Tribal Malaria in India: An Analysis of Malaria Incidence and Mortality over 20-Year Period (2000-2020).

Objective: Tribal malaria is well known for its substantial share in the overall malarial load of the country. This paper examines the levels and trends of malaria incidence and mortality in the tribal population for the past two decades. Methods: Data on malaria incidence and mortality were collected from an online e-repository that provides statistical data and information on 19 sectors, including health. Results: The analysis showed that the malaria incidence and mortality in tribal-dominated regions declined at an average annual rate of 4.3% per annum between 2000 and 2020, which accompanies the tremendous progress made in malaria control at the country level during this time period. The results also showed that between 2016 and 2020, the decline in tribal-dominated regions was consistent and noteworthy in terms of magnitude, a period that marks the implementation of the national framework for malaria elimination in the country. Conclusion: The decisive fall in the incidence and mortality of malaria in the tribal-dominated region has put India on track to achieve the target of 3.3 of the Sustainable Development Goals. However, with the pandemic impacting service delivery, monitoring, and reporting, including malaria control programs, it is important to maintain the momentum of progress in malaria control.

The predictors of COVID-19 mortality among health systems parameters: an ecological study across 203 countries.

BACKGROUND: Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design. METHODOLOGY: Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately. RESULTS: Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability. CONCLUSION: To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.

Need for Gender Focused Policies Addressing Smokeless Tobacco Use among Women in India: A Review.

BACKGROUND: Nearly 8 million annual deaths occurring globally are attributable to tobacco use. Among more than 356 million smokeless tobacco (SLT) users in 140 countries, 82% reside in Southeast Asia with the vast majority being in India and Bangladesh. According to the Global Adult Tobacco Survey -2 data, 21.4% of adults in India consume SLT, among them 29.6% are men and 12.1% women. SLT has received less attention compared to its smoked counterparts in the public health measures to curb tobacco use. Though women are a sizable proportion of users, majority of the awareness building measures as well as governmental policies do not target them. This review aims to highlight these gaps objectively with constructive suggestions to enable a changed strategy to reduce tobacco consumption. AIM: (1) To critically review the gender sensitivity of tobacco control measures in India, (2) to conduct a comparative analysis of gender responsive strategies in India with those in smokeless tobacco high burden countries and (3) to make practical, feasible recommendations to enhance gender responsiveness of tobacco control measures in India in general and smokeless tobacco in particular. METHODOLOGY AND RESULTS: Following a comprehensive literature review to capture key information on gender responsiveness/sensitivity of strategies for tobacco control publications in English within the last 20 years, our search yielded 35 papers and reports from India describing policies relevant to SLT and women. Public health approach to tobacco control in general was found to be gender blind. CONCLUSION: It is evident that tobacco and smokeless tobacco related information and awareness activities need to focus more on women with improved messaging strategy to make it easily understandable and tailor the same to address the immediate and delayed health concerns. This much needed change would receive impetus with revisions in Governmental tobacco control policies, implementation and uptake.

Perceptions Regarding Climate Change and its Health Impact: Reflections from a Community-Based Study in India.

BACKGROUND: In the climate change discourse, a body of scholarship focusing on how people perceive climate change and its impact is increasing. However, in the Indian context, such scholarship is limited. OBJECTIVE: This paper aims to describe the perceptions of people on climate change and its health impacts, which were captured as part of a larger study. METHODOLOGY: A cross-sectional study was conducted in randomly selected 983 households in four districts spread across Madhya Pradesh and Jammu and Kashmir. A semi-structured questionnaire was used to collect the data. RESULTS: For 72% of respondents, the perception was not related to climate change per se. Their perceptions were contextual and were based on the anomalies which are observed in the immediate weather conditions. The health impacts of climate change were also not understood at the first place, but with probing 64% of respondents were able to report seasonal diseases. CONCLUSION: Perceptions of the people regarding climate change are more linked to their own experiences with their local weather conditions rather than the overall concept. This also explains their lack of comprehension about the health impact of climate change, but a sound understanding of seasonal diseases.

Human Resources for Health in India: Need to go Beyond Numbers.

India's commitment to achieve the goal of Universal Health Coverage is evidenced by the launch of Ayushman Bharat and the transformation of Sub-Centres into Health and Wellness Centre to provide secondary and comprehensive primary healthcare to the vast majority of its population. Successful implementation of these initiatives requires adequate and skilled human resources for health and a conducive work environment. There exists a deficiency of doctors and paramedical professionals in different parts of the country. The vacancies in different categories of health functionaries have increased after 2005 despite the National Rural Health Mission/National Health Mission initiatives to strengthen the health system. The distribution of doctors and paraprofessionals in health is skewed, favoring urban areas. Properly oriented, trained, and skilled health workforce and informed public participation are critical to provide quality services for achieving national health goals. Therefore, it is necessary to establish public health cadre in all states of India and ensure appropriately skilled workforce to meet the functional requirements of health-care delivery system at different levels. This will also help to move forward on the way to reach the Sustainable Development Goals.

Assessing health systems' responsiveness in tackling COVID-19 pandemic.

Health systems' responsiveness is the key to addressing infectious disease threats such as pandemics. The article outlines an assessment of health systems based on World Health Organization's building blocks for select countries. It also compares these with the findings from a more comprehensive analysis of Global Health Security (GHS) Index, which assesses the preparedness of the health system for such pandemics. The GHS report (2019) spelt out very objectively that none of the countries of the world was prepared to effectively handle such emergencies, should they arise. Observations emerging from different countries highlight these findings although some of them seem to be discordant. Overall, it appears that Asian countries could fight the battle better than most developed nations in the Europe and America during the current pandemic, despite having poor GHS scores. Experiences of these countries in facing similar crisis in the past probably sensitized their strained health systems for a greater good. There are several lessons to be learned from such countries.

Why me? A missing girl...

Demographic imbalance created because of the declining sex ratio in India is a cause of concern to policy makers, implementers, demographers and social reformers. To take situation under control, Pre Natal Diagnostic Techniques (PNDT) Act is operational since 1996. Authors have critically reviewed the status of women and socio-cultural factors influencing their status based on data from NFHS III and census 2001 and challenges faced in the operationalisation of PNDT Act in India.