as adverse effects following nuclear radiation fallout like thyroid cancer is significantly higher in iodine deficient populations .There is need to institute disaster preparedness measures to mitigate the damage in case of a nuclear accident. Interventions to control adverse fallout of nuclear radiation include evacuation, sheltering and food controls as well as iodine prophylaxis.