Improving Coverage of Vitamin A among the Urban Poor through Establishing Additional Dosing Points and Additional Human Resources - Experiences from Bhopal City, India.

Objectives: Due to rapid urbanization and the absence of an urban health policy until 2013, India's large and rapidly growing urban poor has very limited access to health and nutrition services. The Government of Madhya Pradesh sought assistance to systematically increase coverage of bi-annual Vitamin A supplementation in urban slums of Bhopal - a city of 2.37 million people. The objective was to improve access to and utilization of services provided during biannual VAS rounds in urban-poor settings. Methods: Formative research was undertaken to identify factors affecting utilization of services. Mapping exercises identified new delivery points and staffing needs across under-served slum areas. Based on findings, community awareness generation activities were carried out to reach care-givers and service-providers. Health workers and managers were reoriented on biannual child health round and trained on demand generation, counseling, estimation and management of supplies, program review, monitoring and reporting. Private practitioners were oriented to participate in VAS campaigns. Results: Eight new delivery points in two administrative zones were identified and staffed with trained VAS distributors. VAS coverage by government monitoring systems was 65% in August 2013, a substantial increase from the 22% measured in the November 2012 survey. Conclusions: Mapping, identifying and establishing additional service delivery sites, and capacity building of service providers resulted in improved access to and utilization of Vitamin A services in urban slums. Based on preliminary successes, various components of the program were replicated in other locations of Bhopal city and were included in government plans and budget.

Familial marker in a Down Syndrome Child.

Four months old, female child, referred for cytogenetic analysis, showed mosaiciam for the marker chromosome. Her karyotype: 47,XX,+21/48,XX+21 mar (pat). The karyotype of her mother & her sib were normal. Her father showed, similar to the proband, mosaicism for the marker ie 46,XY/47,XY, + mar. AgNOR technique determined the marker as fused short arms of the acrocentric chromosome. Four months old, female child, referred for cytogenetic analysis, showed mosaiciam for the marker chromosome. Her karyotype: 47,XX,+21/48,XX+21 mar (pat). The karyotype of her mother & her sib were normal. Her father showed, similar to the proband, mosaicism for the marker ie 46,XY/47,XY, + mar. AgNOR technique determined the marker as fused short arms of the acrocentric chromosome.