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N4S

Diseases especially those in the news and relevant in the Indian context have been an important theme for prelims. It is important to note down the type of diseases, its symptoms, its carrier and efforts to eradicate it.

Classification of diseases 

1.Communicable and Non-communicable 

2.Acute and Chronic Diseases

Diseases in news

I.Vector-borne diseases

• Vector-borne diseases are human illnesses caused by parasites, viruses and bacteria that are transmitted by vectors. Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans. Examples – mosquitoes, sandflies, triatomine bugs, blackflies, ticks, tsetse flies, mites, snails and lice.
• Many of these vectors are bloodsucking insects, which ingest disease-producing microorganisms during a blood meal from an infected host (human or animal) and later inject it into a new host during their subsequent blood meal.
• Mosquitoes are the best-known vectors.

India has a National Vector Borne Disease Control Programme (NVBDCP) to counter vector-borne diseases.

1.Filariasis

Disease caused by roundworms with mosquitoes as the carrier.

Filariasis is a parasitic disease caused by an infection with roundworms.  It is also called as Elephantiasis or Hathipaon. India has a campaign – Hathipaon Mukt Bharat (Filaria Free India) for preventive medication.

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

2. Malaria

Malaria is caused by plasmodium protozoa and is most commonly transmitted by an infected female Anopheles Mosquito.
The mosquito bite introduces the parasites from the mosquito’s saliva into a person’s blood. The parasites travel to the liver where they mature and reproduce.

3.Kala-Azar or Black Fever or Dumdum Fever or Leishmaniasis

Protozoan disease with Sandfly as the carrier.

It is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania. There is only one sandfly vector of Kala-azar in India.

India has missed the 2017 deadline that Finance Minister had announced for the elimination of Kala Azar (black fever) in his Budget speech. In fact, endemic blocks have increased from 61 to 68 in 17 districts of Bihar and Jharkhand.

4. Japanese Encephalitis

Viral disease with Culex Mosquito as the carrier.

The death of 63 children in Gorakhpur’s BRD Medical College is being attributed to JE.

5.Kyasanur Forest Disease or Monkey Fever

Viral disease with Tick as the carrier.

Kyasanur forest disease (KFD) is a tick-borne viral hemorrhagic fever endemic (constant presence of disease) in Karnataka State, India.

6. Zika

Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947 in monkeys through a network that monitored yellow fever. The first large outbreak of disease caused by Zika infection was reported from the Island of Yap (Federated States of Micronesia) in 2007

Complications – Microcephaly and Guillain-Barré syndrome

Microcephaly is a condition where a baby’s head is much smaller than expected. It occurs among babies born to women who contracted the virus during pregnancy

Guillain-Barré syndrome is a rare condition in which the immune system attacks the peripheral nervous system. For some, GBS can be quite serious, causing muscle weakness, sensory problems, pain and sometimes, paralysis.

Quick Reference for diseases transmitted by Mosquitos 

Aedes – Chikungunya, Dengue fever, Lymphatic filariasis, Rift Valley fever, Yellow fever, Zika

Anopheles – Malaria, Lymphatic filariasis

Culex – Japanese encephalitis, Lymphatic filariasis, West Nile fever

II.Nosocomial infection/hospital-acquired infection (HAI)

• A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital.
• Bacteria, fungus, and viruses can cause HAIs. Bacteria alone cause about 90 percent of these cases.
• One of the most common wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract an HAI.

Status in India

• Despite being unacknowledged by the healthcare system in India, it is very much a reality
  according to a report published by the International Nosocomial Infection Control
  Consortium in 2015.
• Another study published in the British Medical Journal indicates that that the burden of
  healthcare-associated infections in countries like India is high, with an estimated pooled
  prevalence of 15.5 per 100 patients, more than double the prevalence in Europe and the US.

Causes

? Lack of proper Equipment: This includes both clinical and non-clinical equipment such as oxygen cylinders in the case of Gorakhpur Tragedy. This leads to inappropriate methods of treatments such as putting two infants in the same incubators. According to a CAG (Comptroller and Auditor General), there is 27.21% shortage of clinical equipment and 56.33% of non-clinical equipment.

? Poor knowledge and application of basic infection control measures: This includes absence of sanitization of the hospital premises such as visitor chair as well as strict rules regarding visitation especially in intensive care units (ICUs).

? Poor Infrastructure: Poor infrastructure, in general, includes proper beddings for patients, separate and disinfected lavatories for visitors and patients.

? Understaffing and Overcrowding: This is one of the root causes of non-compliance of the most basic hygiene standards by hospitals.

? Lack of Procedure: Lack of standard procedure for dealing with communicable disease patients increases the risk of HAI exponentially.

? Lack of knowledge of injection and blood transfusion safety: Lack of proper training for such procedures increases risk of contracting infection such as HIV and Hepatitis B. Moreover, with quackery highly prevalent in India (especially in rural areas), this becomes all the more relevant.

? Inadequate environmental hygienic and waste disposal mechanisms: There have been numerous cases of aborted foetuses and hospitals waste being thrown in nearby water bodies. Inadequate waste disposal not only increases chances of HAI but also puts the environment at risk.

? Absence of local and national guidelines: Absence of proper guidelines for hospital maintenance, accreditation and laws puts patients at risk.

Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB).
It generally affects the lungs, but can also affect other parts of the body
It is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze
Vaccine: BCG

INDIA AND HEALTH

Universal Immunization Programme(UIP)

• Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of Immunization’ (EPI) by the Ministry of Health and Family Welfare, Government of India.
• In 1985, the programme was modified as ‘Universal Immunization Programme’ (UIP) to be implemented in a phased manner to cover all districts in the country by 1989-90.
• Through UIP, the Government is providing vaccination free of cost against vaccine preventable diseases which include diphtheria, pertussis, tetanus, polio, measles, severe form of childhood tuberculosis, hepatitis B, meningitis and pneumonia (Haemophilus influenza type B infections), Japanese encephalitis (JE) in JE endemic districts.
• New vaccines have been introduced in the UIP/National Immunization Programme: Rotavirus vaccine, IPV, Pneumococcal Conjugate vaccine (PCV)  and Measles-Rubella (MR) vaccine in UIP/National immunization programme.

Mission Indradanush

• To strengthen and re-energize the UIP and achieve full immunization coverage for all children and pregnant women at a rapid pace, the Government of India launched “Mission Indradhanush” in 2014.
• The ultimate goal of Mission Indradhanush was to ensure full immunization with all available vaccines for children up to two years of age and pregnant women.
• It aimed to fully immunize more than 90% of newborns by 2020 through innovative and planned approaches to reach all children.
• Under Mission Indradhanush, all the vaccines provided under Universal Immunization Program were administered to children and pregnant women.

Intensified Mission Indradanush(IMI)

• To further intensify the immunization programme, Intensified Mission Indradhanush (IMI) was launched in October 2017.
• Through this programme, Government of India aims to reach each and every child up to two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme/UIP.
• The special drive will focus on improving immunisation coverage in select districts and cities to ensure full immunisation to more than 90% by December 2018.
• The achievement of full immunisation under Mission Indradhanush to at least 90% coverage was to be achieved by 2020 earlier. With the launch of IMI, achievement of the target has now been advanced.

National Vector Borne Disease Control Programme (NVBDCP): For control of Dengue and elimination of Kala-azar and Lymphatic Filariasis.

National Leprosy Eradication Programme: India has achieved the elimination of leprosy at national level in December 2005. Focus is now to achieve elimination of leprosy at district level.

National Health Mission(NHM)

• NHM is India’s flagship health sector programme to revitalize rural and urban health sectors by providing flexible finances to State Governments.
• It comprises of 4 components namely the National Rural Health Mission, the National Urban Health Mission, Tertiary Care Programmes and Human Resources for Health and Medical Education.
• It represents India’s endeavor to expand the focus of health services beyond Reproductive and Child Health, so as to address the double burden of Communicable and Noncommunicable diseases and also improve the infrastructure facilities at District and Sub-District Levels

National Strategic Plan for Tuberculosis Elimination(2017-2025)

• Aim: To achieve active case finding of TB to 100% by 2020 and complete elimination of TB by 2025.
• Vision: TB-Free India with zero deaths, disease and poverty due to tuberculosis
• Goal: To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025
• Change of strategy: From the earlier strategy of self-reporting where few patients get themselves tested to Government itself reaching out to patients to detect more cases, both drug-sensitive and drug-resistant.
• The four strategic pillars of the programme are: Detect-Treat-Prevent-Build(DTPB).
• The development of this NSP has been a collaborative effort between all the stakeholders including national and state governments, development partners, civil society organizations, and private sector in India which was led by the Central TB Division, Ministry of Health and Family Welfare.

National Strategic Plan for Malaria Elimination(2017-22)

• The plan aims to achieve universal case detection and treatment services in malaria endemic districts to ensure 100% diagnosis of all suspected cases and full treatment of all confirmed cases.
• Four components of the plan based on WHO Recommendations:
  • Diagnosis and case management
  • Surveillance and epidemic response
  • Prevention — integrated vector management
  • Cross cutting interventions which include communication, advocacy, R&D and other initiatives.
• Categorisation of Districts:
  • The NSP divides the country into four categories, from 0 to 3. The first category, Zero, has 75 districts that have not reported any case of malaria for the last three years.
  • Category 1 has 448 districts, in which the annual parasite incidence (API, or the number of positive slides for the parasite in a year) is less than one per 1,000 population.
  • Category 2, which has 48 districts, the API is one and above, but less than two per 1,000 population.
  • Category 3 has 107 districts, reporting an API of two and above per 1,000 population.

• The plan is to eliminate malaria (zero indigenous cases) by 2022 in all Category 1 and 2 districts. The remaining districts are to be brought under a pre-elimination and elimination programme.
• The NSP also aims to maintain a malaria-free status for areas where transmission has been interrupted. It seeks to achieve universal case detection and treatment services in endemic districts to ensure 100% diagnosis of all suspected cases, and full treatment of all confirmed cases.

E-health Initiatives of the Government

Swasth E-Gurukul

• An e-learning initiative of WHO, which acts as a single repository for training material for all disease programmes such as TB, AIDS, Leprosy, Malaria, Diabetes etc.

NIKSHAY

• An IT tool which facilitates monitoring of universal access to TB patients database.
• Utilises SMS technology for communication with TB patients
• Developed jointly by Ministry of Health and Family Welfare and National Informatics Centre(NIC)

Social Endeavour for Health and Telemedicine(SEHAT)

• A pan-India initiative that aims to connect 60000 Common Service Centres(CSC) and provide healthcare services to citizens.
• Through this, the people in rural areas can consult doctors online and also order generic drugs

SUGAM

• It enables online submission of applications, their tracking, processing and grant of approvals for drugs, clinical trials, medical devices vaccines etc.
• Launched by Central Drugs Control Standard Organisation

Kilkari

• It delivers free, time-appropriate audio messages about pregnancy, childbirth and child care directly to families’ mobile phones via Interactive Voice Response (IVR).

E-Aushadhi

• It is a web based application which deals with the management of stocks of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan state

Mother and Child Tracking System(MCTS)

• It is a name based tracking system to ensure all pregnant women receive their antenatal care check-ups and children receive free immunization.

Here are 2 Back2Basics collections from today’s news items

From news- Narendra Modi to visit Sweden, UK for bilateral talks and two multilateral summits

India-Nordic Summit

1. The first Indo-Nordic summit, focusing on business and investment, is scheduled to take place in Sweden in April 2018
2. The summit is set to attract major investors for the government’s “Make in India” initiative

Commonwealth Heads of Government Meeting (CHOGM)

1. CHOGM is a biennial summit meeting of the heads of government from all Commonwealth nations
2. Every two years the meeting is held in a different member state and is chaired by that nation’s respective Prime Minister or President who becomes the Commonwealth Chair-in-Office until the next meeting
3. The meetings originated with the leaders of the self-governing colonies of the British Empire
4. The First Colonial Conference in 1887 was followed by periodic meetings, known as Imperial Conferences from 1907
5. The majority of the important decisions are held not in the main meetings themselves, but at the informal ‘retreats’

B2B #2: From News- NIIF, Everstone Group in talks to tie up for $500 million fund

Green Growth Equity Fund (GGEF)

1. GGEF, which will invest in renewable energy assets, is a joint venture between NIIF and the UK government
2. It aims to leverage private sector investment from the City of London to invest in green infrastructure projects in India
3. It shall have anchor commitments of GBP 120 million each from Government of India (through NIIF) and Government of UK

Recently in news, because the Indian Air Force (IAF) for the first time planned to deploy the Light Combat Aircraft (LCA) Tejas in its mega pan-India exercise called ‘Gaganshakti‘

About: The HAL Tejas is an Indian single-seat, single-jet engine, multi-role light fighter designed by the Aeronautical Development Agency (ADA) and Hindustan Aeronautics Limited (HAL) for the Indian Air Force and Navy

Special Feature: The aircraft has a tail-less compound delta-wing configuration, which provides for high maneuverability

Origins: It came from the Light Combat Aircraft (LCA) programme, which began in the 1980s to replace India’s ageing MiG-21 fighters. LCA was officially named “Tejas” in 2003, meaning “Radiant” in Sanskrit by the then Prime Minister Atal Bihari Vajpayee

Antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.

Microorganisms that become resistant to most antimicrobials are often referred to as “superbugs”. It compromises medical procedures such as organ transplantation, cancer chemotherapy, major surgeries etc. making them very risky.

Carbapenem Antibiotics – Refer to the line of last resort drug used to treat people with life-threatening infections.

Causes of Antibiotic Resistance

Microorganisms in the news who have shown signs of resistance.

Resistance in Klebsiella pneumoniae – common intestinal bacteria that can cause life-threatening infections – to a last resort treatment (carbapenem antibiotics) has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care unit patients.

Resistance in E. coli to one of the most widely used medicines for the treatment of urinary tract infections (fluoroquinolone antibiotics) is very widespread. There are countries in many parts of the world where this treatment is now ineffective in more than half of patients.

Treatment failure to the last resort of medicine for gonorrhoea.

Colistin is the last resort treatment for life-threatening infections caused by Enterobacteriaceae which are resistant to carbapenems. Resistance to colistin has recently been detected in several countries and regions, making infections caused by such bacteria untreatable.

Besides these – Malaria, TB, HIV, etc all have shown signs of developing resistance.

International Initiatives

• ‘One Health’ approach: to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes against the food safety, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies), antimicrobial resistance etc.
• In 2015, the WHO released a Global Action Plan on AMR (GAP-AMR) urging member countries to develop national action plans by May 2017.
• The Global Antimicrobial Resistance Surveillance System
• Interagency Coordination Group on AMR (IACG)
• World Antibiotic Awareness Week.

Initiatives by India 

1. India recently has launched National Action Plan on Antimicrobial Resistance.

Six strategic priorities have been identified under the NAP-AMR
1. Enhancing awareness among masses and strict adulteration laws.
2. Strengthen knowledge and evidence through surveillance.
3. Optimize the use of anti-microbial agents.
4. Reducing infections
5. Promote investments, research, and innovations.
6. Strengthen leadership on AMR through international collaborations

2. A National Policy for containment of Antimicrobial Resistance (AMR) in the country was formulated in the year 2011 and has been widely disseminated. The said policy envisages enforcement and enhancement of regulatory provisions for use of antibiotics for humans as also for veterinary use.

3. The Drugs and Cosmetic Rule, 1945 were amended in 2013 to incorporate a new Schedule H1 under the said rules containing 46 drugs which include IIIrd and IVth generation antibiotics, anti TB drugs and certain habit forming drugs for having strict control over the sale of these drugs.

4. FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.

5. Red Line Campaign on Antibiotics 2016, was launched to create awareness regarding rational usage and limiting the practice of self-medication of antibiotics among the general public.

6. National Health Policy 2017 envisions a holistic framework against AMR.

National Income Accounting in India

National income of a country can be defined as the total market value of goods and services produced in the economy in a year.

The three-important measure of calculating National Income of a country are:

• The sum of the value of all final goods and services produced.
• The sum of all incomes accruing to factors of production, i.e., Rent, Interest, Profit and Wages.
• The sum of consumer’s expenditure, net investment, and government expenditure on goods and services.

Circular Flow of Income in a Three Sector Economy

• The modern economy is a monetary economy. Money changes hand from one sector to another.
• The Household sector supplies their services like labour, land, Capital and entrepreneurial abilities to firms and receives payments in return in terms of money.
• In the first stage of the model, the Household sector provides their services of labour, land, capital and entrepreneurial skills to the Business firms.
• In the second stage, the Business firms pay back in monetary terms to the Household sector in the form of Wages, Rent, Interest and Profits.
• In the third stage, the money received by household is spent on the goods and services produced by the firms in the form of consumption expenditure. At the same time, the Firms provides their goods and services to the Household in return for the money.
• Thus, we see, that money flows from business firms to households as payments for a factor of production (Labour, Land, Rent and Entrepreneurial skills), and then it flows from Household to firms when Household purchased goods and services produced by the firms. This money flow is called circular flow of income.

Saving and Investment in the Circular Flow

• Along with consumption, the household also saves part of their money.
• When Household saves, their expenditure on purchase of goods and services decline. The decline in the purchase will result in a decline in money received by firms. This will result in less money flow to the household as the firms will reduce hiring and production operations. Thus, saving act as a leakage from the economic system.
• But the important question to ask is, where will savings go in the economy?
• The savings in the economy does not lead to any reduction in aggregate spending and income as the savings flows back into the economic system through Financial Markets (Banks, Stock markets, insurance etc.)
• From Financial Markets, the savings flows back to the Business firms who borrow them and invest it into new forms of investments.
• Thus, the saving which is a leakage in the system also flows back into the system through investment by a firm which acts as injections.

Government Sector in the Circular Flow

• Government affects the economy in a number of ways. The main components of government intervention are in the form of taxes, spending and borrowings.
• Government purchase goods and services just as household and firms do.
• Government financed its expenditure through taxes and borrowings.
• The money flow from Household and firms to the government is in the form of taxes.
• The other form of money flow from Household and firms to government is in the form of Borrowings through financial markets.
• The Government pay back to household and firms in the form of provision of public goods like health, education, Policing, National Defence etc.

National Income and National Product

Net National Product or National Income

• In the production of GNP of a year, a country uses some fixed assets or capital goods like Machinery, Equipments and technology etc.
• The capital goods like machinery, building and equipment’s undergo regular wear and tear during the production process, which reduces their value. This fall in the value of capital assets due to regular wear and tear is called depreciation.
• When the Depreciation is deducted from the Gross National Product, then we get Net National Product.
• It simply means to include all market value of goods and services produced in a year after deducting depreciation.
• NNPMP = GNP- Depreciation.

National Income at Factor Cost

• National Income from Factor Cost is also called National Income of a country.
• National Income means the sum of all incomes earned by the citizens in the form of Rent, Wages, Interest and Profits.
• The difference between National Income at Factor Cost and National Income at Market Price (NNPMP) arises from the fact that indirect taxes and subsidies cause the market price to be different from the factor income received by the citizens.
• Example, A mobile handset of Rs10,000 purchased by you includes a GST of 12%. In this case, while the market price of RS 10,000 includes the GST. The factor of production used to produce mobile handset will only get RS 8800. Thus, the difference between market price and factor cost is the tax.
• Similarly, a subsidy results in the market price of a product to be less than the factor cost.
• Therefore, while calculating National Income, we must deduct indirect taxes and add subsidies into Net National Product at Market Price.
• NNPFC = NNPMP – Indirect Taxes + Subsidies.

Personal Income

• Personal Income includes the sum of all incomes actually received by all the individuals or households during a given year.
• The individual pays income taxes, firms pay corporate taxes, individual also contribute towards social securities in the form of Cess etc., and some individuals receive social security benefits (transfer payments) like pension, unemployment allowances from the government.
• In order to move from National Income to Personal Income of individuals and firms, we must deduct all forms of direct taxes and social security contribution by the individuals and must add transfer payment received by the individuals.
• The basic idea here is to subtract all those income from National Income that is earned by an individual but has not been received like taxes and add all those incomes which are received by the individuals but has not been earned like Old age Pensions.
• Personal Income= National Income – (Undistributed Corporate Profits+ Corporate Taxes + Social Security Contribution) + (Transfer Payments).

By
Himanshu Arora
Doctoral Scholar in Economics & Senior Research Fellow, CDS, Jawaharlal Nehru University

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Here are 3 Back2Basics collections from today’s news items

B2B #1: From News- Cabinet approves downsizing of Competition Commission of India

Competition Commission of India (CCI)

1. Competition Commission of India is a statutory body of the Government of India
2. It is responsible for enforcing The Competition Act, 2002 throughout India and to prevent activities that have an appreciable adverse effect on competition in India
3. The Act prohibits anti-competitive agreements, abuse of dominant position by enterprises and regulates combinations (acquisition, acquiring of control and Merger and acquisition), which causes or likely to cause an appreciable adverse effect on competition within India
4. It is the duty of the Commission to eliminate practices having an adverse effect on competition, promote and sustain competition, protect the interests of consumers and ensure freedom of trade in the markets of India
5. CCI consists of a Chairperson and 6 Members (now 4) appointed by the Central Government

B2B #2: From News- Opposed to ‘weaponisation’ of outer space: India to UN

UN Disarmament Commission (UNDC)

1. In 1952, the UN General Assembly created the United Nations Disarmament Commission (UNDC) under the Security Council
2. The Disarmament Commission was re-established at the first Special Session of the General Assembly devoted to Disarmament in 1978 to succeed an earlier Disarmament Commission, which ceased to convene after 1965
3. It was created as a deliberative body, with the function of considering and making recommendations on various issues in the field of disarmament and of following up on the relevant decisions and recommendations of the special session
4. It has a mandate to prepare proposals for a treaty for the regulation, limitation and balanced reduction of all armed forces and all armaments, including the elimination of all weapons of mass destruction
5. It reports annually to the General Assembly
6. Since 1978, the Disarmament Commission has dealt with numerous disarmament-related questions, both nuclear and conventional

B2B #3: From News- International Press Institute terms contentious fake news guidlines ‘misguided policy’

International Press Institute

1. International Press Institute (IPI) is a global organization dedicated to the promotion and protection of press freedom and the improvement of journalism practices
2. Founded in October 1950, the IPI has members in over 120 countries
3. IPI’s membership is made up of editors and media executives working for some of the world’s most respected media outlets
4. IPI is a member of the International Freedom of Expression Exchange, a global network of non-governmental organizations that monitors press freedom and free expression violations worldwide
5. IPI enjoys consultative status with the UN, UNESCO and the Council of Europe
6. Each year, IPI publishes an authoritative report on media violations around the world: The World Press Freedom Review