HEALTH/EPIDEMICS – 2016 (January to April - 2016)

Compiled By

Fr. Paul G Documentation Centre∗

1. Environmental factors too behind antibiotic resistance? (3)

New York: Can the emergence of antibiotic-resistant bacteria be squarely blamed on the misuse and

overuse of antibiotics? No, there is more to the problem than the misuse of common medications,

says a University of Georgia researcher. J. Vaun McArthur believes environmental contaminants may

be partly to blame for the rise in bacterial resistance, and he tested this hypothesis in streams on the

U.S. Department of Energy's Savannah River Site. McArthur tested five antibiotics on 427 strains of

E. coli bacteria in the streams. His research team collected samples from 11 locations in nine

streams, which included sediment as well as water samples. The level of metal contamination among

these locations varied from little to high. The results revealed high levels of antibiotic resistance in

samples from Upper Three Runs Creek and on two tributaries located in the industrial area, U4 and

U8. McArthur said Upper Three Runs Creek flows through residential, agricultural and industrial areas

before it enters the SRS, so the bacteria in this stream have been exposed to antibiotics. In contrast,

U4 and U8 are completely contained within the site and have no known input from antibiotics. But the

contaminated streams U4 and U8 had the highest level of antibiotic resistance. "These streams have

no source of antibiotic input, thus the only explanation for the high level of antibiotic resistance is the

environmental contaminants in these streams -- the metals, including cadmium and mercury,"

McArthur said.IANS (The Hindu 1/1/16)

2. ‘Women’s health: implementation of welfare schemes has to be ensured’ (3)

Though Tamil Nadu has various welfare schemes for girls and women, disaster-preparedness to deal

with emergencies can have an adverse effect on their health, making them vulnerable to

diseases.“The need of the hour is public pressure,” said Ramya Kannan, Tamil Nadu Bureau Chief,

The Hindu , while emphasising the need for civil-society organisations to invest in private partnerships

to ensure implementation of the key objectives of Sustainable Development Goals, adopted by the

United Nations in September, 2015. She was addressing a meet for journalists organised recently by

the Family Planning Association of India and Citizen News Service on Sustainable Development Goal

and Sexual and Reproductive Health at Hotel Aadithya. Umesh Aradhya, president of FPA India said

that sexual and reproductive health was very much part of human rights. “Sexual and reproductive

health rights include right to equality and protection from any stigma and discrimination,” he added.

Muniappan, ex-Demographer, Government of Tamil Nadu, said that sexuality education was not given

much priority in the State. “Though the sex ratio and maternal mortality ratio in the State are

impressive, there are cases of girls dropping out of school once they attain puberty. Many of them are

anaemic and ignorant about where to access services,” he said. Geeta Sethi, Secretary General, FPA

India, emphasised the media’s role in highlighting the success stories and creating awareness about

the issue. (The Hindu 3/1/16)

3. Rs 16cr plan to check maternal deaths (3)

Pune: The state government has made a provision of Rs 16 crore to improve services at state-run

healthcare centres handling high-risk pregnancies. Delivery room facilities at 110 district and sub-

district women hospitals are expected to be transformed within six months to check infant and

maternal mortality rate. "Women with high-risk pregnancies pose a challenge before, during and after

delivery and they need special care and monitoring to avert complications. The project aims to

upgrade labour rooms, build the capacity of the staff, improve clinical practices and reorganise labour

∗ This is a collection of previously published news and views from the print as well as the electronic media, whose

reference marked at the end of each news items. Department of Documentation and Library (DDL) of the Indian Social

Institute, New Delhi neither claims to the veracity of the facts in the news nor subscribes to the views expressed.

rooms," said Archana Patil, additional director, State Family Welfare Bureau. "We have identified only

those hospitals where a sizable number of deliveries take place every month. We have already

started to procure the required equipment and the upgradation work will be over within six months,"

Patil said. The objective is not just to handle a woman with high-risk pregnancy, but also ensure that

she has a smooth passage all through labour and post-delivery. "Of the total maternal deaths

recorded in the state, 52% occur in postnatal stage - the time between the baby's birth and six weeks

thereafter. Half of the deaths occur soon after the delivery in the first six weeks, followed by 28%

deaths that occur during pregnancy; 18% deaths happen during childbirth," said a state health

department official. The state's current maternal mortality rate is 68 per 1 lakh live births. The mortality

rate is defined as the number of deaths of pregnant women per 1,00,000 live births where the cause

of death is directly attributed to pregnancy or a pregnancy-related complication. It is a direct

parameter of healthcare services available in a geographic area. Senior gynaecologist Charuchandra

Joshi said, "In developed countries, the maternal mortality rate has been brought down to a single

digit. In Maharashtra, it is unacceptably high. In rural areas, it is double than that in urban areas. In

states like Rajasthan, Bihar, Uttar Pradesh and West Bengal, it is more than four times the national

average of 178 deaths per lakh." "There has been no major change in the causes of maternal deaths

over the years. Deaths due to anaemia, obstructed labour, hypertensive disorders and sepsis can be

prevented with adequate antenatal care, referral and timely treatment of complications of pregnancy

and promoting institutional delivery and postnatal care," Joshi said. When contacted, an official from

the state health ministry said, "We are making available a large number of first referral units, providing

training to skilled birth attendants, emergency obstetric care training to doctors and nurses among

others. There is a well thought out and designed system of reporting and analysing maternal deaths.

Local, facility-based regional committees have been formed to analyse the information, plan

strategies and give recommendations." (Times of India 9/1/16)

4. NGO disputes Kerala govt. claim over infant mortality in Attapady (3)

Palakkad: Hardly a week after Kerala Minister for Panchayats and Social Welfare M.K. Muneer

claimed that only 14 infant deaths were reported from Attappady in 2015, a non-governmental

organisation has come out with statistics proving there were 24 such cases during the period. The

Centre for Tribal Education, Development and Research (Thambu) has prepared a detailed list of

infant deaths, miscarriages, and neonatal deaths which occurred in 2015 and dispatched it to the

Chief Minister, Health Minister, and the Scheduled Tribes Welfare Minister. Talking to The Hindu here

on Wednesday, Thambu convener K.A. Ramu said the agency had documentary evidence to prove

that 26 cases of miscarriages and neonatal deaths were reported from Attappady last year. According

to him, three infant deaths occurred at Government Medical College in Thrissur while another

occurred at Palakkad District Hospital. Seven such cases were reported from Government Tribal

Specialty Hospital at Attappady and five deaths reported from Medical College Hospital, Coimbatore.

An infant died while undergoing treatment at Sree Chitra Tirunal Institute for Medical Sciences &

Technology in Thiruvananthapuram and one such case was reported from a private hospital at

Attappady. Six infants died at tribal settlements in Attappady, he said. According to Mr. Ramu, there

was a concerted effort to claim that tribal health in Attappady had improved considerably following

effective government intervention since 2013 when 47 infant deaths were reported. Thambu president

Rajendra Prasad demanded a people’s audit of ongoing government-sponsored welfare schemes in

Attappady. (The Hindu 14/1/16)

5. A tribal hospital crying for attention (3)

Palakkad: Two tribal infant deaths since the beginning of 2016 have added to the chorus for

improving facilities at Government Tribal Hospital at Kottathara in Attappady. The second death was

reported late on Sunday night from Mettuvazhi tribal settlement where a seven-month-old boy died of

diarrhoea, high fever, and dehydration. The baby boy of Pappathi-Ratheesh couple was born

underweight and was suffering from multiple diseases. It was on January 4 that the first infant death

this year was reported. A two-day-old infant from Mulli tribal area was rushed to the tribal hospital

following acute respiratory problems. The infant died on the way to the hospital. The area had

witnessed 24 infant deaths last year. An additional 26 cases of miscarriages and neo-natal deaths

were also reported during the period. “Following the intervention of the State Human Rights

Commission, a fulltime gynaecologist was appointed at the hospital last week. A paediatrician will join

next week. Improving the facilities at the hospital alone can save tribal children and their

undernourished mothers from death,” said tribal activist K.A. Ramu. Though the Palakkad district

administration had written to the State government last year seeking administrative sanction to

construct two more floors for the hospital and increase the number of beds, the sanction is still

awaited. Permission has also been sought for utilising Rs.2 crore sanctioned recently for the health

sector in Attappady to improve facilities at the hospital. According to department officials, the hospital

is facing a number of problems, including lack of specialists and technicians to operate devices. “The

practice of referring patients to hospitals in Coimbatore and Palakkad should end,” said Rajendra

Prasad, social activist. He said improving facilities at the hospital and various primary health centres

under it would be vital to curb infant mortality. The specialty hospital had turned into a referral one due

to lack of doctors and facilities. At present, the hospital has vacancies of 10 doctors. According to

hospital authorities, the absence of a centralised oxygen supply facility and power backup was

hampering surgeries. (The Hindu 19/1/16)

6. Surge in drug-resistant TB cases across state (3)

PUNE: Maharashtra recorded 779 cases of extensively drug-resistant tuberculosis (XDR-TB), the

world's most untreatable form of TB, in 2015 - the highest figure recorded in last five years. Mumbai

registered the most number of cases at 475, higher than the total number of cases (469) reported in

the state in 2014. The latest report of the state health department has revealed this information. XDR-

TB is a rare form of tuberculosis that is resistant to at least four of the core anti-TB drugs. It takes a

substantially longer time to treat this form of the disease than the drug-susceptible form and requires

the use of second-line anti-TB drugs, which are expensive. Health experts say the rise in the

detection rate of XDR-TB cases is not surprising, given the widespread prevalence of TB and the

rising cases of multi drug-resistant tuberculosis (MDR-TB) in the country. That patients often do not

complete the recommended treatment is also a factor adding to the numbers. "The detection of XDR-

TB has increased considerably after more centres equipped with the facility to test resistance to

second-line tuberculosis came up in state. That is one of the reasons for the considerable rise," said

state tuberculosis officer Sanjeev Kamble, who is also the joint director of the state health

department.The department started diagnosing XDR-TB after the first case was reported in 2011 at

Hinduja Hospital in Mumbai. "Earlier, we had to send samples for testing resistance to second-line TB

drug to the National Tuberculosis Institute in Bengaluru. Now, we have five testing centres where

sensitivity to second line drug is tested," Sharad Patil assistant director (TB), said. (Times of India

19/1/16)

7. NHRC intervenes as relief eludes endosulfan victims (3)

Palakkad: Taking cognizance of a report carried by The Hindu on January 18, ‘Relief eludes Kerala

endosulfan victims,’ the National Human Rights Commission (NHRC) has issued notice to the Chief

Secretary of Kerala and the District Collectors of Palakkad and Kasaragod asking why the relief

ordered by the commission six years ago has not reached those affected. In an official release in New

Delhi recently, the commission observed that the report raises ‘a serious issue of violation of right to

the health of the victims.’ It sought detailed reports within two weeks. Observing that the Kerala

government was bound to compensate and rehabilitate the victims, the commission recalled that the

State government, in its order dated May 26, 2012, had notified that the recommendations of the

NHRC were to be implemented and laid down the method by which the compensation was to be paid

to various categories of the victims. “If the victims of endosulfan are not being compensated in terms

of the order, it amounts to violation of their human rights. An unofficial survey has found that 613

children below the age of 14 continue to suffer from the illness caused by the aerial spraying of the

pesticide in mango plantations of Muthalamada in Palakkad district. The newspaper report cites the

case of a girl named Hemalatha, who, despite having born after two years of a global ban on the

pesticide, suffers from physical illness because of the residuary effect of the pesticide,’’ the release

said. The commission stressed the need for an expert study on the impact of endosulfan at

Muthalamada, Velanthavalam, Vadakarapathi, Eruthempathy, Nenmara, and Nelliampathy

panchayats of Palakkad. As per the earlier order of the commission, the State government was

directed to pay at least Rs.5 lakh to the relatives of those who died because of the aerial spraying of

the pesticide. An equal amount was promised to those who permanently bedridden and suffered from

severe deformities. The NHRC ordered to pay at least Rs.3 lakh to all those who became living

victims of the killer pesticide. (Thwe Hindu 24/1/16)

8. Alarming malnutrition, neo=natal mortality in Madhya Pradesh: NFHS 4 (3)

BHOPAL: More than 40 out of 100 children in Madhya Pradesh are malnourished if the latest National

Family Health Survey (NFHS) is anything to go by. Besides, MP has been registering the highest

infant mortality rates in the country for almost a decade and currently 51 infants out of 1000 don't get

to celebrate their first birthday. NHFS 4, released for 13 states and 2 UTs paints a grim picture for the

state where children are already reeling under acute malnutrition and high infant mortality. As per an

analysis by voluntary organisation Child Rights and You (CRY), 'the latest data shows that more than

40% children under the age of 5 are stunted (low height for weight) while 42.8% children below 5 are

underweight. The percentage of children who are wasted (low weight for age) has come down from

35 to 25.8% but the number is still considered very high by WHO standards.'Stung by the high levels

of malnutrition, one of the highest in the country, in the previous NFHS 3 survey the state had

launched several initiatives to contain malnutrition including the Atal child health and nutrition mission.

It also commissioned a comprehensive district wise NIN (National Institute of Nutrition) survey in

2010. Meanwhile, only 18% infants receive health check-up within two days of birth. With a huge

number of newborns dying within the first 24 hours of birth immediate health checkups must be

prioritized at all district levels. 50% of the state's children have not received full immunization needed

for prevention of critical preventable diseases. The state in 2014 has renewed its campaign on

vaccination through mission Indradhanush and this should hopefully tilt the figures in the state's favor

in the next survey. Moreover the percentage of children below two years of age receiving both breast

milk and solid- semi solid food stands at a dismal 6.6%.Soha Moitra, regional director (North), says,

"The NHFS is not just a reflection of the state of health and nutritional well-being of children but it also

provides direction for corrective measures in state policies and programmes. For MP, the data so

released not only highlights the extremely slow pace of progress vis a vis child care and health but

also reinforces the need to address nutritional security of children as an emergency." "In context of

malnutrition, strengthening of Anganwadi Centres and a robust system of growth monitoring,

becomes imperative," she added. (Times of India 25/1/16)

9. Poor Nutrition, Child Marriage Behind Low IMR and MMR (3)

SRIKAKULAM: Though the government has been initiating several welfare programmes to increase

the girl birth rate, to minimise the infant mortality and maternal mortality rates, there is no progress in

the district. Due to the child marriages, malnutrition, poverty and superstition a large number of

children die in the district, particularly in the rural pockets, every year. The Pre-Conception and Pre-

Natal Diagnostic Techniques Act, 1994, is not being implemented in the district properly. During the

past 20 years statistics point to the high need to save the girl child in the district. Over 50 per cent of

the pregnant women do not have nutritious food and surprisingly majority of them is not taking even

one fruit/egg a day. In 2015 34 women died during delivery in the district. During the past 20 years,

the sex ratio declined to the disadvantage of the girl child. According to the reports, there are only 945

females against 1,000 males and the government’s initiative is not bearing fruit to save the girl child in

the district. Stressing the need to implement the PNDT Act and prevent the child marriages to ensure

no early pregnancies in the district, the government has decided to take up massive awareness

programme through schoolchildren. “In 2015, due to malnutrition and early pregnancies there were

509 stillbirths and 524 total child deaths (one to five years) were reported last year. The district

administration would launch a massive awareness programme to educate people on the problems of

child marriages and malnutrition in the villages. The schoolchildren would be educated to create

awareness among their parents. As many as 50,000 deliveries took place in 2015 and 34 mothers

died. However, the district administration is very keen to bring the death rate to zero, said collector P

Lakshminarasimham. One can report on the toll free number 1098, police helpline 100 and Women

and Child Development department 08942-240630 on the child marriages, the collector added. ..

(New Indian Express 27/1/16)

10. TS outperforms AP in IMR: report (3)

HYDERABAD: The latest population based survey, National Family Health Survey (NFHS-4) 2015-16,

which was released by the Union Government a few days ago, has given clear indication of

improvement of Infant Mortality Rate (IMR) levels for Telangana State. In fact, Telangana has

managed to outperform Andhra Pradesh (AP) in the IMR, which is the mortality rate of infants for

every 1,000 live births. According to the NFHS-4, the IMR for Telangana State (both urban has rural)

is at 28 for every 1,000 live births. At the same time, average IMR (urban and rural) for AP is at 35. In

urban Telangana, the IMR is at 20 while in rural areas, the IMR in Telangana is a bit higher at 35

deaths. In urban AP, the IMR was at 20 while in rural areas, Andhra Pradesh has an IMR of 40.

Expert researchers and health care workers, however, point out that compared to other States and

even developed countries, the IMR rates in Telangana and AP are very high. In States like Kerala,

Tamil Nadu and even for that matter Karnataka, the neonatal mortality rate hovers between 10 and 18

infants for every 1,000 live births. According to NFHS-4, both Telangana and AP have very under-five

mortality rate (U5MR) per every 1,000 live births. The average U5MR in Telangana, according to

NFHS-4 is 32 while for AP it is at 41. Senior paediatricians pointed out that the high level of under-five

mortality rates highlight the need to strengthen long-term care for infants soon after they are born. In

this direction, the recently launched Telangana New Borne Action Plan, which is a part of the India

Newborn Action Plan (INAP) launched by Government of India (GOI), could go a long way in

improving things. Essentially, the TNAP and INAP outline ‘a targeted strategy for accelerating the

reduction of preventable newborn deaths and stillbirths in the State and elsewhere in the country.’

“Would-be mothers have to be take care right from conceiving stage till delivery and later after the

birth. To a large extent we have been successful in providing this level of care in Telangana,” says

Head, Paediatrics, Gandhi Hosptial, Dr. J. Venkteswara Rao. Till recently, the IMR levels in TS was

between 33 and 35. “Earlier surveys in Telangana had indicated that IMR was at around 35. When we

compare this to NFHS-4 survey that indicates that IMR is now 28, it is definitely heartening. However,

when we look at the overall picture, we are way behind States like Kerala or even Karnataka, we are

behind. In the end, we must aim to bring down the IMR to a single digit,” points out president of the

National Neonatology Forum (NNF) of India, AP and TS chapters, Dr. T Usha Rani. (The Hindu

29/1/16)

11. Doctors hail, NGOs flay Maneka proposal on mandatory sex test (3)

CHENNAI: Union minister for women and child development Maneka Gandhi's proposal to make

prenatal sex determination tests mandatory could significantly improve the health of mother and child

and eventually slash the maternal and infant mortality rate -issues that have bedevilled the public

health system, doctors say. Revealing a baby's sex to curb female foeticide is an idea that doctors

say Maneka deserves credit for. They say such "out-of-the box thinking" is probably the only way to

solve a problem that the ban on sex determination tests has for decades grappled with. The minister's

suggestion will allow the authorities to keep track of a pregnant woman and her fetus till delivery.

Public and private health officials will have to carry out regular checks for anaemia, malnutrition,

diabetes and hypertension, the cause of most maternal deaths, and institutionalise all deliveries. "If

we are able to keep track of women as suggested by the minister it may work," obstetrician and

gynaecologist Dr Kamala Selvaraj said. "What we need is a foolproof tracking system." Creating such

a system may be tough but it's not impossible, say doctors. In Perambalur district, administrators and

doctors set up a system that helped bring down mortality to near zero in four years. The Union health

ministry in 2015 declared that India had missed its millenium development Goal target of reducing

maternal mortality rate (MMR) to 109 per 1,00,000 live births by 31points. Doctors say early screening

will also help doctors identify abnormalities and de velopmental disorders such as Down Syndrome.

"We cannot deny women advantages of medical technology to prevent feticide," fetal health expert Dr

S Suresh said. Most NGOs, however, have dismissed the minister's idea as outlandish. Members of

Human Rights Research and Advocacy Foundation, which also runs campaigns against sex selective

abortion, fear it could lead to an increase in domestic violence against women. "Why should we give

men a chance to torture their wives early in pregnancy? We have not been able to keep track of

women's health because we don't have a good system. How will sex determination change this,"

asked Indra, a coordinator with the foundation. Most doctors don't agree."We have been sitting with

this law for more than two decades and we have achieved nothing. We haven't been able to reverse

sex ratio," Dr S Suresh said. (Times of India 3/2/16)

12. Maternal deaths increasing at Government Medical College and Hospital (3)

Aurangabad: Maternal deaths due to pregnancy and delivery complications have increased at

Aurangabad Government Medical College and Hospital to 108 MMR last year. Maternal mortality rate

(MMR) is the the number of deaths of pregnant women per one lakh live births in a given year,

caused by complications during pregnancy or delivery. It is an important indicator of healthcare

services in a particular area. The state had fared second best in the country after Kerala on MMR

during 2010 -12, with Maharashtra recording 68 maternal deaths per lakh. "To bring down maternal

mortality, Association of Maharashtra Obstetrics and Gynaecological Societies (AMOGS) has chalked

out a two-year exercise of creating awareness and providing treatment facilities to women at all

levels. This might help bring a real change in association with the public health sector from villages to

the cities," said Kanan Yelikar, GMCH Obstetrics and Gynaecology department head and newly

elected AMOGS president. "The maternal mortality ratio in Maharashtra has declined from 105 to 68

per one lakh live births since 2012, which was 200 per one lakh live births 10 years ago. Despite this,

the pace of decline is insufficient to achieve the major development goals for maternal mortality.

Hypertensive disorders, anaemia and post-partum haemorrhage (PPH) of pregnancy are a major

cause," said Yelikar. Among the various reasons for the deaths, post-partum haemorrhage

contributes 25%, high blood pressure 18%, anaemia 8%, and sepsis 12%. Meanwhile, lack of

transport facility resulting in delayed treatment also is one of the factors, she said. "Maternal deaths

get automatically checked when pregnant women are encouraged to approach health care

establishments for deliveries. Delivery complications are taken care of and effectively managed when

a woman delivers a baby in a hospital. The rate of institutional deliveries - deliveries taking place at

hospitals - has been consistently on the rise in the state due to various government sponsored

schemes," said Srinivas Gadappa, a gynaecologist at GMCH."However, the rate of maternal death is

recorded at alarming 108 per one lakh live births at GMCH since women here are generally brought in

urgent conditions, such that most of the mortalities are reported within 12 hours of admissions.

Meanwhile, since this is the biggest referral hospital in the region patients not only from across

Marathwada are brought here but critical patients from nearby regions like Khandesh, Vidarbha and

Andhra Pradesh borders too are referred here," she said…. (Times of India 4/2/16)

13. 51k Cancer Cases Reported Every Year (3)

BENGALURU: Karnataka sees 51,000 new cases of cancer every year and about three lakh people

come for follow-on treatment. This trend can be brought down by collective efforts and by creating

awareness, said Dr K B Linge Gowda, director of KIDWAI Institute of Oncology. He was speaking at a

seminar for nursing students -- ‘We care, You care and I care’ -- organised by the Institute on the

occasion of World Cancer Day here on Thursday. “About 19,000 patients are from West Bengal,

Assam, Uttar Pradesh and Odisha. Most of them come at the advanced stage. The success rate of

treatment depends on early diagnosis. The treatment involves chemo and radio therapy, along with

drugs and diet,” Dr Gowda added. Dr Prathima Murthy said that alcohol and drug abuse, tobacco use

and unhealthy lifestyle are contributory factors to this deadly disease. Environmentalist Suresh

Heblikar said the government should focus on keeping tabs on pollution. “Giving importance to

industries in the city will add to pollution. This will lead to other health hazards. The investment should

be done in coastal belts and other places to improve those areas and decongest Bengaluru,” he said.

Dr Mahadevappa, former V-C of the University of Agricultural Sciences, Dharwad, who is a cancer

survivor, felt that educating farmers to grow crops with organic manure rather than the chemical ones

will have good impact of health. K C Lakshmaiah, Head, Medical Oncology, KIDWAI Institute, said, “In

rural areas, the situation is very scary as most of them are battling cancer in the last stage.” Institutes

across the city had organised events to raise awareness about cancer.According to health ministry

data, out of 300 cancer centers in India, 40 per cent are not adequately equipped with advanced

cancer care facilities. India needs at least 600 additional cancer care centers by 2020 to meet the

requirement. Annually, nearly 5,00,000 people die of cancer in India alone. (New Indian Express

5/2/16)

14. Health research lacks peer support, mentors: ICMR chief (3)

CHENNAI: Health research in India needs a lot of advocacy and great examples to go forward, said

director general of the Indian Council for Medical Research (ICMR), Soumya Swaminthan. “Many

researchers struggle with no peer group or mentors, and we need to see how we can create virtual

networks, to share ideas, get inputs and discuss. Research needs intellectual inputs all the time, it

cannot be done in isolation,” she said. Dr. Swaminathan was speaking at the inauguration of a

seminar on ‘Prevention and control of non-communicable diseases,’ conducted by the Madras

Diabetes Research Foundation (MDRF) in collaboration with the University of Alabama, Birmingham,

United States. Capacity building is high in the priorities of the ICMR, Dr. Swaminathan said, adding

that multi-disciplinary research units had been set up at 48 medical colleges in the country, including

at Madras Medical College. Model rural health research units had also been set up at 12 places, she

said. “We are also thinking about how to establish centres of advanced research with public and

private partners,” she said. On the rising incidence of non-communicable diseases, Dr. Swaminathan

said there was need to see whether schoolchildren were receiving the right kind of diet and exercise,

adding that a study had shown that the amount of salt Indians consumed on an average was higher

than what it should be. Dr. Swaminathan was also conferred the eleventh MDRF-UAB-FIU Gold

Medal Oration Award for her contribution to the field of medicine. MDRF, along with Dr. Mohan’s

Diabetes Specialties Centre, had also taken up a programme on ‘Strengthening Indian NCDs clinical

research and training capacity,’ supported by the University of Alabama and the Florida International

University and University of Minnesota, said V. Mohan, president, MDRF. The seminar will end on

February 7. (The Hindu 7/2/16)

15. ‘Fluorosis spreading alarmingly in TS’ (3)

HYDERABAD: Even as the Telangana State is yet to tackle the dreaded disease of fluorosis in

Nalgonda district caused due to presence of alarming levels of fluoride in its ground water, there is

more bad news for the State. The tentacles of fluorosis that leaves people crippled is threatening to

spread across the State as nine out of 10 districts barring Hyderabad has high levels of fluoride

content in the potable water. The data on the basis of water sample study commissioned by Centre

across the country and uploaded in the net revealed startling facts. The fluoride levels in nine districts

of Telangana except Hyderabad account for high content of fluoride while it should be below 0.5 ppm

or 0.5 mg/lIn fact water samples in Adilabad turned out to be worse than that of Nalgonda followed by

Ranga Reddy, Khammam and Medak districts respectively, says Dr. D.Raja Reddy, who had been

working for containing the adverse impact of fluorosis on people through better nutrition with optimum

intake of calcium, magnesium and Vitamin C. Hyderabad was not included in the study as it got good

water from Manjira, Krishna, Godavari rivers and tanks receiving rain waters. Fluorosis is a disease

caused by excessive intake of fluorides through water, beverages like tea and food and the disease is

further aggravated by malnutrition. About 66 million people in 21 States across the country are at risk

of contracting fluorosis and six million are already crippled because of it. It is a major health concern

in the country and more so in Telangana where people mainly depend on ground water, he says.

Rural Telangana was more at risk for fluorosis as widely prevalent malnutrition aggravates fluorosis

incidence, points out Dr.Raja Reddy, former Director of Nizams Institute of Medical Sciences and

Consultant Neurosurgeon of Apollo Hospitals. Dr. Reddy who as advisor to Madhya Pradesh

government has been working on tackling fluorosis incidence through better nutrition says they have

seen significant improvement in the tribal children affected by the disease. Adding to the burden of

fluorosis, bacterial contamination in rural areas of Telangana without protected water supply was

another public health concern in the State, he explains. Even if surface water from tanks in some

areas is good with permissible limits of fluoride, they are bad due to bacterial contamination of E.Coli.

Until alternate safe drinking water is made available, Dr. Raja Reddy suggested that the Government

should take up an exercise to identify the water source/ borewell in each village which has lowest

fluoride level among all water sources and direct villagers only to use that source for drinking and

cooking. The fluoride content of every drinking water source should be displayed so that people avoid

such waters. Other urgent measures include emphasis on nutrition rich in calcium, magnesium and

vitamin C for containing fluorosis. To brace one self from bacterial contamination of water and

diarrhoea, which is the third leading cause of death of Indians, drinking water should be mandatorily

consumed only after boiling and cooling in all rural areas without protected water supplies. Till such

time Government could supply surface water from perennial rivers for drinking and cooking needs of

people in areas with excessive amount of fluorides in ground water and take measures to store rain

water, the above measures become imperative for public health, he says. (The Hindu 12/2/16)

16. High rate of maternal mortality, C-section cause for concern (3)

KOCHI: Even after achieving an enviable position in primary health care, the State continues to have

a high maternal mortality rate (MMR). With 250 mothers dying in child birth against over four lakh

deliveries in 2013-14, the MMR is in the range of about 50 to 60 deaths per one lakh births. Though

the State provides a better picture of maternal health against the all India MMR hovering around 200

deaths, the State forum of gynaecologists is coming up with a study on why mothers in Kerala die. A

case study of mothers dying during child birth has been taken up to find out causes and address them

with skill and technical support. “The problem is data collection and comprehensive action,” senior

gynaecologist V.P. Paily, who was president of the All Kerala Federation of Obstetrics and

Gynaecology, told The Hindu . The State achieved MMR of 87 in 1992, but made no major progress

till 2009 when MMR was 81. The Tamil Nadu government had achieved better results by providing

companions to expectant mothers. The companion would monitor the mother’s health during the time

of labour too. The companion had to be a woman who had attended classes along with the expectant

mothers. While the State is battling to raise the bar in providing basic health care to expectant

mothers with a target of achieving an MMR of 10 to 15, it is also faced with a high rate of Caesarean

section deliveries. “With less than 30 per cent deliveries happening in government hospitals, the

compilation of data is a major problem,” said Dr. Paily. Though the Federation had provided

guidelines for C-section deliveries, an analysis of the problems leading to C-section could be made

only when the full data was available. The Federation is looking at reducing the primary C-section

rate. If the first child is delivered through a C-section, the probability of the second child being

delivered through C-section becomes rather high. (The Hindu 15/2/16)

17. Maternal mortality down with Asha assistance (3)

Nashik: Over 3,000 Asha workers are motivating rural women across the district to opt for institutional

deliveries to promote child survival and reduce maternal mortality. And the result is evident. Of the

60,893 maternal deliveries in the rural parts of the district in 2014-15, as many as 57,061, or 93%,

were institutional deliveries, district Health Officer Sushil Wackchaure said. "Over the past eight to

nine years, institutional deliveries in Nashik rural have increased from 51% to 95%," he said. Last

year saw 16,669 cases, in which the Asha workers were directly involved in motivating the women for

institutional deliveries. Health officials said the rate of maternal mortality came under control when the

women were encouraged to approach healthcare services for delivery. An official said hospitals are

properly equipped with tackling complications during deliveries and monitoring the health of the

newborns.Wackchaure said the Asha workers have also started keeping a check on the health of the

newborns till they turn a year old. The aim of the follow-up of the newborns by the Asha workers is to

bring down the Infant Mortality Rate in the tribal blocks such as Peth, Surgana,Trimbak, Nashik,

Satana, Deola, Igatpuri, Kalwan and Dindori. The Asha workers have also been instructed to

immediately call up 108 ambulance on call, which is a free-of-cost government service, to take the

pregnant women to state-run hospitals for deliveries. Once a woman delivers a baby, the ambulance

drops her and the newborn home. The officials said among other incentives, the Asha workers are

provided with Rs 300 for motivating a woman for institutional delivery and another Rs 300 to provide

services to a pregnant woman such as health check-up and providing the the required medicine

during pregnancy. The district has as many as 3,293 Asha workers. One Asha worker caters to a

population of 1,000 in the tribal areas and one to 1,500 in the non-tribal areas. (Times of India

17/2/16)

18. Rabies deaths double in state, 41 died in 2015 (3)

CHENNAI: Rabies is hounding Tamil Nadu, claiming almost twice as many lives in 2015 as two years

earlier. Official records show that 41 people infected by the virus died in Tamil Nadu in 2015, up from

24 in 2013. But the government has an action plan to counter the fatal disease, spread mostly by free-

ranging stray dogs. The state health department, animal husbandry and various civic bodies hope to

bring rabies deaths to zero in five years through the `One Health Programme'. "The draft plan is proof

that we have the knowledge, tools and, more importantly, the will [to end deaths due to rabies],"

health secretary J Radhakrishnan said. That will came from a success story that the Nilgiris district

silently scripted. Three years ago, officials at Pasteur Institute of India, Coonor, a central government

institute that manufactures anti-rabies vaccines, began investigations on why the district had no cases

of rabies. After a year-long detailed study the institute announced that there we re n o h u m a n cases

since 2009 because no animal domestic, stray or wild -had the virus. The study showed that two non-

government organisations, India Project for Animals and Nature (IPAN) and Worldwide Veterinary

Services, have been sterilising strays and periodically vaccinating them. "We had remarkable results,"

says Pasteur Institute director Dr B Sekar. "Now we know that no dog in the district has the virus."

Veterinarians with the state animal husbandry department conducted postmortems on ownerless

dogs to confirm this. Forest department officials, meanwhile, have also been conducting postmortems

on wild animals to ensure the virus does not infect any wild animal. Officials have decided to urge the

World Health Organisation to declare the district "dog rabies free". The state directorate of public said

this is likely to take time as they have to submit adequate documents to the agency . Officials have

nevertheless now adopted an action plan that can slash the incidence of rabies across the state,

particularly in large cities like Chennai and Madurai.Rabies spreads when the saliva of infected

mammals, mostly dogs, enters the body through a bite or broken skin.The virus travels through

peripheral nerves from the wound to the brain where it causes inflammation. Symptoms that include

violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body,

confusion and loss of consciousness then show and death almost always follows. 'One Health

Programme' is a worldwide strategy to expand interdisciplinary collaborations and communications for

humans, animals and the environment."It is team work on a massive scale and we will be attempting it

for the first time in the country," animal husbandry secretary S Vijayakumar said. "If this works well we

will be able prevent the spread of several zoonotic diseases." The health department will intensify its

rabies awareness campaigns and vaccination drive for people exposed to rabies through its medical

colleges and public health facilities and the animal husbandry department will simultaneously step up

its stray dog birth control and vaccination project and ensure that other mammals are not infected.

The forest department will also test wild animals. "The aim is to safeguard the health of both animals

and humans," he said. (Times of India 18/2/16)

19. WHO chief in Brazil to assess Zika outbreak (3)

United Nations : World Health Organization (WHO) chief Margaret Chan is in Brazil to assess the Zika

virus situation and response, a UN spokesman said. Chan is visiting Brazil along with the director of

the Pan American Health Organization, Carissa Etienne, UN spokesman Stephane Dujarric said at a

daily news briefing here on Tuesday, Xinhua news agency reported. Their itinerary includes meetings

with Brazilian President Dilma Rousseff and a visit to the National Center for Risk and Disaster

Management, Dujarric said. The visit comes after an increase in babies born with microcephaly in

northeast Brazil. The WHO still cautions that more investigation is needed to better understand the

relationship between microcephaly in babies and the Zika virus outbreak. The WHO said that an

increase in Guillain-Barre syndrome in Brazil has coincided with Zika virus infections. The Zika

outbreak in Brazil has caught the attention of the WHO as the virus would cause infants to be born

with microcephaly if their mothers are infected during pregnancy. More than 4,000 reported cases of

microcephaly have been registered in Brazil, among them more than 400 have been confirmed. Of

the confirmed cases, 141 were attributable to the Zika virus. (Business Standard 24/2/16)

20. NHRC notice to M.P. govt. over denial of treatment to pregnant women (3)

New Delhi: The National Human Rights Commission has issued a notice to the Madhya Pradesh

government over alleged denial of treatment at government hospitals to two expecting mothers

afflicted with HIV and Hepatitis B. The Commission has taken suo motu cognisance of two media

reports describing how the two expecting mothers, suffering from HIV+ve and Hepatitis B, were made

to shuttle from one hospital to another and still denied treatment by Government Hospitals in Madhya

Pradesh. “The contents of the press reports, if true, raise serious issue of violation of human rights of

the victims due to apathetic attitude of the medical staff at the Government hospitals,” observed the

Commission while issuing a notice to the Secretary, Department of Health, M.P ,directing him to get

the allegations probed and submit a report within four weeks. In the first case, reportedly, a pregnant

woman, who had been HIV-positive for the last eight years, approached the Civil Surgeon, Vidisha,

with her sonography report, and was adviced to go to the Hamidiya Hospital, Bhopal, as the hospital

at Vidisha, did not have appropriate facilities to operate upon HIV+ve patients. Reportedly, the

woman, along with her husband, approached the Chief Minister for help. The officials at the Chief

Minister’s house gave them a letter for treatment at Sultania Women Hospital, Bhopal. On

approaching that hospital, they were further referred to ART Centre, Indore. Accordingly, the couple

went to the ART Centre. But the doctor at ART Centre asked them to first get the financial assistance

from the Chief Minister’s Fund, as they were a BPL card holder. However, they were not given the

estimate of expenditure for the treatment to enable them to apply for the grant from “CM or PM Fund”,

an NHRC statement said. In the other case, another pregnant woman was allegedly denied treatment

at District Hospital, Satna, on the ground that she was suffering from hepatitis B and her condition

was serious. Hence, she was referred to the Rewa Medical College. As she was not in a position to

be taken to the Medical College, Rewa, which is 52 km away from Satna, she was forced to deliver

the child at a private hospital in Satna, the statement added. PTI (The Hindu 25/2/16)

21. INDIA: Ad-hoc action will perpetuate child malnutrition (3)

If the government does not take charge of the problem of child malnutrition, others will take advantage

of the vacuum. Powerful international players ready to feed on hunger have their foot in the door.

When all is done and dusted, the Modi government’s claims to success will be judged against India’s

darkest distended underbelly, its millions of malnourished children. And, the key for the government

lies in its ability to replace ad hoc action with coordination, to lower the numbers of all forms of child

undernutrition, and not in trying to treat malnutrition with ready-to-use foods. Today, India still has

more malnourished children than any other country. The National Family Health Survey-3 (2005)

found that 42.5% of children under five years old are underweight. The recently released Rapid

Survey on Children (RSOC), conducted by UNICEF and the Government of India, has found that this

figure is now closer to 30%. Statistically speaking, this is good news. From nearly every second

Indian child being underweight, now only around every third child is so. Still, the bad news is 40

million children remain undernourished. India still has a greater percentage of underweight children

than the continent of Africa, where the figures stands at 21%. These Indian children are chronically

undernourished. In the lead up to the last national elections, and since taking power, Mr. Modi has

often spoken about India’s strength being its “demographic dividend”. But, if a large section of this

dividend, i.e. the future of India and Indian growth, are growing up stunted, sickly, and underweight,

the returns are bound to be poor. And, it is certainly not only a question of economics. The choices

that another undernourished generation will make in a democracy will affect not only the entire Indian

society, but given the numbers, the region and the wider integrated world. For its part, the incumbent

Bharatiya Janata Party (BJP) government did promise to address malnutrition before the election. The

Party Election Manifesto stated the following: “One of our main targets will be to eradicate the curse

of malnutrition. We will do so by revamping existing programmes and launching a multi-pronged war

against malnutrition across the nation, especially in the under-developed areas, with the help of State

Governments. All resources will be provided to achieve this goal.” These pleasing words are fit for a

manifesto. They sound determined. But, what is the reality one year after the BJP assumed power?

… (Asian Human Rights Commission 26/2/16)

22. Nod for birth companions in public health facilities (3)

NEW DELHI: In an innovative move aimed at reduction in Maternal Mortality Ratio and Infant Mortality

Rate, the Ministry of Health and Family Welfare has announced that it will allow birth companions

during delivery in public health facilities. Birth companions are women who have experienced labour

and provide continuous one-to-one support to other women experiencing labour and child birth. The

presence of a female relative during labour is a low-cost intervention that has proved to be beneficial

to women in labour. Birth companions provide emotional support (continuous reassurance),

information about labour progress and advice regarding coping techniques, comfort measures

(comforting touch, massages, promoting adequate fluid intake and output), and advocacy (helping the

woman articulate her wishes to the other). (The Hindu 26/2/16)

23. 64 years on, NGO helps treat leprosy patients

NAVI MUMBAI: For the last 64 years, a discreet little NGO has been treating and curing leprosy

patients totally free of cost. Shantivan Ashram or Kushtarog Nivaran Samiti as it is also known, has

been running a programmen for leprosy patients and have treated over 10,000 patients from 170

villages in Panvel. Although Christian missionaries pioneered the efforts of taking care of leprosy

patients in India, it was a group of Gandhians who started this facility. At that time the occurrance of

leprosy in this area was almost 17% and with much effort, the centre now operates from a sprawling

122 acres of land. "We still conduct door to door programmes and treat detected cases. There are

nine centres now opened all across the taluka," he said.The ashram is run with aid from the

government under National Leprosy Prevention Programme and also receive funds from donors.

"There are also centres that look after dependents and senior citizens, naturopathy clinics, rural

development, dairy, and schools for adhivasi children," Prabhudesai added. The samiti has around 60

acres of land where rice, vegetable and fruit trees are grown, a goshala where the 52 cattle provide

milk for the residents and fertiliser for the plantations, rural welfare programme that integrate leprosy-

affected patients with society, a credit society for the villagers, a library and a co-operative society that

sells ration run by the patients. "But more that all the activities the most important remain the

awareness programmes we conduct for people to understand that leprosy is not to be isolated and if

detected, it can be treated and cured," Prabhudesai said. (Times of India 29/2/16)

24. Health Budget 2016: A mere eyewash? (3)

The much awaited Union budget 2016-17 is here. FM Arun Jaitley has announced that the

government will set up 3000 new drug stores across the country to handle the shortage of drugs,

especially in rural areas. He has also provided health insurance of up to Rs 1 lakh per family. Another

important announcement was about the launch of National Dialysis Programme to deal with the high

costs involved in renal dialysis processes. As part of the programme, every district hospital will have

facilities of renal dialysis. Jaitley also added in his budget speech that dialysis equipment will be

exempt from customs duty, fully or partially. Here's what the health industry has to say: Dr. Prathap C

Reddy, Chairman, Apollo Hospitals Group. With specific focus on improving the livelihood of India's

soul, its rural population, the Union Budget 2016-17 seems to be aimed at putting more money in the

hands of the citizens. Three specific initiatives that I think will go a long way in creating an educated,

healthier and stronger India are the government's aim to double income of farmers in five years; new

initiatives to increase irrigation access, and its objective to skill 1-crore youth in the next three years.

On the other hand, healthcare has finally taken the center stage in the Budget. The Health Protection

Scheme of Rs 1 lakh to cover unforeseen illness in poor families with an additional Rs 30,000 for

senior citizens is a long-awaited and welcome step in deepening access. In addition, the

government's plan to add 3,000 pharmacies under the Jan Aushadhi Yojana to provide generic drugs

at affordable rates is a commendable move. Moreover, the announcement of a National Dialysis

Services Programme could not have come at a better time, given the burgeoning growth of non-

communicable diseases. According to the Finance Minister, the programme will be made available in

all district hospitals on a public-private partnership model and on behalf of all the healthcare private

sector providers, we welcome this endeavour. As always, the health sector in the country will be

happy to partner with the government to ensure a healthier India.Mr. Anjan Bose, Secretary General,

NATHEALTH. The 15% increase in government spending on the social sectors with focus on

healthcare should go a long way in ensuring universal health coverage. It is promising to note that the

Government intends to provide health insurance coverage to under privileged class through the new

Health Protection Scheme of Rs 1 lakh to cover unforeseen illness in poor families. This should also

act as a catalyst for investment in healthcare sector and help in improving affordability and

accessibility of quality healthcare. This is all the more important considering that nearly 75% of India

population is currently without any health insurance. Further, announcement of National Dialysis

Service programme is yet another welcome measure for the health sector. The industry could have a

major role to play in this as the programme would be carried out in PPP mode in district hospitals.

Exemption of custom duty on dialysis equipment would further support this commendable

programme. However, the health care industry is concerned since the Government has not addressed

the issue of recent increase in import duty on medical equipment and devices. The medical

technology sector is in an infancy stage with manufacturing limited to less complex devices. More

than 75% of medical equipment / devices are still imported and hence the duty increase will result in

increase in healthcare cost. Healthcare sector was also looking forward to positive response from the

government to its recommendations of Exempting of Healthcare Services from GST, Increase of tax

holiday for establishing healthcare facilities from the current period of five to ten years in non-metros,

Increase in Tax Exemption on Preventive Health checkup and setting up of a healthcare infrastructure

fund as well as a medical innovation fund. .. (Times of India 1/3/16)

25. Gender's effect on health outcomes is exacerbated: WHO (3)

Mumbai: In WHO South-East Asia Region, approximately 61 000 women died in 2015 while giving

birth. The Region ranked third in maternal mortality with 164 deaths for every 100 000 live births. Dr

Poonam Khetrapal Singh, WHO Regional Director for South-East Asia said that women across the

world have unique health needs that are often underserved. "Social, cultural and economic dynamics

negatively affect access to existing services. In low and middle-income countries gender's effect on

health outcomes is exacerbated," she said. She called for a larger social, cultural and economic

change where health systems make a bigger contribution. "Achieving universal health coverage is

one of the most effective ways to allow women to access the care they need. Universal coverage

mitigates economic and physical barriers to accessing care and enhances women's ability to take

care of their health," she said. Nearly 38% of women in the South-East Asia region experience

gender-based violence at least once in their lifetime. At the same time, ingrained social roles mean

women account for the bulk of the 1.6 million annual deaths from household air pollution. Due to the

economic structure of many households, investing in a woman's or girl's health is often overlooked in

favor of other priorities. "In line with Sustainable Development Goal five, which outlines the need to

achieve gender equality and empower all women and girls, seven of the 11 countries in WHO South-

East Asia Region have pledged to 'Step it Up For Gender Equality' and have begun multi-sectoral

efforts to achieve this goal," she said. (Times of India 9/3/16)

26. Rise in number of abandoned patients chokes mental hospital (3)

Thiruvananthapuram: The number of inmates abandoned by relatives at the Govt Mental Health

Institute at Peroorkada is on a steady rise. Around 150 inmates at the hospital, though medically fit to

be discharged, are still left behind with no family members willing to receive them. What it all boils

down to is an extra burden on the doctors and staff of the institution and leaves less bed space for

newly admitted patients. The hospital has a total bed count of 507."The free treatment and

wholehearted care given by the doctors, nurses and staff at the hospital is often taken for granted by

the relatives of some patients. By providing fake addresses and contact numbers, they escape from

the duty of receiving the patients back," said the chief consultant in psychiatry and additional director

of health services Dr K J Nelson. Four voluntary organizations specifically work on reuniting these

deserted patients with their families. The southern region of Kerala has around 30 private charitable

mental healthcare institutes that often adopt patients from the government hospitals. A decade ago

when such institutions were not as popular, the government hospitals were overcrowded much

beyond their bed capacity. Also two 'Abhaya' rehabilitation centers run by the government for the

unclaimed patients have members brimming to their maximum capacity. Of the 150 people stranded

at the hospital, 83 are identified as being from other states, brought in by the police after court

procedures. Although serious efforts are made by the officials at the District Legal Services

Authorities in association with government hospitals to send these inmates back to institutes in their

home states, their efforts largely failed to bear fruit. "A new system should be brought about where the

mental institutes across the country can enable transfer of inmates with ease and lesser legal

formalities. Such a system is currently not in place," said Dr Nelson. The fund required to transfer and

transport cured patients was earlier being sourced from the hospital development committee. But the

authorities have blocked these funds. This will cripple the process, which will eventually leave more

patients in the lurch, he added. (Times of India 8/3/16)

27. 'Bone TB is the prime cause for bone, spine deformities' (3)

New Delhi: With the rise in the number of people suffering from bone Tuberculosis in India, medical

experts have said that the disease is one of the major reason behind bone and spine deformities. The

ignorance about bone TB, during which the bacterium causing TB affects bones and the spine, also

leads to limb shortening in growing children and full body paralysis. According to the medical

statistics, 5-10 percent of the total TB patients in India suffer from bone TB and the figure was on rise.

India witnesses 15 lakh TB patients every year. In India, Uttar Pradesh has the maximum number of

bone TB cases followed by Maharashtra. "Bone TB requires a different approach and duration of

treatment is usually prolonged as compared to lung TB. About 50 percent of the bone TB affects

spine, which causes paralysis if not treated well," said Abhay Nene, Spine Consultant at Mumbai

based Wockhardt Hospitals. "The worst suffering are to live the life with a painful deformity, limb

shortening in growing children. Young spine TB patients (growing age) can present with late onset

paralysis years after their disease has healed. The loss of spinal cord function or permanent paralysis

which doesn't recover is also not very rare in spinal TB patients." According to the doctors, the

disease starts growing over the cartilage and then extends to the underlying bone. "The symptoms

include fever, chills, weight loss, and swelling. Bone TB is non infectious," Nene said. The doctors

have also said that the bone TB causes damage to the bone marrow. Vispute, general physician at

S.R.V. Hospital has said: "Bone TB may affect the bone marrow. After the drugs are given, the

disease may live dormant in the bone marrow, causing it to affect the body's mechanisms of self

renewal." (Business Standard 10/3/16)

28. Punjab tops chart in clearing medical negligence cases (3)

Pune: Punjab topped the charts in delivering judgement in cases of medical negligence slapped either

against doctor or hospital last year with 24%.West Bengal, Maharashtra and Tamil Nadu followed with

17%, 16% and 11%, respectively. The figures were announced at the 8th annual medico-legal review

for 2015, held here on Friday. The event is held consecutively since 2009 by Institute of Medicine and

Law (IML). The need for inclusion of doctor-judges in the panels dealing with cases of medical-legal

matters was also underlined at the review meet. The need was expressed both by experts from

medical and legal fraternities while discussing various aspects of legal complications involved in

medical treatments, particularly those with medical negligence or faulty medical events occurring

during treatment regimes. "At many occasions, judges are in a fix due to limited knowledge about

medicine and related issues, thereby sometime delaying in awarding judgement. There is a need of a

doctor to advise the legal team in order to handle these cases better," said senior Supreme Court

lawyer and director of Institute of Medicine and Law (IML), Mahendrakumar Bajpai. When asked

about having a doctor on the panel, an official on the condition of anonymity said the Medical Council

of India (MCI) fails to do its duties in addressing these legal cases." The MCI comprises doctors and

other experts from the medical fraternity who are well aware and understand the cases better.

Sadly,due to their callousness, the body is as good as as being toothless in this matter," the official

complained. Among the several reasons that the patients file complaints, the key ones included

medical negligence by doctors, delay in initiating treatments, charging exorbitant medical fee and lack

of communication between the hospital and patient's family about the treatment, medical fees among

others.Speaking on the occasion, chief cardiologist and managing trustee of Ruby Hall Clinic P K

Grant, said, " It is true that there is lack of communication between the hospital, doctors, paramedical

team and the patient and family. This needs to be increased." (Times of India 12/3/16)

29. Govt Move on Security for ASHA Workers (3)

BHUBANESWAR: In a bid to provide safe and secure work atmosphere to frontline women health

workforce like ASHAs and protect them from sexual harassment and other exploitation, the State

Health Department on Tuesday issued instructions for strengthening prevention and grievance

redressal mechanisms at all levels. The district Collectors, health authorities and heads of health

institutions have been directed to ensure adequate safety and security measures across all work

spheres of ASHAs. The ASHA Gruhas or resting place for the health workers who accompany

pregnant women to hospitals should be located adjacent to labour rooms and provided with security

personnel. The issues of sexual harassment at workplaces should be dealt sternly. Each sub-centre,

PHC and CHC level meeting must specifically include discussion on whether any frontline health

worker has faced any form of sexual or gender harassment or discrimination. Even perceived threat

or harassment must be taken seriously. Functioning of district and block level ASHA grievance cells

must be strengthened and complaints dealt in a timely manner. The Gaon Kalyan Samiti meetings

should also be used to support ASHAs and other female workers, Health Secretary Arti Ahuja stated

in a circular issued to all district Collectors. Further, a complaint committee headed by a woman as

per Visakha Committee guidelines is to be set up in every workplace or facility. Gender sensitisation

training of all service providers are to be undertaken so that complaints are investigated properly and

action taken on them. (New Indian Express 16/3/16)

30. Tribal areas have more lepers than others (3)

NASHIK: Noting the fact that the numbers of lepers in tribal areas is still very high - more than two per

10,000 of population, the additional district collector, Kanhuraj Bagate asked the medical teams to

scan the areas to find out the exact numbers of sufferers from the disease and start earlier

intervention programmes. "The numbers of people suffering from leprosy is quite under control in the

district, but somewhat on the higher side in several parts - tribals - of the district which need special

attention and hence we have suggested for a special drive in the latter half of the month of March,"

Bagate said.The administration has formed 3,802 teams of officers and employees - totaling 7,308,

which are set to scan the population of Nashik district - including the Nashik city. The exercise will be

carried out jointly by medical officers and employees of Nashik Municipal Corporation (NMC), district

health offices in the city and the rural areas. Every person including child above 2 years of age will be

examined for the presence of leprosy signs by the medical teams visiting the house holds throughout

the district. "There are people who still do not disclose the disease because of stigma associated with

it or on the other hand they do not have any idea of the same. This is the reason that the patients

coming to are in the later stages of the disease. We have therefore decided to carry out massive

operations in the district to get the right impression of the people affected with the disease and the

spread of the same," Joint director Dr PM Padvi, said. (Times of India 18/3/16)

31. WHO calls for direct engagement to end tuberculosis (3)

New Delhi, Mar 21 () Ahead of World Tuberculosis Day on March 24, WHO today pitched for a direct

engagement with communities for case detection, treatment completion and addressing out-of-pocket

expenditures and stressed on addressing its social determinants to end the disease. "To end TB,

there is a need to reach out to and engage with communities directly for case detection, treatment

completion and addressing out-of-pocket expenditures. "Forging partnerships with civil society groups

and between public and private care providers will likewise ensure that present gaps are closed and

that a society-wide movement to end TB develops," Poonam Khetrapal Singh, Regional Director,

WHO South-East Asia Region, said. Singh was speaking at an event 'Unite to End TB: Fast Tracking

access to quality diagnosis and treatment' organised by Health Ministry and WHO. Singh also

stressed on addressing the social determinants of tuberculosis as it still remains a disease of the poor

and the marginalized, with a disproportionate number of cases found among people living with HIV,

migrants, refugees and prisoners. "Addressing poverty and other determinants will have a dramatic

effect on the disease's burden. Policies in this regard could include increasing access to safe housing

and providing viable social security among other options. "TB isn't only a health problem. Therefore,

its solutions must also encompass the full range of multi-sectoral dimensions and multi-stakeholder

engagement. It is one of those diseases that require health in all policies, coupled with strengthening

the full spectrum of human rights that guarantee a TB patient the right to the best treatment possible,"

she said. Universal health coverage means unreached and marginalised populations can access TB

screening, and, if infected, can receive the care they need. With approximately 1 million missing

cases in the region, increased screening and treatment will also prove critical to stopping TB

transmission, particularly of the disease's drug-resistant strains, she said. "Also, political commitment

at the highest level, must be reinforced. The mission-like zeal with which polio and HIV/AIDS have

been fought must be reproduced in the battle against TB and must lead to organisational and

programming shifts," she said. (Times of India 21/3/16)

32. Undetected cases of TB a health hazard: experts (3)

Kannur: Despite the awareness campaign and aggressive measures by the Health Department, and

the highly effective method of providing DOTS (directly observed treatment, short-course), to

eradicate tuberculosis by 2035, many cases of the disease go undetected posing new challenges, say

officials. "It is estimated that every day nearly 5000 new cases of TB are reported in India and also

two TB deaths in every three minutes, which shows the gravity of the situation," said district medical

officer (DMO) Baby P K, addressing a press conference here on Tuesday in connection with

observing the World TB Day which falls on Wednesday.Though 135 people among one lakh get the

infection every year in the country, which is more or less the same in the State too, thus incurring a

financial loss of Rs 13000 crore to the national exchequer, people are still hesitant to go to the doctor

when they have the symptom, he said. As per the national average, there should be around 3200 new

cases reported in the district every year, but only 1524 patients came for treatment in 2015, which

means many patients are still there who do not avail treatment and they are the biggest challenge to

the mission to eradicate TB, said the DMO, adding that a lung TB patient who does not get treatment

spreads it to 15 new people every year. Incidentally, 25 percent of the TB patients in Kerala are

diabetics, which points to the fact that diabetes patients are more prone to the infection, said Bindu K

M, district TB officer. In Kannur also, 23 percent of the diagnosed TB patients are diabetics and there

are 21 HIV infected people too, she said, adding that both the HIV infected people and the diabetics

have equal chance of getting TB infection. What is alarming today in Kerala is the increased instances

of multi-drug resistant tuberculosis (MDR-TB) and Single Drug-Resistant Tuberculosis (SDR-TB),

which is caused due to improper use of the drugs, said the district TB officer urging the patients not to

discontinue medicine without the doctor's approval. (Times of India 23/3/16)

33. First indigenous rotavirus vaccine to be unveiled today (3)

New Delhi: In its effort to bring down the infant mortality rate (IMR), the government will on Saturday

introduce the first-ever indigenous rotavirus vaccine in its routine immunisation for protecting children

from diarrhoea. Union health minister J.P. Nadda will launch the vaccine in Orissa, Andhra Pradesh,

Haryana and Himachal Pradesh. Manufactured by Bharat Biotech, the vaccine is expected to reduce

more than a lakh deaths per year from diarrhoea. “It’s a great move. The vaccine will drastically

reduce the infant mortality rate by saving lives of children,” C.K. Mishra, additional secretary in the

health ministry, said. An estimated 8.53 lakh children under the age of one will be administered the

vaccine annually at 6, 10 and 14 weeks. Rotavirus is the primary cause of moderate to severe

diarrhoea morbidity and mortality among children less than five years of age. According to

government data, rotavirus alone is responsible for up to 40% of all cases of severe diarrhoea in

India. Of the overall child mortality in India, diarrhoea is responsible for 10% burden. About 78,000

children died due to rotavirus in 2014 and about 8.7 lakh hospitalisations were reported due to the

virus. A recent study published in the Lancet claimed that a “single episode of diarrhoea increases the

risk of death of a child by 8 times”. Severe dehydration caused by rotavirus can cause death among

young children. Importantly, so far 80 countries have introduced a rotavirus vaccine in their national

immunisation programmes, which includes many low-income countries in Africa too. In fact, the

introduction of vaccine has helped many countries bring down deaths in children. Significantly, Mexico

recorded a 46% drop in diarrhoea-related deaths in children under the age of 5 after the introduction

of the vaccine in 2007. Also, in Brazil, a 22% drop in deaths was recorded after the introduction of

vaccine. Once launched, the vaccine will be available at all government health facilities for free.

However, as of now, it is also available in over a 100 countries in the private market, including India.

In 2011, the Indian Academy of Paediatrics included the rotavirus vaccine in its recommended

immunisation schedule. The vaccine is available in the private sector at about Rs 3,000 for a full

course. The vaccine also provides “herd immunity” by reducing transmission of rotavirus. (Asianage

26/3/16)

34. In rural health, Gujarat among BIMARU states (3)

Gujarat is 3rd in shortfall of doctors at PHCs, while Bihar and Rajasthan have surplus.Gujarat is 3rd in

shortfall of doctors at PHCs, while Bihar and Rajasthan have surplus. Although the Gujarat

government claims to be giving incentives to doctors working in remote areas, the state is facing a

shortage of specialists like gynecologists and paediatricians, to the extent that even BIMARU states -

Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh -are better off with regard to healthcare

facilities and infrastructure. This specialist shortfall particularly affects the health of mothers and

children, which is apparent with the so called developed state, reporting a maternal mortality rate

(MMR) of 127 and an infant mortality rate (IMR) of 36 according to the figures last released in 2013.

MMR is the number of mothers dying per 1,00,000 live births. IMR is the number of infants dying in

their first year for every 1,000 live births. Gujarat has the fifth highest shortfall of specialists including

surgeons, gynecologists, physicians and paediatricians among 36 states and Union Territories in

terms of numbers. It 1,206 specialists short at community health centres (CHCs). According to the

figures from the Union health department, states like Bihar and Madhya Pradesh are ahead Gujarat in

terms of total number of specialists at CHCs. Shockingly, the shortfall of specialists persists because

the state government has not sanctioned recruitment to fill these vacancies. There is an acute dearth

of surgeons at CHCs in Gujarat, which has just 32 surgeons in place against the required strength of

320.Gujarat ranks 5th in the shortfall of surgeons, while states like Bihar and Madhya Pradesh doing

slightly better with deficits of 49 and 283 surgeons respectively. The position is similarly pathetic at

primary health centres (PHCs) and sub centres. Gujarat has the second highest shortfall in terms of

numbers of health workers at sub centres and PHCs. Against the required strength of 9,310 health

workers, there are just 6,938 workers at various sub centres and PHCs, a shortfall of 2,372.

Shockingly, 247 sub centres in rural areas are without s single health worker. Gujarat ranks third in

shortfall of doctors at PHCs, with states like Bihar and Rajasthan enjoying a surplus. Only two states,

UP and Chhattisgarh, have bigger deficits of doctors, 1,288 and 424 respectively. … (Times of India

30/3/16)

35. WHO urges nations to intensify efforts on universal health coverage (3)

New Delhi: The WHO on Thursday urged the Southeast Asian nations to intensify efforts to make the

Universal Health Coverage a reality, and ensure that no individual is left out. Among the initiatives

needed to be taken care of include access to enhancement of quality frontline healthcare and creation

of a well trained, highly motivated health workforce. "Universal Health Coverage means that all

people, however rich or poor, and wherever they live, are able to access the healthcare they need

without incurring financial hardship. We must make UHC a reality and ensure that no one is left

behind," said Poonam Khetrapal Singh, regional director for World Health Organisation (WHO)

Southeast Asia. A three-day meeting on "Health, SDGs and the role of Universal Health Coverage"

began on March 30, where health ministers and experts from across the region are discussing ways

to accelerate health coverage and attain the Sustainable Development Goal (SDG) of ensuring

healthy lives and promoting the well being for all at all ages. According to WHO, an estimated 130

million people in WHO Southeast Asia region lack access to essential health services and over 50

million people are pushed into poverty every year because of healthcare costs. Khetrapal said they

were emphasising on the reduction of out-of-pocket payments of poor people. "At present, out-of-

pocket expenditures in the region account for as much as 70 percent of all healthcare spending. This

represents a tremendous financial burden for individuals and their families. For many of the poorest it

means healthcare is simply inaccessible," she said. Khetrapal said countries must monitor who is not

getting access to care and who is being impoverished as a result of healthcare costs. She said

enhancing coverage will help reduce maternal, newborn and child deaths, help end the epidemics of

AIDS, TB and malaria as well as hepatitis and other communicable diseases, and enhance access to

sexual and reproductive health care services. "It will also help tackle new areas of focus in the region,

including alarming rise in non-communicable diseases such as diabetes and hypertension, as well as

multi-sectoral issues such as antimicrobial resistance," said Khetrapal. (Business Standard 1/4/16)

36. India sacks some foreign-funded consultants; health programmes may suffer (3)

NEW DELHI: India is firing dozens of foreign-funded health experts working inside the government,

seen as part of a broader clampdown to reduce the influence of non-government organisations

(NGOs) on policy. The loss of these professionals, most of whom are Indian nationals, has raised

concerns that signature programmes to combat HIV/AIDS and tuberculosis may suffer just as they

face funding shortages due to slow bureaucracy. A shortage of technical experts has for years forced

India to turn to the World Health Organization (WHO) and aid groups like the Bill & Melinda Gates

Foundation to manage large-scale public health schemes. Of the nearly 140 people who run India's

HIV/AIDS programme, 112 are consultants seconded from foreign organisations. Some are engaged

in planning and monitoring of prevention activities in high-risk Indian states. Last week, Prime Minister

Narendra Modi's government ordered 45 of them to be removed from service by June as they had

served more than three years, according to health ministry officials and a document seen by Reuters.

By December, 70 of these experts will leave, while others, who have worked for less than three years,

face a government screening committee to decide whether they are needed. "It's like questioning our

integrity just because we are foreign funded," said an HIV/AIDS consultant who worked in the health

department for three years and is now looking for a job. The programme has won global acclaim for

sharply reducing annual new HIV infections, but the rate of decline has slowed in recent years. India

recorded 86,000 new infections last year. S. Selvakumar, a joint secretary in the finance ministry who

signed off on clarifications to the new policy rules in January, said he did not know why consultants

working in the government were being removed. He said the finance ministry received a request from

the cabinet secretariat to compile a list of government consultants last May. Two other finance

ministry officials said the move was driven by fears that foreign agencies could use their consultants

to influence policy in New Delhi. "Their loyalties would be divided," said one. The security of

information was also a concern, the other officer said. More than 500 consultants work across the

Indian government, about half in the health sector alone. Some are from Britain's Department for

International Development (DFID) and the United Nations' UNICEF. A spokeswoman for the Bill &

Melinda Gates Foundation did not comment on the government's decision, but said it would adhere to

the directive. A DFID spokesman said the department had "not received any complaints from the

government of India about data theft or undue influence on policies." …. (Times of India 2/4/16)

37. Decline in number of patients visiting government hospitals (3)

Patna: The year 2016 has brought a shocker for the state on the healthcare front. CM Nitish Kumar

had repeatedly said that the number of patients going to government hospitals has steadily increased

during his regime, but the status presented in the state's Economic Survey 2015-16 shows a reversal

of the trend. So is the case of institutional delivery in the state, which showed decline after constant

increase in last several years. The survey states that the monthly average number of patients visiting

government hospitals declined by 5.8% in 2014, the last year for which the stats have been

presented. From 2011 to 2013, the figure showed a constant rise. Experts attribute it primarily to non-

availability of drugs in government facilities. Besides drugs, the patients also have to incur huge costs

on pathological services, a point underlined by the CAG report for 2014-15. "Pathology (facility) was

available in 54% referral hospitals (RHs) and 31% primary health centres (PHCs). Thus, health care

units in the state did not have the required diagnostic facilities," the report says. Similarly, sonography

facility was available in 14% referral hospitals and nine per cent PHCs. Dr Shakeel, the Bihar

representative of People's Health Movement, said "When patient has to spend so much out of his

pocket on drugs and diagnostics, he finds no point in visiting government hospitals." So far as

institutional delivery is concerned, the survey shows that for the first time in eight years, it declined by

6.1 per cent in 2014-15, after going up from 2006 to 2014. While the economic survey is silent about

the reasons, experts say one could be non-disbursal of claims under Janani Suraksha Yojana (JSY).

Under the scheme, all pregnant women who deliver in health centres are eligible for a cash incentive

of Rs 1400 and Rs 1,000 in rural and urban areas, respectively. The CAG report presented this year

also substantiates the claim. It says payment was made to only 66% beneficiaries of institutional

delivery. "It was also observed that payments to 6,027 beneficiaries of JSY amounting to Rs 82.35

lakh pertaining to 27 test-checked RHs/PHCs was entered in cash book but the cheques remained

undelivered to beneficiaries as on date of audit (June-July 2015)." … (Times of India 7/4/16)

38. Poor, needy patients suffered most due to doctors' strike: Bombay HC (3)

MUMBAI: Observing that it is mostly poor patients who approach government hospitals, and that 13

reportedly died in JJ hospital alone in three days since resident doctors struck work, a special holiday

bench of the Bombay high court ticked off doctors and asked them to immediately call off the

indefinite strike they were on from April 3 and resume work. The strike was to protest against the JJ

hospital dean, Dr T P Lahane and by its fourth day had spread across the state. The HC said, "The

poor and needy patients are not being attended and suffering the most because of the strike resorted

to by the doctors." The HC accepted a suggestion by Maharashtra Association of Resident Doctors

(MARD) to reconstitute a grievance redressal committee after they complained that the existing

committee comprised of the very Dean who the doctors had grievances about. The association which

on Friday lent its muscle and support to the strike, then made a statement that it would withdraw the

strike, with immediate effect. A specially constituted holiday bench of the HC on Saturday, a court

holiday—heard a plea by an activist to stay the doctors' strike. Afak Mandaviya, an RTI activist moved

the HC through his lawyer Datta Mane on Thursday to seek action against the striking doctors. The

bench was constituted keeping in mind the "grave urgency" of the situation as Mane said 4000

resident doctors had joined the strike. Mane argued that from April 4 to April 6, 13 died in the state-

run JJ Hospital alone. He also said that in one day between 8am on April 8 to 8am next day, 11

patients died in Aurangabad, four in Nanded, eight in Ambejogai, four in Yeotmal and one in Sangli

taking the toll to 41 in four days. (Timwes of India 9/4/16)

39. Shifting of Paravur victims not being considered (3)

Thiruvananthapuram: A special review meeting held at the Government Medical College Hospital

(MCH) here on Monday by the doctors, health administrators and expert teams of doctors from New

Delhi decided that there is no situation which warranted the shifting of any of the patients currently at

the MCH to other specialised centres. The meeting was chaired by Health Minister V. S. Sivakumar.

The group of 20 doctors from the All India Institute of Medical Sciences, Ram Manohar Lohia

Hospital, Safdurjung Hospital has been camping at the MCH since Sunday and helping in the

management of trauma victims. They were joined by a four-member team of burns specialists from

the Amrita Institute of Medical Sciences on Monday. At present, seven persons with burns of over 60

per cent were battling for their lives inside the Burns ICU. Another seven persons with about 40 per

cent burns were also under treatment and these cases are salvageable with proper treatment.

Serious head injuries have been sustained by 27 persons and their condition also needs monitoring. It

has been decided to shift two of the patients to the Liver Transplant ICU and another to the

Gastroenterology ICU. Three operation theatres are ready for performing emergency surgeries for

burns patients. It was decided to buy five new ventilators and to move three ventilators from other

hospitals to the MCH. Twenty attenders would be appointed from Kudumbasree as the hospital

desperately needs additional hands to help out. The doctors pointed out that the trauma victims

needed comprehensive care and management to ensure that they came back to normal life and that

much more attention needed to be paid to their mental health and post-trauma rehabilitation. A team

of mental health experts and doctors from the Physical Medicine Department will help in the proper

rehabilitation of the patient while they recover from their physical injuries. Others who participated in

the meeting included Health Secretary K. Ellangovan, District Collector Biju Prabhakar, State Mission

Director of NHM G.R. Gokul, Director of Medical Education Ramla Beevi, Principal of the Medical

College Thomas Mathew, Superintendent D. Mohandas, Deputy Superintendent S. Sreenath and

Deputy Superintendent of the Super Speciality Block Ramesh Rajan. (The Hindu 12/4/16)

40. Women in MP fare low on hygiene during menstrual cycle: Survey (3)

Bhopal: Menstrual hygiene practices depend on an individual's socio economic status, local traditions

and belief, access to water and sanitation. But despite several programmes by state government

across state, it has been found in NFHS (National Family Health survey) 2016 that only 37.6% women

between age group of 15-24 years use hygienic methods of protection during menstrual period. This

includes both - urban and rural areas in Madhya Pradesh. The figure is second lowest across country.

Roli Shivhare of Vikas Samvad said, "Generally girls and women use cloths during menstrual cycle.

They wash and reuse these cloths rather than using disposable pads. The reused cloths are not often

washed with soap and clean water. Also they don't dry it in sunlight owing to social taboos.

Unhygienic practices are found more in rural areas as compared to urban areas." In urban areas

65.4% women use hygienic method across state. Talking about the figures, women and child

development department secretary JN Kansotia said, "Udita project to provide low cost napkins has

been taken up in last six months and about 25,000 aganbadis have been provided with vending

machines that spew sanitary napkins. This project will have a designated amount for its

implementation and figures of rural areas might change through the survey." Activist Poornima Singh,

who has been working to promote good menstruation health in rural areas said, "Poor practices can

increase a woman's susceptibility to reproductive tract infections (RTI) and Urinary tract infection

(UTI)." Bihar fared the poorest in the survey with only 31 per cent girls in 15-24 years of age having

hygienic menstraution practices, followed by Tripura (43.5 per cent) and West Bengal with 55 per

cent. Highest numbers of young women using hygienic methods during menstruation are in Tamil

Nadu with 91.4 per cent. Puducherry, a union territory, recorded highest 96.9 per cent females using

hygienic methods. Across India, there are 73 per cent urban women using hygienic methods of

protection during menstruation and only 47.6 per cent women using hygienic method in rural areas.

(Times of India 14/4/16)

41. ‘Maternal mortality rate showing improvement’ (3)

Maternal and Child Health Care Day was observed under the auspices of the Health Department with

a focus on checking the post partum haemorrhage in pregnant mothers admitted to the labour wards.

Doctors and gynaecologists underlined the role of child care nurses in checking the maternal mortality

rate by a sustained follow-up on the pregnant women. S. Syed Mohideen, Joint Director of Health and

Rural Services, said the district had been making good headway in improving maternal and child

health care delivery. The district had registered a record in the reduction of the maternal mortality rate

from 89 per 1,000 live births in 2012 to 63 in 2015. In fact, the district had bagged a certificate of

appreciation from the State government. V.C. Subash Gandhi, coordinator of the Tamil Nadu Health

System Project, said the staff nurses should play a key role in bringing down the maternal mortality

rate. A close observation and surveillance would go a long way in achieving the desired results, he

added. Earlier, D. Parimala Devi, Dean of the Government Medical College and Hospital, gave away

the Dr. Muthulakshmi Memorial Award to R. Sujatha Pudukottai District Maternal and Child Health

Officer. G. Kalyani, Aranthangi District Maternal and Child Health Officer, was present. (The Hindu

17/4/16)

42. Lifestyle ailments continue to be Mumbai’s most lethal killer (3)

Mumbai: With demanding work schedules and volatile environmental changes, it's hardly shocking

that lifestyle ailments continue to be Mumbai's most lethal killer. For the 15th year in a row, coronary

heart diseases have topped this list, with almost four lakh people succumbing to heart-related

dysfunctions over the years, according to an RTI query. The data is based on death certificates

issued by the Brihanmumbai Municipal Corporation (BMC) between 2001 and 2015. A close second

on this list is cancer, which has moved up a slot in the last 15 years. The condition that claimed 3,031

lives in 2001 is responsible for 7,272 deaths in 2015, a staggering 140% increase. As per the data,

cancer deaths are recording a double-digit rise year-on-year. The overall disease trend in Mumbai,

experts said, is akin to many developed nations, where heart diseases and cancer, both preventable

to a great extent, are contributing to high mortality. "Besides lifestyle, there is tremendous

environmental stress and pollution in the city. Nanoparticles and gaseous fumes emitted from vehicles

or other sources are also contributing to an increase in the risk of coronary artery disease," said

cardiologist, Dr Brian Pinto. For youngsters, psychosocial stress to earn and commute is adding to the

stress. Smoking, of course, remains a major underlying cause for cancer and heart ailments. The only

silver lining has been a significant decline in tuberculosis, HIV/Aids and deaths due to burn injuries.

One of the most dreaded communicable diseases, TB, recorded a near 30% decline in deaths in

2015, compared with 2001. "TB, at second position in 2001, climbed down to third. But we still lose at

least 18 lives to the disease every day," said RTI activist Chetan Kothari, who had filed the query.

Kidney and liver diseases have also shown a sharp increase. Deaths due to kidney failure, for

instance, have grown by 141%. "Indians are already at a higher risk of developing kidney diseases

because of the surge in patients suffering from diabetes and high blood pressure. It is one of the fast

emerging non-communicable disease threats," said a nephrologist from KEM Hospital, Parel. (Times

of India 17/4/16)

43. Health disasters waiting to happen (3)

Mumbai: A white paper on the lackadaisical attitude towards citizen grievances and civic issues by the

Brihanmumbai Municipal Corporation (BMC) administration as well as elected councillors released on

Tuesday by the Praja Foundation, has pointed out the civic wards that are close to tipping point on

aspects related to health. Projections indicate K west (northern Andheri suburb), G south (western

region of south Mumbai) and D (central Mumbai region in Grant Road) wards as mostly likely to be

the worst-affected due to water contamination and, therefore, diarrhoea deaths by 2018. Similarly, the

S (Bhandup), N (Ghatkopar) and B (eastern regions of south Mumbai) wards would are projected to

suffer the most due to less than effective pest control measures causing increased deaths due to

malaria and dengue. “Between 2008 to 2015 maximum citizen complaints were received regarding

water contamination in the aforementioned wards and an assessment of diarrhoea deaths reported in

the city lead us to conclude that these are health disasters waiting to happen. Similarly, the wards

where dengue and malaria deaths are more prevalent have been identified on the basis of complaints

for pest control and actual deaths due to the two diseases,” founder trustee of the foundation Nitai

Mehta told mediapersons on Tuesday. He pointed out that while the BMC administration was

focussed upon infrastructure projects, distribution of tablet computers and construction of mega

hospitals, data unearthed from the civic administration through the Right to Information Act (RTI)

revealed the real priority areas of health that need to be taken up on a war footing. “There have been

45,000 deaths due to Tuberculosis alone in Mumbai city over the last five years. Today sadly, things

come into focus only when they go out of hand. Take the example of the Deonar dumping ground.

NSA satellites have picked up the huge fire that was reported in the dumping ground earlier this year.

Other nations are proud when satellite images pick up the great China Wall, but Mumbai has left a

satellite footprint of the raging fire at Deonar that has cause immense air pollution and health hazards

for citizens,” Mr Mehta said. He also cited the example of six corporators-turned MPs and MLAs who

found no time for their civic responsibilities after getting elected to higher bodies of governance. “Only

Mumbai city has this peculiar situation where corporators can continue in their posts after being

elected to the state legislature or Parliament. New Delhi does not have such a scenario and we must

change this aberration in our civic system.” While the dumping ground has been in the news for all the

wrong reasons, Mr Mehta added that the 17 ward committees in Mumbai city witnessed only nine

questions related to them in the last five years.“Deonar is the symbol of what is going wrong in BMC.

Despite the Bomay High Court order to the state government to set up a common complaint number,

they are still playing with the idea,” he said. (The Hindu 21/4/16)

44. 234 open-defecation spots in city, finds survey (3)

New Delhi: At least 234 spots in Delhi are used by the poor as open defecation grounds, a first ever

citywide survey on the practice has revealed. Most of these spots are open fields next to slums or

spaces along railways tracks. The survey was carried out by Delhi Urban Shelter Improvement Board

engineers to provide real time data on the problem of open defecation. "All engineers of DUSIB were

asked to visit slums and its surroundings to identify common open defecation spots between 5am to

8am on two non-working days—Ram Navami and Mahavir Jayanti. They were asked to record not

just the sites but also capture details about existing individual and community toilets," DUSIB CEO V

K Jain said. "A database of images from the field has also been created for reference for planners,"

Jain said. According to an estimate, there are 17,000 community toilets across the 700-odd slums in

the city, where 3.14 lakh jhuggis are home to almost 15 lakh residents. Another 21,000 community

toilets will be required to make Delhi open defecation free. DUSIB estimates show there are about

79,000 individual toilets attached to jhuggis. That means only 25% jhuggis have access to individual

toilets. The Aam Aadmi Party government, which is drawing up an open defecation-free plan for the

capital, has set out a steep target of building 10,000 toilets in the current fiscal and meet the

remaining requirement of 11,000 toilets by March 2018. However, the linkage of individual and private

household toilets with sewer systems remains a huge challenge. Most of these toilets in slums either

use septic tanks or open out into storm-water drains, aggravating the sanitation disaster in these

places. Aam Aadmi Party in its manifesto had promised to build two lakh new public toilets over five

years. In its first year in power, DUSIB says it has been able to build just 4,500 new toilets. The two-

lakh target is clearly appearing hard to achieve, so the focus is shifting to making Delhi open

defecation-free. The government has assigned about Rs 100 crore under the Delhi budget for building

the 10,000 toilets in the current financial year…. (Times of India 25/4/16)

45. Over 1 million children under 5 die in India every year: Govt (3)

NEW DELHI: Around 1.26 million children under five years of age die in India every year with

prematurity and neonatal infections being the major causes accounting for almost 57% of the total

deaths, the government informed the Rajya Sabha on Tuesday. "57 percent of under-five deaths

occur in neonatal period, which is within the first 28 days of life, the major causes being prematurity

and low birth-weight, neonatal infections, birth asphyxia and birth trauma," health minister J P Nadda

said in a written reply to the House. In the post-neonatal period, pneumonia and diarrhoea are found

to be the major reasons for under five mortality. Over 3.8 lakh new cases of pneumonia among

children annually, India tops the list of 15 countries in terms of total under-five deaths due to the

disease, Nadda said in response to another question. Besides India, Nigeria, Pakistan, the

Democratic Republic of the Congo, Ethiopia, Angola, China, Afghanistan, Indonesia, Kenya, Sudan,

Bangladesh, Niger, Chad, and Uganda comprised the 15-nation list. Highlighting the need for

vaccinations and institutional deliveries to reduce the neonatal as well as infant mortality, Nadda said

the government has taken a decision to provide free vaccination of pneumococcal conjugate (PCV) to

children. "The National Technical Advisory Group on Immunisation has recommended introduction of

pneumococcal conjugate vaccine in Universal Immunisation Programme in three doses at six weeks,

14 weeks and booster at nine months," he said. The proposal to introduce the vaccine in a phased

manner has been approved by the 'mission steering group' under the health ministry's flagship

National Health Mission. The Global Alliance for Vaccines and Immunisation (GAVI) has agreed to

support PCV introduction by providing PCV for 20% cohort for three years, Nadda said.For a focused

approach, the government has also identified 184 high priority districts for implementation of

Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving

improved maternal and child health outcomes.The government has also initiated an SMS based

electronic vaccine intelligence network (e-VIN) to enable real time monitoring of vaccine stocks at

4,476 cold chain storage points across all 160 districts of three states - Uttar Pradesh, Rajasthan and

Madhya Pradesh. The infant mortality rate (IMR) in India is pegged at 40 per 1000 live births while the

Neonatal Mortality Rate is 28 per 1000 live births. (Times of India 26/4/16)