Toilets constructed under Swachh Bharat Mission improved child health in India, claims Nature article

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Toilets constructed under Swachh Bharat Mission improved child health in India, claims Nature article

The paper by researchers from Ohio State University says the scheme averted 60,000-70,000 infant deaths annually

Swachh Bharat Mission (SBM), has contributed significantly to reducing infant and under-five mortality rates across the country – averting 60,000 – 70,000 infant lives annually, researchers from Ohio State University have estimated in a paper published in Nature Scientific Reports.

The study analyzed data from 35 Indian states and 640 districts spanning a decade (2011-2020), focusing on infant mortality rate (IMR) and under-five mortality rate (U5MR) per thousand live births as the primary outcomes. “The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries,” the researchers concluded.

Press Information Bureau which is the communications wing of the government of India, in a statement about the article said that over 117 million toilets have been constructed since 2014 with a public investment of over 1.4 lakh crore. India has the highest annual birth cohort in the world – about 25 million babies are born in India every year. It is also among the countries that have the highest number of baby deaths in the world. In 2022, India’s infant mortality rate was 25.5 deaths per 1,000 live births.

Swachh Bharat Mission was launched in 2014, with the mission to make India free of open defecation. The mission was among the very first launched by the then newly elected NDA government headed by prime minister Narendra Modi. This is not the first time that the scheme has been lauded for its public health benefits. The World Health Organisation reported 300,000 fewer diarrheal deaths in 2019 compared to 2014, directly attributable to improved sanitation. The period has also been marked by concomitant rises in vaccination rates across the country.

WHO guidance first time addresses issue of antibiotic contamination during manufacturing

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WHO guidance first time addresses issue of antibiotic contamination during manufacturing

Waste generated from the manufacture of pharmaceutical products is among the three main routes of their introduction into the environment

There are many ways in which organisms can be unduly exposed to antibiotics, leading to drug resistance. One of these is during the manufacture of the antibiotics when residues may be inadvertently released into the atmosphere through the waste.

To address this issue, the World Health Organisation has come up for the first time come up with a global guidance on waste water and solid waste management for manufacturing of antibiotics. The United Nations General Assembly (UNGA) High-Level Meeting on antimicrobial resistance (AMR) taking place on 26 September 2024. AMR refers to a situation when irrational use of antibiotics or other factors that cause pathogens to be exposed to antibiotics but in doses not sufficient to kill them, enabling them to develop mechanisms that can help them thwart the effects of these antibiotics. 

“Pharmaceutical waste from antibiotic manufacturing can facilitate the emergence of new drug-resistant bacteria, which can spread globally and threaten our health. Controlling pollution from antibiotic production contributes to keeping these life-saving medicines effective for everyone,” said Dr Yukiko Nakatani, WHO Assistant Director-General for AMR ad interim.

Globally, there is a lack of accessible information on the environmental damage caused by manufacturing of medicines. “The guidance provides an independent and impartial scientific basis for regulators, procurers, inspectors, and industry themselves to include robust antibiotic pollution control in their standards,” said Dr Maria Neira, Director, Department of Environment, Climate Change and Health, WHO. “Critically, the strong focus on transparency will equip buyers, investors and the general public to make decisions that account for manufacturers’ efforts to control antibiotic pollution.” 

Waste generated from the manufacture of pharmaceutical products is among the three main routes of their introduction into the environment. According to a 2022 paper in the Journal of Water Processing Engineering: “The main entry routes of pharmaceutical residues (including antibiotics) into the aquatic environment are excretions after use, poor disposal of unused medicines and the waste generated after their production. From the routes of entry, they arrive to the waste water treatment plants.”

As medicos agitate for security, health ministry asks institutes to design desi convocation gear

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As medicos agitate for security, health ministry asks institutes to design desi convocation gear

The ministry of health wants AIIMS and other medical teaching institutes to shun the black gown and cap and design Indian wear 

The ministry of health and family welfare has written to all All India Institutes of Medical Sciences, central government teaching hospitals and Institutes of National Importance to design their own convocation wear as the black cap gown combination normally used for such ceremonies is a “colonial” vestige.

The communication comes just one day after it took an intervention by the Supreme Court to get medical students back to work in the wake of the gruesome rape and murder of a doctor in Kolkata’s R G Kar Hospital on August 9. Medical students in that city are still on the warpath demanding justice.

The health ministry order dated August 23

“…it is observed that currently as a matter of practice black robe and cap is being used during convocation by various Institutes of the Ministry. This attire originated in the middle Ages in Europe and was introduced by the British in all their colonies. The above tradition is a colonial legacy which needs to be changed. Accordingly it has been decided by the ministry that the various institutes of the ministry including AIIMS/INIs engaged in imparting medical education will design appropriate India dress code for the Convocation Ceremony of their Institute’ based on local traditions of the State in which the Institute is located. The proposal to this effect should be submitted to the Ministry through their respective Divisions of Ministry for consideration and approval of Secretary (Health),” reads the communication signed by under secretary Thawngzachin Chinsum Naulak.

The ministry has referenced the Panch Pran (five oaths) enunciated by prime minister Narendra Modi for this order, the timing of which has come as a bit of an oddity. Since August 10 large parts of the country has seen agitations and strikes by doctors and medical students demanding security in hospitals and a central law that protects doctors against assaults and attacks in the workplace. The apex court during its hearing on Thursday asked for the Central Industrial Security Force to be deployed in R G Kar Hospital. 

Bihar announces HPV vaccination programme for 9-14 year old girls, to spend about Rs 150 crore

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Bihar announces HPV vaccination programme for 9-14 year old girls, to spend about Rs 150 crore

Earlier this year, the government of India had announced in the Union Budget its policy of encouraging states to start HPV vaccination

The government of Bihar has announced that it will vaccinate all girls in the 9-14 year age group against the Human Papilloma Virus (HPV). HPV is the leading cause of cervical cancer which is the second commonest form of the disease in India.

The Mukhya Mantri Balika Cancer Pratirashan Yojana (Chief Minister Scheme for Protection of Girls Against Cancer) will benefit about 95 lakh, announced Dr S Siddharth who is principal secretary to chief minister Nitish Kumar. Earlier this year, the government of India had announced in the Union Budget its policy of encouraging states to start HPV vaccination.

Bihar government will procure the vaccines through the Tata Memorial Cancer Hospital in Mumbai. They have already signed the memorandum of understanding, Siddharth said. The estimated cost of the programme is Rs 150 crore. Several other states in the country have already rolled out a HPV vaccination programme among young girls. These include Punjab, Delhi and Sikkim. 

India has a high burden of cervical cancer and a policy level commitment since 2010 to screen women for the disease has not been implemented because of several factors, one of which is women’s reluctance to get tested. Data suggests that in 2022 India had reported 1,27,000 new cases of cervical cancer and 80,000 deaths. 

In 2022, the Serum Institute of India had unveiled Ceravac the first indigenously manufactured cervical cancer vaccine that was expected to bring down the cost of vaccination significantly. Health minister J P Nadda recently said that the government is considering the introduction of the HPV vaccine into the Universal Immunisation Programme but some logistical challenges remain.

New cervical cancer test on the anvil: it is less invasive, can be done at home

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New cervical cancer test on the anvil: it is less invasive, can be done at home

In 2022 India had reported 1,27,000 new cases of cervical cancer and 80,000 deaths. 

An US company has developed a cervical cancer screening test that will make the invasive and sometimes painful speculum – the medical instrument used to collect vaginal swabs – redundant. The tests is currently being evaluated by the USFDA which is the apex regulatory body in that country.

Earlier this year Teal Health, a woman led company was granted breakthrough designation by the FDA for its novel at-home self-collect cervical cancer screening device, the Teal Wand. “The Teal Wand is a proprietary device designed to enable people to easily, comfortably, and confidently collect their own vaginal sample for cervical cancer screening from their home or health clinic, without the need for an invasive exam. Users will mail their sample to a laboratory for testing on an FDA-approved diagnostic test for primary screening of high-risk HPV (human papillomavirus), which is recommended by medical guidelines. From within the Teal Health patient portal, users will then receive clearly communicated test results, have direct access to women’s health providers, and when appropriate receive assistance in securing follow-up care or procedures,” the company had said in a statement.

India has a high burden of cervical cancer and a policy level commitment since 2010 to screen women for the disease has not been implemented because of several factors, one of which is women’s reluctance to get tested. Data suggests that in 2022 India had reported 1,27,000 new cases of cervical cancer and 80,000 deaths. 

While technology developed and approved in the United States may take some time to reach India largely because of the cost implications, medtech companies are eager to enter the Indian market through innovative partnerships because of the sheer size of it. India has for long banked on the visual inspection of the vagina using acetic acid as its chosen screening method but voices are now getting louder for a better and more modern method that removes the element of subjectivity and health workers’ training from the equation.

USFDA approves first over the counter home syphilis test but highlights need for confirmation

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USFDA approves first over the counter home syphilis test but highlights need for confirmation

The regulator has said that treatment decisions should not be made based on the results of this test alone 

The USFDA, which is the drug regulator in the United States of America has approved the first over the counter syphilis test that can be administered at home. However the results of this test cannot be the basis of treatment decisions and a confirmatory test is required.

Syphilis is a bacterial infection and one of the most common sexually transmitted infections in the world. If left untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness and paralysis. When transmitted during pregnancy, it can cause miscarriage, lifelong medical issues and infant death.

This is the first over the counter syphilis test. It looks in the blood for antibodies to the Trepanoma pallidum – the organism that causes syphilis – to decide whether or not a person has caught the infection. It takes about 15 minutes to arrive at a result but users are expected to take it to a physician to decide on the next course of action including the administration of a confirmatory test.

“We continue to see advancements in tests, particularly tests for sexually transmitted infections, which can give patients more information about their health from the privacy of their own home,” said Michelle Tarver, M.D., Ph.D., acting director of the FDA’s Center for Devices and Radiological Health. “Access to home tests may help increase initial screening for syphilis, including in individuals who may be reluctant to see their health care provider about possible sexually transmitted infection exposure. This can lead to increased lab testing to confirm diagnosis, which can result in increased treatment and reduction in the spread of infection.”

The United States has been seeing a surge in numbers of the infection in recent years with an almost 80% increase reported between 2018 and 2022.

 

Once more labelled a public health emergency of international concern: what exactly is MPox?

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Once more labelled a public health emergency of international concern: what exactly is MPox?

PHEICs are usually diseases that can rapidly travel across the globe putting large populations in danger; this is the second time MPox has been given this status

The World Health Organisation has declared Mpox as a Public Health Emergency of International Concern (PHEIC) giving the outbreak in Congo a status that was once accorded to COVID19.

The PHEIC status has been accorded as per the recommendations of an expert committee. Committee Chair Professor Dimie Ogoina said, “The current upsurge of MPox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe. Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.” WHO Director-General Dr Tedros Adhanom Ghebreyesus said that a coordinated international response is needed to the disease.

Medibulletin takes you through the disease and the global health classification.

What is Mpox?

Mpox is a viral disease that is characterised by fever and pus filled painful boils all over the body. It spreads either by skin to skin contact or by coming in contact with the scabs shed by a patient who is suffering from the disease. Pregnant mothers can transmit the infection to their babies through what is known as vertical transmission. It can also occasionally spread from animals to people. The treatment for the disease is mostly supportive or symptomatic.

Which countries have been affected by MPox?

The major Mpox outbreak has been happening in the Democratic Republic of Congo with more than 22,000 cases and 1200 deaths being reported from the beginning of this year. In the past month, over 100 laboratory-confirmed cases have been reported in four countries neighbouring the DRC that have not reported mpox before: Burundi, Kenya, Rwanda and Uganda. Several other countries including neighbouring Pakistan have started reporting sporadic cases of the disease. 

What is a PHEIC?

PHEIC is a term that comes from the International Health Regulations which is a binding international agreement among 196 countries to help the global community respond to public health risks. A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This is applied for a sudden or unexpected situation that has the potential to quickly cross political borders.

Report any incident within six hours, DG health services issues order for hospital administrators

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Report any incident within six hours, DG health services issues order for hospital administrators

Protests continued across the country with the AIIMS faculty association too going on strike; some private hospitals have allowed doctors to skip OPD

As the protests over the Kolkata rape torture and murder of a 31-year-old doctor continued, the director general of health services has issued an order saying hospital superintendents are expected to report any incident within the hospital premises within six hours. 

Faculty members at the All India Institute of Medical Sciences New Delhi have decided to suspend routine hospital services today. They want a Central Protection Act to be implemented that will ensure safety of practising doctors. While services have largely remained unaffected in private hospitals many are reporting sporadic protests by doctors and at least one corporate hospital has informally told consultants that they can skip OPDs today.

AIIMS Faculty Association letter

The order issued by the Directorate General of Health Services makes no mention of the Kolkata incident and is largely generic in nature but comes in the wake of the CBI questioning the now removed principal of R G Kar Medical College Dr Sandip Ghose to probe allegations of lapses and cover up. There have been at least two instances of vandalism in the hospital since the incident, one which the hospital administration claimed was routine “planned” demolition work near the seminar hall where the incident happened.

“Recently it has been observed that violence has become common against doctors and other healthcare staff in government hospitals. A number of health workers suffer physical violence during the course of their day. Many are threatened or exposed to verbal aggression. Mostof this violence is done by either patients or patients’ attendants. In view of the above, it is states that in the event of any violence against any healthcare worker while on duty, the head of the institution shall be responsible for filing an institutional FIR within a maximum of six hours of the incident,” reads the office memorandum signed by DGHS Dr Atul Goel that was issued Friday.

According to the letter from the faculty association addressed to the director of the institute, in AIIMS only emergency medical services will be functional. No routineOPDs, laboratory services or surgeries will take place.

Over 28% UG medical students suffering from mental health problems, finds NMC survey

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Over 28% UG medical students suffering from mental health problems, finds NMC survey

Highest prevalence found of sleep problems; anxiety, burnout, depression among other problems that are common among young medicos

A survey conducted by the National Medical Commission has found that 28% undergraduate and 15% postgraduate medical students in India are suffering from mental disorders.

Of the 25,590 undergraduate medical students who responded to the online survey, mental health conditions have been diagnosed in 7,115 (27.8%) students, with 3,780 (14.8%) having one condition, 1,851 (7.2%) having two, and 1,045 (4.1%) having three conditions. Among postgraduate students, 5,337 participated in the survey. The survey results reveal that 4518 (84.7%) of postgraduate students have not been diagnosed with any mental health condition, while 819 (15.3%) have been diagnosed with one. A notable percentage of the students suffer from mental illness 819 (15.3%), which could be exacerbated by the high levels of stress reported. 

These are the findings of a National Task Force on Mental Health and Wellbeing of Medical Students. “Given the pervasive stressors involved in medical training, it is not surprising that medical students and doctors are at an increased risk of psychological distress and mental ill health relative to the general population. This is not merely a national phenomenon but a global one. Existing global literature consistently recognizes that 30-40% of medical students report mental health problems. There is high prevalence of anxiety, depressive disorders, suicidal ideation, substance use disorders, as well as stress and burnout in this population. Hence, a national task force was set up to assess the mental health and well-being of medical students in India and to suggest remedial measures,” reads the report.

The identified stressors included family pressure to perform well, work pressure, long and erratic working hours, inadequate counselling services and also ragging which, even though illegal, was reported at multiple levels of the survey.

The survey also found a worrying degree of suicides and suicidal ideations among medical students. In the past five years, 122 medical students (64 undergraduate and 58 postgraduate students) have died by suicide. This translates to an estimated 25-26 medical student suicide per year.

75000 medical seats to be added over the next five years, PM Modi announces in I-Day address

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75000 medical seats to be added over the next five years, PM Modi announces in I-Day address

There are a little over one lakh undergraduate medical seats in India currently; admissions happen through the NEET

Prime minister Narendra Modi announced Thursday that 75000 medical seats will be added over the next five years. He was delivering his Independence Day address from the ramparts of the Red Fort.

The government of India has, for some years now, followed a policy of phased increase of medical seats in a bid to ensure trained medical professionals are available and equally distributed in various parts of the country. India currently has a little over one lakh undergraduate medical seats; admissions happen through the NEET (National Entrance and Eligibility Test) that has been mired in controversy in recent months because of alleged irregularities in the conduct of the exam process in various centres across the country. 

The announcement also comes in the backdrop of widespread protests by medical students and common citizens across the country against the rape, torture and murder of a 31-year-old doctor in Kolkata’s R G Kar Medical College that has also led to widespread disruption of medical services.

According to government data there are 1308009 allopathic doctors in the country currently and India’s doctor patient ratio stands at 1:834 taking both allopathic and AYUSH doctors together. “As informed by the National Medical Commission (NMC), there are 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on June, 2022. Assuming 80% availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is 1:834. Also, there are 36.14 lakh nursing personnel in the country as on December, 2022. Assuming 80% availability of nursing personnel, the nurse- population ratio is 1:476,” the ministry of health had told the Rajya Sabha some time ago.

Under the Centrally Sponsored Scheme (CSS) for “Establishment of new Medical College attached with existing district/referral hospital” 157 medical colleges have been approved since 2014. 

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