Measuring the Effect of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) on Health Expenditure among Poor Admitted in a Tertiary Care Hospital in the Northern State of India.

Background: Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology: It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results: A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (~93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion: AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Background: Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. Methods: A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. Results: A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. Conclusion: A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

Multi-sectoral implementation interface framework (MIIF) to achieve the objective of tobacco-free Himachal Pradesh.

The limitations observed in achieving the goal of a tobacco-free Himachal Pradesh have necessitated the need to contextualize the existing policy directives in tobacco reduction. Our observation has been that despite having clearly defined policy guidelines and laws, the implementation may not have followed suit. An analysis of the gaps observed had led us to develop an implementation interface framework involving stakeholders from multiple sectors.

Assessing Adequacy of Iodine Intake among Children from 6 Months to 15 Years of Age from Hilly Terrains of North India.

BACKGROUND: Routine outcome-based monitoring is required to assess the status of consumption of iodized salt as USI strategy. OBJECTIVE: To assess the extent of recent iodine intake among children from 6 to 15 years of age in the hilly terrain of northern states of India. METHODS: A school-based cross-sectional observational study among 227 children attending school was done for assessment of socio-demographic, dietary, salt consumption and urinary iodine concentration (UIC). RESULTS: Mean age of children was about 6 years and 87.7% were consuming salt of >30 and none with <15 ppm iodine content. Median UIC was 138.0 µg/L. Among those assessed, 37.9% had adequate level of UIC, whereas about 20% and 40% participants had less (<99.0 µg/L) and more than adequate to excessive (≥200 µg/L) levels of UIC. Insignificant difference (p = 0.07) was observed for mean log UIC between cabbage eaters (2.3) and non-eaters (1.9) consuming salt >5 grams/day. CONCLUSION: Recent iodine intake among children observed to be inadequate and effect of cruciferous food items on UIC needs to be studied despite high coverage of iodized salt among children.

Iodine intake among pregnant mothers residing in hilly terrains of two districts of Himachal Pradesh, India.

BACKGROUND: Under programmatic settings, routine monitoring and evaluation of household consumption of iodized salt are recommended to track the reach of universal salt iodization strategy. The program needs evaluation in different settings and locations. OBJECTIVE: The objective of this study was to assess urine-based estimation for recent iodine intake among pregnant women living in hilly terrains of two districts of northern state of India. METHODS: A community-based cross-sectional observational study was conducted during September- December 2019 among 202 randomly selected pregnant women in two districts of Himachal Pradesh. With a predesigned schedule, data regarding sociodemographic and behavioral factors and salt consumption were collected by interview. Iodine level of salt was assessed by spot iodine testing kit and urinary iodine concentration (UIC) was measured using ammonium persulfate digestion using spectrophotometer. RESULTS: Women had a mean age of about 26 years, and the period of gestation was of mean 163.7 days. The consumption of iodized salt (>15 ppm) at family level was found to be 83.7%, and the median UIC was 169.0 µg/L. Among assessed, 26.7% had an acceptable level of UIC, whereas 41.1% and 32.2% of women had less (<150 µg/L) and excessive (>250 µg/L) level of UIC, respectively. CONCLUSION: Recent iodine intake among pregnant women was observed to be adequate, but efforts are to be done to assess the reasons for less and excessive UIC among women.

Drawing inference from nationwide lockdown as a response towards novel Cornavirus-19 (CoVID-19) epidemic in India.

BACKGROUND: Lockdown effectively can only result in relative freezing of populations that is expected to slow down the disease spread rather than zeroing it. Flattening of epidemic curve Current analysis was carried out to observe a pattern in the rise of CoVID-19 cases along with concurrent announcements of strategies to control the spread of disease. MATERIAL AND METHODS: Data in from of daily number of cases and issued notifications were studied from the official website of Government of India from 30/01/2020 to 03/05/2020. Qualitative assessment with thematic analysis was carried out for notifications issued by the government. The fit to data on cumulative cases was observed with R2 and checked for linearity, logarithmic, polynomial, and exponential growth. Daily growth fraction (Gt) was calculated based on the difference between current and previous number of cases, thereafter daily doubling time (Td(t)) was estimated. RESULTS: Daily reported cases were entered and cumulative growth of cases observed with a polynomial increasing pattern (third-order) with better fit (R2: 0.999). Total 108 notifications were issued, and as compared to phase-0 and 1 (87.0%), few (12.9%) notifications were issued in phase-2 of study period. As compared to phase-0 and 1, rising trend of cumulative cases and Td(t) was high in phase-2. CONCLUSION: Across phases of lockdown along with a rising trend of COVID-19 cases, the country has managed to increase the doubling time of cases with an effort to flatten the epidemic curve.

Does temperature and humidity influence the spread of Covid-19?: A preliminary report.

INTRODUCTION: Climate change has been known to influence infectious diseases. The reason for this being the fact; disease agents and their vectors each have particular environments that are optimal for growth, survival, transport, and dissemination. MATERIALS AND METHODS: The WHO's website was accessed to look for the Novel Coronavirus (COVID-19) situation dashboard and comprehensively study and assess the report. An attempt was made to look for countries, areas or territories with maximum and minimum number of cases of lab confirmed COVID cases. Further, we entered the words "Climate" in google for each of the aforementioned countries and searched for the results. A comparison was established by including countries from both the hemispheres (northern and southern). The preliminary analysis was based on the reports from countries with established testing facilities for Covid-19. RESULTS: The report suggests that countries with higher number of cases are the countries with cold weather. These are also the countries with low humidity which could be favoring the transmission and survival of the SARS-COV-2. CONCLUSIONS: The results though preliminary point to a pattern which favors the hypothesis that the extensive spread of Covid-19 maybe limited by temperature and humidity.

MR Imaging of hypoxic ischemic encephalopathy - Distribution Patterns and ADC value correlations.

BACKGROUND AND PURPOSE: Neonatal hypoxic-ischemic encephalopathy causes hypoxic brain injury. Due to differences in brain maturity at time of insult, severity of hypotension and duration of insult, there are four distinct patterns of brain injury. Magnetic resonance imaging is the most sensitive modality for evaluating these patterns of brain injury. Additional role of Diffusion weighted imaging and ADC values can be useful in the evaluation of such cases. We conducted this study to analyse the usefulness of ADC values in the brain tissue affected by hypoxic-ischemic injury. MATERIALS AND METHODS: We conducted a prospective study of all the patients referred to our department for magnetic resonance scanning of brain with history of hypoxic ischemic encephalopathy and clinical features cerebral palsy. 23 Cases with imaging manifestations of hypoxic ischemic encephalopathy were included in the study. We studied distribution patterns of HIE in our cases and calculated the ADC values of involved as well as normal grey and white matter. Further, sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized diffusion and ADC values were obtained Wilson Score method. RESULTS: The most common distribution pattern in our study was involvement of peri-rolandic area (15 cases, 65%). ADC values were significantly (p < 0.005) increased in abnormal white matter. No significant changes (p = 0.8) were seen in ADC values of normal and abnormal grey matter. CONCLUSIONS: Due to significant increase in ADC values of affected white matter, ADC value can be used as a marker to detect chronic sequel of hypoxic ischaemic brain injury. Another observation was the perirolandic brain tissue being most common area of involvement in the cases with cerebral palsy.

Game change in Indian Health Care System through reforms in medical education curriculum focusing on primary care- Recommendations of a joint working group.

Despite the stated aim of Medical Council of India (body regulating medical education in India) to produce an Indian Medical Graduate with requisite knowledge, skills, attitudes, values and responsiveness, so that he or she may function appropriately and effectively as a doctor of first contact of the community while being globally relevant, it appears that we failed. The joint working group extensively consisting of medical teachers have come up with suggestions which may work as the game changer in Indian Health care system. The key is to dedicate medical education towards primary care.

Superior semicircular canal dehiscence: A new perspective.

OBJECTIVE: To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its association with ear pathologies and to find whether it is an acquired condition and its association with increase in age. MATERIALS AND METHODS: study was performed in a tertiary care institute present in a village, following approval of the institutional ethical committee. Retrospective review of temporal bone CT examinations performed between September 2016 and March 2017 was done. 1 mm interval axial images with sagittal and coronal reformatted images were reviewed for the presence of canal dehiscence and thinning by investigators. We characterised the Superior semicircular canal status as normal, frank dehiscence or thinning. Frank dehiscence was further classified anatomically as anterior limb, apex and posterior limb dehiscence.The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group. RESULTS: Retrospective review yielded 80 positive cases which included SSC dehiscence (N = 39) and thinning (N = 41). 80 normal scans were selected as control group retrospectively. Statistical analysis was performed to assess for differences between the groups studied. Pearson chi-square test applied. there was a significant association of SSC pathologies prevalence with increasing age (p = < 0.001). No significant relationship was found between SSCD and presence of either CSOM or Cholesteatoma (p = 0.285). Vertigo rather than Tullio phenomenon was the statistically significant complaint (p = <0.001). which brought the patient to the hospital. CONCLUSIONS: The SSCD and thinning belong to the same spectrum and are acquired conditions. Increasing prevalence in old age suggests it to be an acquired condition rather than a congenital one. No significant association of these condition was seen with CSOM and cholesteatoma. Vertigo is the predominat symptom bringing the patient to hospital along with Tullio phenomenon.

Pattern of health promises for Indian democracy: A qualitative review of political manifestos.

INTRODUCTION: India is a multiparty parliamentary democracy and second most populous country in the world. In spite of pressing needs of the population, healthcare is still not considered a driving electoral mobilizer as compared to the older democracies such as the UK and USA. Only three National Health Policies (1983, 2002 and 2017) have been promulgated by the respective governments during the past 70 years of India's independence. National policies are often preceded by commitment of political parties documented in the manifestos. Type and nature of promises in the manifesto of National Political Parties (NPPs) are reflective of vision and intentions of parties. The present study was done to qualitatively analyze the pattern of expressed intensions in terms of health promises made for 16th Lok Sabha (people house) elections of India in the year 2014 by its NPPs. METHODS: Manifestos of NPP, as notified by election commission of India, were retrieved from their respective website and effort was also made with an online search. Manifesto of five out of total seven NPPs could be accessed and analyzed. Consensus-based criteria of assessment were developed by public health experts and each manifesto was assessed independently by two experts. In a case of difference in scoring, independent opinion was sought from the third expert for adjudication. RESULTS: Two NPPs mentioned majority of statements as goals and rest focused for health strategies. The focus of statements was for public health problems (11.5%), public health financing (9.0%), and improving infrastructure (9.0%). All parties were committed for improving health services as it shared 30.8% space as statements in all five manifestos. All statements were of primary or secondary prevention in nature and focused more on improving processes (47.4%) and increasing inputs (31.6%). Whereas, Communist Party of India focused only on inputs (60.0%) and outputs (40.0%). CONCLUSION: Promises made by all NPPs were quite progressive, inclusive, and comprehensive in nature; however, much of these do not find space in public debates on television and election speeches.

Epidemiological study of non-communicable diseases (NCD) risk factors in tribal district of Kinnaur, HP: A cross-sectional study.

BACKGROUND: There are no data available on the prevalence of non-communicable diseases (NCD) risk factors among the tribal population of hill state of Himachal Pradesh (HP). The epidemiological study of NCD risk factors was done in the tribal population of district Kinnaur of HP to estimate the burden of NCD risk factors and their risk determinants. METHODS: WHO STEP wise approach was used for screening of the core NCD risk indicators in 3582 randomly selected natives of Kinnaur aged 20-70 years by trained Health workers of the district health services. RESULTS: The hypertension was prevalent in 19.7% (18.4-21.1%) and diabetes in 6.9% (6.1-7.8%) of the population. Awareness of hypertension and diabetes was 39.8% and 40.8% respectively. The adherence to prescribed medications was reported in 52.1% and 56.4% of patients of aware hypertension and diabetes respectively. Overall, 23.3% and 8.5% of the patients with hypertension and diabetes had controlled BP and blood glucose respectively. Overweight and obesity were observed in 38.2% (36.6-39.9%) and 8.8% (7.9-9.8%) of the population respectively. The consumption of tobacco and alcohol was reported in 22.6% and 24.9% of the population, respectively, and 34.5% were physically inactive. Physical inactivity, BMI, high alcohol consumption, and age were independently associated with risk of hypertension, while age was the only determinant of risk of diabetes. Education and women gender had a significant influence on tobacco and alcohol consumption behavior adjusted for age. CONCLUSION: NCD risk factors are prevalent in the tribal district of Kinnaur. The awareness, treatment, control of blood pressure and blood glucose were found to be suboptimum in the study subjects. INTERPRETATION: Strengthening of primary health care services and community based interventions are urgently required to improve awareness and control of NCD risk factors in this tribal district of HP.

Risk factors for cancer cervix among rural women of a hilly state: a case-control study.

In Himachal Pradesh, cancer cervix is a major public health problem since it ranks as the number one female cancer. A case-control study of 226 newly diagnosed, histopathologically confirmed cases of cancer cervix and equal number of matched controls was conducted at Regional Cancer Center, Himachal Pradesh during the period from July 2008 to October 2009 with the objective to study the common factors associated with cancer cervix. Univariate analysis identified 10 risk factors associated significantly with the disease. On multiple logistic regression, however, only seven risk factors were found to be associated significantly with the disease. These were: Age at birth of first child, spacing between two children, age at marriage, literacy, socioeconomic status, multiparity, and poor genital hygiene. Risk factors such as poor genital hygiene, age at birth of first child <19 years, early marriage, illiteracy, multiparity, and low socioeconomic status were highly prevalent in the study subjects and were found to be significantly associated with cancer cervix.