Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study.

Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6-12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25-33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.

Map, know dynamics and act; a better way to engage private health sector in TB management. A report from Mumbai, India.

BACKGROUND: India, world's leading Tuberculosis burden country envisions to End-TB by optimally engaging private-sector, in-spite of several unsuccessful attempts of optimal private sector engagement. Private Provider Interface Agency (PPIA), a new initiative for private-sector engagement, studied the private-sector networking and dynamics to understand the spread, typology of providers and facilities and their relations in TB case management, which was critical to design an intervention to engage private-sector. We report the observations of this exercise for a larger readership. METHOD: ology: It is a descriptive analysis of mapping data (quantitative) and perceived factors influencing their engagement in the PPIA network (qualitative). RESULTS: Of 7396 doctors, 2773 chemists and 747 laboratories mapped, 3776 (51%) doctors, 353 (13%) chemists and 255 (34%) laboratories were prioritized and engaged. While allopathic doctors highly varied between wards (mean ratio 48/100,000 population; range 13-131), non-allopathic doctors were more evenly distributed (mean ratio 58/100,000 population; range 36-83). The mean ratio between non-allopathic to allopathic doctors was 1.75. Return benefit, apprehension on continuity of funding and issues of working with the Government were top three concerns of private providers during engagement. Similarly, irrational business expectations, expectation of advance financing for surety and fear of getting branded as TB clinic were three top reasons for non-engagement. CONCLUSION: A systematic study of dynamics of existing networking, typology and spread of private providers and using this information in establishing an ecosystem of referral network for TB control activities is crucial in an effort towards optimal engagement of private health providers. Understanding the factors influencing the network dynamics helped PPIA in effective engagement of private health providers in the project.

Implementation of a confidential helpline for men having sex with men in India.

BACKGROUND: In India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively. OBJECTIVE: The objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India. METHODS: We established the "Sahaay" mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided. RESULTS: The helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was "interpersonal communication" (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing. CONCLUSIONS: National HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing.