Category Archives: Health

Health: National Deworming Day, National Deworming  Initiative, Significance of Deworming Programme

Headline : Telangana government stalls deworming drive for children

Details :

The News:

  • The deworming drive aimed at distribution of Albendazole tablets to around 6.68 lakh children in both some districts of Telangana as part of the National Deworming Programme (NDP) could not be held as per schedule.
  • The drive has been put off after two batches of the anti-worm tablets supplied to both the districts were found to be ‘Not of Standard Quality’ (NSQ).

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In Focus: National Deworming  Initiative

Background:

  • According to World Health Organization, 241 million children between the ages of 1 and 14 years are at risk of parasitic intestinal worms in India, also known as Soil-Transmitted Helminths (STH).
  • More than 1.5 billion people, or 24% of the world’s population, are infected with soil-transmitted helminth infections worldwide.
  • As per WHO, 64% of the Indian population less than 14 years are at risk of STH infections.

About STH:

  • Helminths (worms) which are transmitted through soil contaminated with faecal matter are called soil-transmitted helminths (Intestinal parasitic worms).
  • Roundworm, whipworm and hookworms are worms that infect people.

STH transmission:

  • They are transmitted by eggs present in human faeces which in turn contaminate soil in areas where sanitation is poor.

Effects of STH infections:

  • STH infections can lead to anemia, malnutrition, impaired mental and physical & cognitive development, and reduced school participation.

 

About: National Deworming Day

  • It is a single fixed-day approach to treating intestinal worm infections in all children aged 1- 19 years, and is held on 10 February and 10 August each year.
    • Note: This year the NDD was being conducted on 8th February and mop up day on the 14th February.
  • National Deworming Day program initiative is implemented with an objective to reduce the prevalence of Soil Transmitted Helminths (STH) or parasitic intestinal worms so that they are no longer a public health problem.
  • The programme was first launched in 2015 and was implemented in 11 States/UTs across all Government and Government-aided schools and Anganwadi centres targeting children aged 1 to 19 years.
  • After conducting five rounds of National Deworming Day since 2015, the program has been scaled up throughout the country.
  • Albendazole tablets given: The NDD program is a cost-effective program at scale that continues to reach crores of children and adolescents with deworming benefits through a safe medicine Albendazole.
  • Objective:
    • To deworm all preschool and school-age children (enrolled and non-enrolled) between theages of 1-19 years through the platform of schools and Anganwadi Centers in order to improve their overall health, nutritional status, access to education and quality of life.
  • Awareness:
    • To increase programme outreach to private schools and maximize deworming benefits for large number of children various awareness activities (media mix) are involved under the programme.
    • Campaigns are conducted to spread awareness about importance and benefits of dewarming, as well as prevention strategies related to improved behaviors and practices for hygiene and sanitation.
  • Reaching out to Private Schools and Out-of-School children:
    • In addition to including government and government-aided schools and anganwadis, all states makes special efforts to reach out-of-school children, who are most vulnerable to worm infections.
    • Private schools across the country, since they have high enrolment of children, have also enthusiastically joined the program, so that children in these schools, too, get deworming treatment and contribute to overall reduction in worm prevalence in communities.

 

Significance of Deworming Programme:

  • reduce absenteeism in schools;
  • improve health, nutritional, and learning outcomes; and
  • increase the likelihood of higher-wage jobs later in life.

 

Way ahead:

  • Apart from being dewormed, maintaining healthy and hygienic practices will help children and communities remain safe from worm infections.
  • The MoHFW envisions an open-defecation-free India which holds the capacity to reduce the overall worm burden in a community.
Section : Social Issues

In Brief: About Anti-vaccine campaign, About Measles

Headline : Global measles cases up 300 per cent year-on-year, WHO

Details :

News Summary

  • According to WHO, the number of cases of measles world over has seen an increase by 300% in the first 3 months of 2019 compared to same period in 2018.
  • The increase in measles cases around the world is attributed to anti-vaccination stigma. According to WHO data, the global vaccination rates have decreased.

 

Data

  • According to WHO, total number of measles cases reported globally is 112,163 between January and March 2019.
  • Africa with low vaccination coverage has witnessed a spike in 700% in measles cases reported.
  • Israel, Thailand and Tunisia have also experienced alarming outbreaks among unvaccinated groups.
  • Philippines and Brazil saw the biggest increase in 2018.

 

About Anti-vaccine campaign

Introduction

  • Anti-vax campaigns are campaigns against the use of MMR vaccine against measles, mumps and rubella.
  • The main reason attributed to spike in measles cases is decreasing global vaccination rates.
  • Global vaccination rates are decreasing due to growing vaccine hesitancy.
  • Vaccine hesitancy for measles has been growing world over as result of anti-vaccination stigma.

Anti-vax campaign: Reasons

  • Link with autism:The campaigns are spreading misinformation that MMR vaccine is linked with autism in children.
  • Religious reason: Besides some ultra-orthodox communities are resisting MMR vaccines for religious reasons like a particular Jew community in New York.
  • Social media: Besides social media has accelerated the speed at which the misinformation in spread across the world.
  • Populist measure: In countries like Italy and France, politicians have supported the anti-vaccination campaign as a populist measure.

 

About Measles

Introduction

  • It is a contagious air-borne infection of the respiratory tract.
  • It is caused by a virus in the paramyxovirus family.
  • It can spread through direct contact or coughing, sneezing etc.

High-risk group

  • It affects mostly children under the age of 5 years.
  • Unvaccinated groups including children, pregnant women.
  • People with weak immune system.

Symptoms

  • High fever
  • Runny nose and cough
  • Red and watery eyes,
  • Small white spots inside the cheeks
  • Rashes in face, upper neck, hands and feet

Effects

  • Severe respiratory infections such as pneumonia.
  • Serious complications include blindness, encephalitis (brain swelling), and diarrhea.

 

Section : Social Issues

Five actions to turbocharge India’s public healthcare Editorial 7th Apr’19 IndianExpress

Headline : Five actions to turbocharge India’s public healthcare Editorial 7th Apr’19 IndianExpress 

Details : 

India’s rising population has great health services need:

  • India has the world’s second largest population which went from 760 million in 1985 and doubled in size by 2015.
  • This rapid rise in population has not seen an appropriate increase in health services for the population.

But Budgetary allocation for health insufficient:

  • Budgetary allocation to public health is only 1.2 per cent of the total health expenditure which is far lower than the WHO recommendation of 5 per cent.
  • This lack of funds hits public healthcare infrastructure, lack of experienced medical staff to manage the burgeoning population.
  • Government statistics show that community healthcare centres are falling short of specialists and 63 per cent of hospital beds belong to private sector.
  • This gap is sharper when you look at the rural sector which has a higher percentage of the population and are financially weaker.

Technology and Innovation to tackle healthcare challenges:

  • India is experiencing a fast-paced growth on the back of technological disruption and innovative thinking.
  • This provides an opportunity to bring the same to solve the public healthcare challenge.

Five urgent actions that can be taken on healthcare:

1. Tracking health outcomes

  • Tracking the healthcare outcomes on a real-time basis will allow for a clearer picture for the authorities to deploy funds and resources in the most appropriate manner.  
  • Judging the health care providers performance on outcomes would introduce a clear target that rewards innovation.
  • To ensure this, the policy makers should introduce a standardized collection and reporting methodology.

 

2. Maintaining digital health records

  • India needs a universal system of tracking health records. The system would contain every patient’s complete medical history and would be available to any healthcare provider while still ensuring the privacy and security of the patient information.
  • Budgetary allocation while the data collected can also be leveraged to understand the efficacy of the processes and protocols being implemented.
  • The larger analysis of this data can help keep a track of healthcare trends, track disease, understand policy impact and anticipate demand for drugs / care.
  • This information would be vital to better divert funds to specific resources that are required at the point in time.

3. Government health insurance

  • Most people are vulnerable to financial distress related to critical medical procedures and require the national health insurance system for economically viable health coverage.
  • Through the use of artificial intelligence and the use of digital health, records actuaries (like insurance analysts) would be able to detect any claim anomalies to prevent fraud.

4. Leveraging a connected India

  • Over 60 per cent of the population live in rural areas in India that are in remote locations without easy access to the primary health centres.
  • These people avoid treatment for minor injuries and ailments that exacerbate due to non-treatment or incorrect home remedies.
  • Mobility and digital technology platforms have the potential of bridging this deficit by allowing doctors to remotely treat patients in under-resourced areas efficiently and economically.

5. Mobile resources for last mile delivery

  • Healthcare service professionals who are delivering at the last mile must be empowered with mobile-enabled resources to provide lifesaving care to the doorstep of those living in remote areas.
  • These resources can enable mobile diagnostics, improve collection of data and real-time consultation with doctors that are available through Telemedicine solutions.

Importance:

GS Paper II: Social Issues

Section : Editorial Analysis

A Rare Opportunity Editorial 11th Apr’19 IndianExpress

 

Headline : A Rare Opportunity Editorial 11th Apr’19 IndianExpress 

Details : 

Rare diseases:

  • A rare disease affects a small percentage of people.
  • Most rare diseases are chronic and severe, leading to death or disability.

Problems in diagnosis, understanding and treatment:

  • Since these diseases are not found commonly, doctors are typically unaware about them and therefore either misdiagnose or do not diagnose them.
  • This further decreases recorded incidence of the disease, which in turn diminishes interest in understanding the disease and finding treatments for it.

Needs support of government:

  • The issues related to rare diseases can only be overcome by strong support from the government.

National Policy for the Treatment of Rare Diseases suspended in 2018:

  • However, in 2018, the Union government suspended the National Policy for the Treatment of Rare Diseases.
  • This came as a shock to those patients who were relying on the money allotted through the policy for life-saving treatments.
  • The Centre said that the current policy for rare diseases needed to be reframed due to challenges in implementation and costs.
  • The Union Health Ministry termed the policy “untenable” as the implementation of the policy was moved out of the Public Health Division to the National Health Mission (NHM).

Low public health expenditure necessitated this decision:

  • India’s meagre 1.15 per cent of GDP allocation to healthcare means government has to make a decision of “balancing” disease incidence.
  • In this, rare diseases lose out due to the high cost of treating them.

But patients with rare disease should not be discriminated against due to costs:

  • A utilitarian calculation is not the right basis for public policy because it perpetuates marginalisation and subverts the state’s duty to treat its citizens equally.
  • The Delhi High Court recognised the rights of rare disease patients, and said that low disease incidence cannot be the state’s basis for denying someone the right to life enshrined under Article 21 of the Constitution.

Need a new rare disease policy:

  • The Delhi HC has also demanded that the government promptly frame a new rare disease policy that incorporates global best practices.
  • To respect the HC’s directions, a new policy must be founded on non-discriminatory ideals.
  • Policymakers will have to address fiscal constraints without devaluing lives of patients with rare diseases.

The new policy should be different from the earlier policy:

  • The government should create a new policy that is based on different fundamentals.
    • Attention should be on all rare diseases: The earlier policy had a narrow focus on allocating funds to treat a select few rare diseases that could be treated, while it excluded untreatable diseases. This is problematic as only 5 per cent of all rare diseases are treatable, and thus effectively excludes 95 per cent of rare diseases from its purview. The new policy should deal with this.
    • Greater resources: A new and inclusive rare disease policy should allocate substantial resources to research for the development of new platform therapies that could commonly treat different rare diseases, while simultaneously bringing down the costs of current treatments.
    • More research: More research will also facilitate greater interest in rare diseases in the medical community, increasing rates of diagnosis and improving medical care. Increased focus on research could help develop cheaper treatments.
  • Take care of cost of treatment: Giving incentives to pharmaceutical companies to develop treatments for rare diseases has resulted in discovery of treatments but their cost is prohibitively high. In India, where most patients are un-insured and rare diseases fall outside the insurance system, this increases patient dependence on government financing. Ways must be found to incentivize discovery of new treatments while keeping treatment costs affordable.

Conclusion:

  • Low incidence makes rare diseases “unprofitable” and companies are reluctant to invest in them.
  • The government must not abandon the rare disease community to the market mechanism

Objectives of Ayush Mission

The Government has launched the National AYUSH Mission with the objectives of:

 providing cost effective AYUSH Services, with a universal access through upgrading AYUSH

Hospitals and Dispensaries,

 co-location of AYUSH facilities at Primary Health Centres (PHCs), Community Health Centres

(CHCs) and District Hospitals (DHs),

 strengthening institutional capacity at the state level through upgrading AYUSH educational

institutions, State Govt. ASU&H Pharmacies, Drug Testing Laboratories and ASU & H enforcement

mechanism,

 supporting cultivation of medicinal plants by adopting Good Agricultural Practices (GAPs) so as to provide sustained supply of quality raw-materials and support certification mechanism for quality standards,

 Good Agricultural/Collection/Storage Practices and supporting setting up of clusters through convergence of cultivation, warehousing, value addition and marketing and development of infrastructure for entrepreneurs.

Lymphatic Filariasis

Introduction

• The national health policy had aimed at eliminating filariasis by 2015 but the deadline was extended to 2017 and now has been shifted to 2020.

• But India is likely to miss the target date of stamping out elephantiasis or lymphatic filariasis.

Filariasis

• Filariasis, called hathipaon (elephant foot) locally, can cause limbs, usually the leg, knee downwards, to swell enormously or hydrocele (swelling of the scrotum), causing disfigurement and disability.

• It is caused by various coiled and thread-like parasitic worms.

• These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.

• The disease is caused by the nematode worm, either Wuchereria bancrofti or Brugia malayi and transmitted by ubiquitous mosquito species Culex quinquefasciatus and Mansonia  annulifera/M.uniformis respectively.

• The worms produce about 50,000 microfilariae (minute larvae) that enter a person’s blood stream and get passed on when a mosquito bites an infected person.

• The larvae develop into adult worms that can live upto 5-8 years and more in humans. They damage the lymphatic system though no symptoms may show for years.

• It is found that though changes to lymphatic vessels occurred early in the infection, treatment could reverse these in most cases.

Lymphatic filariasis (LF)

• Lymphatic Filariasis (LF), commonly known as elephantiasis is a disfiguring and disabling disease, usually acquired in childhood.

• In the early stages, there are either no symptoms or non-specific symptoms but the lymphatic system is damaged.

• The long term physical consequences are painful swollen limbs (lymphoedema or elephantiasis).

• Hydrocele in males is also common in endemic areas.

• Due to damaged lymphatic system, patients with lymphoedema have frequent attacks of infection causing high fever and severe pain.

National Filaria Control Programme (NFCP)

• After pilot project in Orissa from 1949 to 1954, the National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem, to undertake control measures in endemic areas and to train personnel to man the programme. The main control measures are:

1 Mass DEC administration

2 Antilarval measures in urban areas

3 Indoor residual spray in rural areas.

Strategy to tackle the disease

• Mass drug administration (MDA) in endemic districts ensuring coverage of over 65% population is the global strategy to eliminate the disease.

• Since 2004, the health ministry has been carrying out mass drug administration as part of the Hathipaon Mukt Bharat (Filaria Free India) programme for preventive medication.

• This involves giving at least 65% of the population in endemic districts two drugs:

1 Tablets of diethylcarbamazine citrate (DEC)

2 Albendazole once a year for five years

• Children below two years, pregnant women and seriously-ill people are not eligible for these drugs.

• After five years of MDA and 65% coverage, a transmission assessment survey is conducted to see if the district qualifies for stoppage of mass drug administration.

• The new three-drug combination, IDA, involves adding tablets of Ivermectin to the DEC and albendazole tablets and has been shown to reduce microfilariae by 99% with the first dose itself.

• The two-drug regimen (DEC and albendazole) reduces the disease by 60-80% and hence requires five rounds.

• The new drug regimen is expected to help clear the infection faster as IDA would require just two rounds.

Challenges

• India stopped the MDA in 96 of the 256 districts last year. But many of the 96 districts failed a treatment assessment survey by external evaluators.

• The surveillance that identified the 256 endemic districts is now outdated. A fresh survey could push up the number of endemic districts to over 300. This would require an overhaul of programme strategy and consequently, the chances of meeting the 2020 target are slim.

• It’s also a challenge to get people to take as many as four tablets simultaneously, especially when they have no symptoms. Health workers must ensure the person consumes the tablets right then which doesn’t always happen.

• Recently added drug Ivermectin has to be given according to bodyweight, which could mean adding 2-4 tablets to the existing drug regimen depending on the person’s body weight.

• That could be an additional challenge to the programme, the success of which hinges on community compliance (ensuring people take the medicine) and coverage (ensuring medicines reach at least 65% of the population).

• WHO gives India albendazole free of cost but it has to buy 70% of the required DE, 30% is free. Government will now have to find the funds to buy Ivermectin and meet the cost of expanding the programme. Budget approvals for the same are still in the pipeline.

Everything about Japanese Encephalitis

Japanese Encephalitis

  • It is a viral disease that infects animals and humans.
  • In humans, it can cause inflammation of membrane around the brain.
  • Japanese encephalitis virus (JEV) is the most important cause of viral encephalitis in Asia.
  • JEV is a mosquito-borne flavivirus and belongs to the same genus as dengue, yellow fever and West Nile viruses.
  • The first case of Japanese encephalitis viral disease (JE) was documented in 1871 in Japan.

Signs and symptoms

  • Most JEV infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 250 infections results in severe clinical illness.
  • Severe disease is characterised by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and ultimately death.
  • Acute encephalitis syndrome (AES) is a clinical condition caused by infection with JEV or other infectious and noninfectious causes.

Transmission

  • JEV is transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
  • Domestic pigs and wild birds are reservoirs of the virus.
  • In most temperate areas of Asia, JEV is transmitted mainly during the warm season, when large epidemics occur.
  • In the tropics and subtropics, transmission can occur year-round but often intensifies during the rainy season.

H1N1 Flu:

H1N1 Flu:

  • It is a respiratory disease caused by a strain of the influenza type A virus known as H1N1.
  • H1N1 Flu is also known as swine flu.
  • It is called swine flu because in the past the people who caught it had direct contact with pigs.
  • It can be transmitted from one person to another by coughing and sneezing.
  • Its symptoms are similar to those of standard, seasonal flu like fever, cough, sore throat, body aches and chills.
  • The vulnerable groups include pregnant women, children under five, the over-65s and those with serious medical conditions.
  • The virus first appeared in Mexico in 2009 and rapidly spreaded around the world.
  • In 2009, H1N1 was spreading fast around the world, so the World Health Organisation called it a pandemic.

What makes Maharashtra, particularly vulnerable?

  • Urbanisation and overcrowding: More the number of people, more are the chances of spreading the disease.
  • Good surveillance system: Presence of good surveillance system helps in tracking of all the cases. The increased number of cases is a reflection of good surveillance system.
  • Antigenic shift: It is a process in which two or more strains of a virus combine to form a new subtype. It is observed at regular intervals which is the main reason why there has been a spurt in the cases.
  • Failure to detect on time: The symptoms of disease such as fever, a runny nose and a sore throat are often ignored and self-treated. By the time patients consults the doctor two or three days have been wasted.
  • Faded effect of vaccination: Vaccine against H1N1 was administered to the patients in 2015 when major cases were reported. The vaccine gives immunity for about 8-9 months. This could be the reason why state of Maharashtra did not have many cases in 2016 but now see a rise in number of cases.

NATIONAL PHARMACEUTICAL PRICING AUTHORITY:

NATIONAL PHARMACEUTICAL PRICING AUTHORITY:

  • The National Pharmaceutical Pricing Authority (NPPA) is a government regulatory agency that controls the prices of pharmaceutical drugs and equipments in India.
  • NPPA is an organization of the Government of India which was established to fix/ revise the prices of controlled bulk drugs and formulations and to enforce prices and availability of the medicines in the country, under the Drugs (Prices Control) Order.
  • The organization is also entrusted with the task of recovering amounts overcharged by manufacturers for the controlled drugs from the consumers.
  • It also monitors the prices of decontrolled drugs in order to keep them at reasonable levels.
  • At present the Drug Price Control Order (2013) regulates ceiling prices of 432 medicines based on “essentiality.”

Everything about Surrogacy

What is surrogacy?

  • Surrogacy is where a woman becomes pregnant with the intention of handing over the child to someone else after giving birth.
  • Generally, she carries the baby for a couple or parent who cannot conceive a child themselves – they are known as “intended parents”.
  • There are two forms of surrogacy.
  • In traditional surrogacy, the surrogate mother’s egg is used, making her the genetic mother.
  • In gestational surrogacy, the egg is provided by the intended mother or a donor.
  • The egg is fertilised through in vitro fertilisation (IVF) and then placed inside the surrogate mother.

Is surrogacy legal?

  • It varies from country to country.
  • Countries such as France, Germany, Italy, Spain, Portugal and Bulgaria prohibit all forms of surrogacy.
  • In countries including the UK, Ireland, Denmark and Belgium, surrogacy is allowed where the surrogate mother is not paid, or only paid for reasonable expenses.
  • Paying the mother a fee (known as commercial surrogacy) is prohibited.
  • Commercial surrogacy is legal in some US states, and countries including, Russia and Ukraine.

Where do people go for surrogacy?

  • countries popular with parents for surrogacy arrangements are the US,  Thailand, Ukraine and Russia.
  • Mexico, Nepal, Poland and Georgia are also among the countries described as possibilities for surrogacy arrangements.
  • Costs vary significantly from country to country, and also depend on the number of IVF cycles needed, and whether health insurance is required.

Cambodia the new destinations:

  • While Cambodia has become popular among people — both Indians and from other parts of the world — countries such as Ukraine and Kenya are attracting doctors from India.
  • India is no longer on the surrogacy map and after Bangkok and Thailand stopped surrogacy, Cambodia opened up.
  • As in the early days of surrogacy in India, the lack of proper laws or guidelines in Cambodia has proved a big attraction.
  • There is growth in surrogacy in Cambodia since last year.
  • There is a huge pressure building and Cambodia is ill-prepared to handle it.
  • Besides, there are no laws in place in Cambodia.
  • Doctors who offered surrogacy service in India are aware of the new hubs.