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Subject: Health

  • Connection between Anaemia and Maternal Health

    anaemia

    Introduction

    • Recent discussions in India have brought anaemia to the forefront, with debates surrounding the measurement and management of haemoglobin levels.
    • The WOMAN-2 trial collaborators published a study in The Lancet, emphasizing the importance of anaemia in postpartum haemorrhage and calling for informed policy decisions in India.
    • Anaemia affects a significant number of women worldwide and is associated with high mortality rates in postpartum haemorrhage cases.

    What is Anaemia?

    • Anaemia is a medical condition characterized by a decrease in the number of red blood cells or a deficiency in haemoglobin, the protein responsible for carrying oxygen throughout the body.
    • This condition can lead to a reduced capacity of the blood to deliver oxygen to tissues and organs.
    • The symptoms of anaemia can vary depending on the underlying cause and the severity of the condition.

    However, some common symptoms of anaemia include:

    1. Fatigue and weakness: Feeling tired and having a lack of energy is a common symptom of Anaemia. This occurs because the body’s tissues and organs do not receive enough oxygen.
    2. Shortness of breath: Due to the reduced oxygen-carrying capacity of the blood, individuals with Anaemia may experience difficulty breathing, especially during physical activity or exertion.
    3. Rapid or irregular heartbeat: In an attempt to compensate for the lack of oxygen, the heart may beat faster or irregularly. This symptom is particularly noticeable during physical activity or when the individual is at rest.
    4. Dizziness and light-headedness: Anaemia can cause a decrease in blood flow to the brain, leading to feelings of dizziness and lightheadedness.
    5. Cold hands and feet: Reduced blood flow can result in a sensation of coldness in the extremities, such as the hands and feet.
    6. Headaches: Some individuals with anaemia may experience frequent headaches, which can be a result of the decreased oxygen supply to the brain.

    How Anaemia is linked to maternal risks?

    • Increased risk of complications: Anaemia during pregnancy raises the risk of preterm birth, low birth weight, and maternal mortality.
    • Fatigue and weakness: Anaemia can cause exhaustion, making it harder for pregnant women to handle physical demands.
    • Preeclampsia: Anaemia is linked to a higher likelihood of developing preeclampsia, a dangerous condition.
    • Postpartum haemorrhage: Anaemia increases the risk of excessive bleeding after childbirth.
    • Impaired immune function: Anaemia weakens the immune system, making pregnant women more susceptible to infections.
    • Iron deficiency Anaemia: Common during pregnancy, it can negatively impact maternal and fetal health.

    Link between Anaemia and Postpartum Haemorrhage

    • Global anaemia burden: Over half a billion women of reproductive age suffer from anaemia worldwide.
    • Postpartum haemorrhage risk: Anaemia increases the risk of postpartum haemorrhage, a leading cause of maternal deaths, particularly in low- and middle-income countries.
    • WOMAN-2 trial: The trial examined the association between prebirth haemoglobin levels and postpartum haemorrhage risk in women from Pakistan, Nigeria, Tanzania, and Zambia.

    Findings from the WOMAN-2 Trial

    • Continuous relationship: Lower haemoglobin levels were directly associated with increased blood loss and clinical postpartum haemorrhage.
    • Impact on maternal function: Women with anaemia experience reduced oxygen-carrying capacity, leading to shock after smaller blood loss volumes.
    • Severity of anaemia: Severe anaemia was associated with higher odds of death or near-miss events compared to moderate anaemia.

    Recommendations and Prevention Strategies

    • Preventive treatment: Attention should be given to preventing and treating anaemia in women of reproductive age.
    • Existing initiatives: The Indian government provides iron and folic acid supplements to address anaemia, especially among adolescent girls.
    • Challenges and mission-mode approach: Rising levels of anaemia in India require an intensified public health approach to combat the issue effectively.
    • Cultural and social considerations: Public health programs should consider cultural attitudes and preferences regarding blood draws for accurate haemoglobin measurement.
    • Outreach program considerations: A comprehensive understanding of cultural and social realities is crucial to ensure the success of anaemia prevention initiatives.

    Conclusion

    • The WOMAN-2 trial highlights the significance of anaemia in postpartum haemorrhage, urging policymakers in India to use evidence-based guidelines for anaemia management.
    • The Indian public health program should focus on prevention, treatment, and community engagement to combat rising anaemia levels effectively.
    • Cultural and social factors must be considered when designing outreach programs, ensuring their relevance and acceptance by the target population.

     

  • Centre planning new Bill on Stray Dog Issue

    dog

    Centre Idea:

    • The Centre will soon formulate a law on the issue of stray dogs, Union Minister Parshottam Rupala said.

    Stray Dog Menace in India

    • Cities have witnessed a sharp increase in the stray dog population, which as per the official 2019 livestock census stood at 1.5 crore.
    • However, independent estimates peg the number to be around 6.2 crore.
    • The number of dog bites has simultaneously doubled between 2012 and 2020.
    • Experts agree there may be a correlation between urbanisation and solid waste production, made visible due to the mismanagement of waste disposal.
    • Tepid animal birth control programmes and insufficient rescue centres, in conjunction with poor waste management, result in a proliferation of street animals in India.

    Reasons behind

    • Poor waste management: Inadequate waste disposal facilities and the mismanagement of solid waste often lead to the congregation of stray dogs around garbage dumps and landfills, where they scavenge for food.
    • Unplanned urbanization: The population boom in Indian cities has led to a sharp increase in the stray dog population. Rapid urbanization has led to the creation of slums and unmanaged solid waste, which attract dogs.
    • Lack of food and shelter: The availability of food and shelter determines the carrying capacity of a city. In the absence of these facilities, free-ranging dogs become scavengers that forage around for food, eventually gravitating towards exposed garbage dumping sites.
    • Territoriality: Stray dogs often become territorial and aggressive about public spaces where they are fed, leading to increased attacks on humans.
    • Improper sterilization and rescue centres: Tepid animal birth control programmes and insufficient rescue centres, in conjunction with poor waste management, result in a proliferation of street animals in India.

    Food wastage in India

    • A population boom in Indian cities has contributed to a staggering rise in solid waste production. Indian cities generate more than 150000 metric tonnes of urban solid waste every day.
    • According to a 2021 UNEP report, an estimated 931 million tonnes of food available to consumers ended up in households, restaurants, vendors and other food service retailers’ bins in 2019.
    • Indian homes on average also generated 50 kg of food waste per person.
    • The presence of free-roaming dogs in urban areas is determined by the “carrying capacity” of a city, which is the availability of food and shelter.

    Urban Stray Dogs and Waste Disposal

    • Food and shelter: The wastage food often serves as a source of food for hunger-stricken, free-roaming dogs that move towards densely-populated areas in cities, such as urban slums which are usually located next to dumping sites.
    • Sanitation assists food hunt: In the absence of proper sanitation and waste disposal facilities, stray dogs become scavengers that forage for food around exposed garbage dumping sites.

    Impact of Unplanned and Unregulated Urban Development

    • ABC Program: Under Animal Birth Control (ABC) program, municipal bodies trap, sterilize, and release dogs to slow down the dog population. This approach aims to control the number of strays while avoiding the inhumane practice of killing them.
    • Rabies Control Measures: Another anchor of India’s response is rabies control measures, including vaccination drives. Rabies is a fatal disease that can be transmitted to humans through dog bites. Thus, preventing rabies is essential in addressing the issue of stray dogs.
    • Informal Measures: These include mass killing of dogs in states like Kerala, which is a controversial practice as it is often inhumane and does not address the root causes of the issue. Other measures include imposing bans on the entry of stray dogs in colonies or feeding them in public.

    Why address stray dog attacks issue?

    • Adds Vulnerability to the poor: The disproportionate burden of dog bites may also fall on people in urban slums, which are usually located in close proximity to dumping sites.
    • Exposes harsher realities: The rise in such attacks speak to core issues of lack of serviced affordable urban housing for all, lack of safe livelihood options and improper solid waste management”.

    Empathizing the strays

    • Abandoned, not strayed: Stray dogs are sentient social beings capable of feeling pain, fear, and joy. Urban living patterns have largely impacted their abandonment.
    • Subjected to abuse: They are often victims of neglect, abuse, and abandonment, and are forced to survive in harsh conditions on the streets.
    • Neglected community guardians: Stray dogs can serve as community guardians by alerting us to potential dangers and can also provide emotional support to humans.

    Way forward

    • Improve waste management: Efficient management of solid waste can help reduce the availability of food for stray dogs and limit their population growth.
    • Increase vaccination and sterilization: ABC and vaccination programs should be implemented in a more organized and efficient manner to control the stray dog population and the spread of rabies.
    • Encourage responsible feeding practices: Regulating feeding around bakeries and restaurants and improving waste management in public spaces can reduce the carrying capacity of the environment for stray dogs and minimize the congregation of dogs in certain areas.
    • Develop national policy: There is a need for a comprehensive national policy that addresses the issue of stray dogs and their management in a more systematic and humane manner.
    • Stop gruesome brutality: Stopping brutality towards dogs is a crucial step towards creating a more compassionate and just management of stray dogs menace.

     

  • What is Medicines Patent Pool (MPP)?

    medicine

    Central Idea

    • The Medicines Patent Pool (MPP) has entered into sub-licence agreements with Indian and Indonesian companies to produce generic versions of the cancer drug Nilotinib.
    • Nilotinib is used in the treatment of chronic myeloid leukaemia, a type of blood cancer.

    What is Medicines Patent Pool (MPP)?

    • Mission and Purpose: The MPP is a United Nations-backed organization focused on increasing access to life-saving medicines for low- and middle-income countries.
    • Addressing IPR: The MPP works to overcome barriers related to intellectual property rights and patents that limit the availability and affordability of essential medicines.
    • Voluntary Licensing Agreements: The MPP negotiates voluntary licensing agreements with pharmaceutical companies to allow the production of generic versions of patented medicines.
    • Production of Affordable Generics: By securing licenses, the MPP enables qualified manufacturers in low- and middle-income countries to produce and distribute affordable generic medicines.

    Need for MPP

    • Collaborative Approach: The MPP collaborates with governments, non-profit organizations, civil society groups, and pharmaceutical companies to address global health challenges and promote access to medicines.
    • Focus on Priority Diseases: The MPP’s efforts are particularly significant in diseases like HIV/AIDS, tuberculosis, hepatitis C, and other priority areas where access to affordable medications is crucial.
    • Sustainable Supply of Generic Medicines: Through licensing agreements, the MPP ensures a sustainable supply of quality-assured generic medicines, promoting market competition and expanding treatment options.
    • Improving Health Outcomes: The MPP’s work reduces the burden of high drug costs and enhances access to life-saving treatments, ultimately improving health outcomes and saving lives.
    • Benefit for Low- and Middle-Income Countries: The MPP’s initiatives directly benefit patients in low- and middle-income countries by increasing access to affordable medicines and reducing disparities in healthcare.

    Recent agreements signed

    • Licence Agreement with Novartis: In October 2022, the MPP signed a licence agreement with Novartis Pharma AG, the Switzerland-based pharmaceutical corporation that holds the patent for Nilotinib.
    • First Sub-Licence Agreements: The recent sub-licence agreements with Indian companies Eugia, Hetero, and Dr. Reddy’s Laboratories, along with the Indonesian firm BrightGene, mark the first such agreements for a cancer treatment drug by the MPP.

    Benefits

    • Generic Versions of Nilotinib: The licensed manufacturers can produce generic versions of Nilotinib.
    • Manufacturing: The selected manufacturers have the rights to manufacture generic Nilotinib in India and seven middle-income countries.
    • Supply in 44 Territories: The non-exclusive licence agreement allows for the supply of generic Nilotinib in 44 territories covered by the agreement, subject to local regulatory authorisation.
    • Affordable Treatment Option: Charles Gore, the executive director of the MPP, states that the production of generic Nilotinib will provide an affordable treatment option for people diagnosed with chronic myeloid leukaemia in the covered countries.
    • Increasing Access to Cancer Medication: The MPP’s initiative aims to improve access to essential cancer medications by reducing costs and increasing availability.

  • India’s Rising Burden of Diabetes: Urgent Actions Needed

    diabetes

    Central Idea: A recent study by ICMR has raised concerns about the emerging crisis of diabetes in India and the urgent need for effective strategies to tackle this escalating issue.

    What is Diabetes?
    Type 1 Diabetes Type 2 Diabetes
    Prevalence Generally diagnosed in children and young adults Usually diagnosed in adults, but can occur at any age
    Autoimmune Autoimmune condition, immune system attacks pancreas Not autoimmune, insulin resistance or impaired insulin production
    Insulin Dependence Requires insulin injections or insulin pump May be managed with lifestyle changes, oral medication, or insulin
    Onset Sudden onset Gradual onset
    Causes Genetic predisposition and environmental factors Genetic and lifestyle factors, including obesity
    Body Weight Often normal or underweight Often overweight or obese
    Insulin Production Little to no insulin production Insulin resistance or inadequate insulin production
    Treatment Insulin therapy, blood sugar monitoring Lifestyle changes, oral medication, insulin therapy if needed
    Complications Higher risk of diabetic ketoacidosis Higher risk of heart disease, stroke, and other complications
    Lifestyle Factors Cannot be prevented or reversed Can be prevented or managed through lifestyle changes
    Prevention No known prevention strategies Focus on healthy lifestyle, weight management

     

    Burden of Diabetes in India

    • The results of the largest long-term study on metabolic factors in the Indian subcontinent, known as the ICMR-InDiab study, were recently published in The Lancet.
    • This study, conducted between 2008 and 2020, aimed to estimate India’s burden of chronic non-communicable diseases (NCDs).

    Key Findings

    The study revealed alarming statistics regarding diabetes in India:

    1. Approximately 11% of the population has diabetes.
    2. Another 15.3% of the population is in the pre-diabetic stage.
    3. This translates to an estimated 101.3 million diabetics and 136 million individuals in the pre-diabetic stage.
    4. Urban areas have a higher prevalence (16.4%) compared to rural areas (8.9%).

    These numbers underscore the need for immediate attention to prevent the further rise of diabetes and manage its complications effectively.

    Reasons for India’s Rising Burden

    India’s escalating burden of diabetes can be attributed to several factors:

    • Genetic Predisposition: Indians have a higher genetic susceptibility to diabetes.
    • Changing Lifestyles: Urbanization, sedentary habits, and unhealthy dietary patterns contribute to increased obesity and diabetes risk.
    • Obesity Epidemic: Rising obesity rates in India are a major risk factor for diabetes.
    • Socioeconomic Factors: Limited access to healthcare, lack of awareness, and resource constraints hinder diabetes management.
    • Urban-Rural Divide: Diabetes is no longer limited to urban areas, as rural regions also experience a growing prevalence.
    • Delayed Diagnosis and Treatment: Late diagnosis and treatment initiation impede effective disease management.

    Addressing India’s Rising Burden of Diabetes

    To combat this crisis, key interventions include:

    • Prevention and Health Promotion: Encouraging healthy lifestyles and stress reduction.
    • Early Detection and Diagnosis: Promoting awareness and implementing screening programs.
    • Access to Quality Healthcare: Improving healthcare infrastructure and ensuring equitable access.
    • Education and Awareness: Public health campaigns to raise awareness and encourage lifestyle modifications.
    • Policy Interventions: Implementing policies for healthy environments and regulating unhealthy products.

    Conclusion

    • India is facing a significant health crisis with the rising burden of diabetes.
    • It is imperative to prioritize diabetes prevention and management to ensure a healthier future for the nation.

  • Jal Jeevan Mission: Saving Lives through Access to Piped Water

    jal jeevan mission water

    Central Idea

    • Potable water: The Jal Jeevan Mission aims to provide piped potable water to all of India.
    • Potential Life-Saving Impact: If successful, the mission could avert nearly 400000 deaths from diarrhoea.
    • Reduction in Disease Burden: The mission could avoid 14 million DALYs (Disability Adjusted Life Years) related to diarrhoea.

    Disability Adjusted Life Years (DALY)

    • DALY is a metric used to measure the burden of disease on a population.
    • It combines years of life lost due to premature mortality (YLLs) and years lived with a disability (YLDs) into a single measure.
    • DALYs provide a comprehensive assessment of the impact of diseases, injuries, and disabilities by quantifying both the years of healthy life lost and the years lived with a disability.
    • This metric helps policymakers and researchers prioritize health interventions and allocate resources effectively to address the overall disease burden in a population.

     

    About Jal Jeevan Mission

    • Launch: Government initiative launched in 2019
    • Goal: Provide access to clean and piped drinking water to every rural household
    • Focus: Water supply infrastructure development, community participation, water quality monitoring
    • Objective: Improve health, well-being, and productivity of rural communities, Addressing challenges of water scarcity, contamination, and inadequate infrastructure
    • Target: Achieve 100% coverage by 2024 for reliable and sustainable water supply
    • Definition of functional Connection: A fully functional tap water connection means receiving at least 55 litres of potable water per capita per day throughout the year

    The key objectives of the Jal Jeevan Mission include:

    1. Universal coverage: Mission aims to achieve tap water connections for all rural households, ensuring access to potable water within premises.
    2. Sustainability: Focus on long-term sustainability through community participation, water resource management, and water conservation practices.
    3. Quality assurance: Prioritizing safe and clean drinking water by implementing water quality monitoring systems and adhering to prescribed standards set by BIS.
    4. Convergence and coordination: Emphasis on collaboration among stakeholders to effectively achieve mission objectives.

    Socioeconomic Benefits of the Mission

    • Economic Savings: The study suggests that the mission could save close to $101 billion.
    • Time Savings: It could save 66.6 million hours per day that would have been spent collecting water, primarily by women.
    • Improved Quality of Life: Access to piped water connections would enhance convenience and overall well-being.
    • Sanitation benefits: Every dollar invested in sanitation interventions yields a $4.3 return in reduced healthcare costs.

    Progress status of the scheme

    • Current Coverage Levels: Around 62% of rural households have piped water connections.
    • States and UTs at Full Coverage: Five states and three Union Territories have reported 100% coverage.
    • Progress of states: Himachal Pradesh is at 98.87% coverage, while Bihar is at 96.30% and nearing saturation.

    Limitations and Considerations of the Study

    • Extrapolation of Data: The study extrapolates data and does not compute current levels of coverage.
    • Contamination Concerns: The study does not account for the degree of contamination in the piped water provided.
    • Data Sources: The authors used population data from the United Nations, the 2018 National Sample Survey, and water quality data collected by the Jal Jeevan Mission.

    Challenges Addressed by the Mission

    • Water scarcity: Mission aims to tackle the challenge of inadequate water availability in rural areas.
    • Contamination: Focus on improving water quality and addressing issues of waterborne diseases.
    • Infrastructure gaps: Efforts to bridge the gap in water supply infrastructure in rural regions.

    Way forward

    • Enhancing Capacity of Local Bodies: Provide support and resources to strengthen the capacity of local governance institutions in effectively managing and governing rural water supply systems.
    • Promoting Community Participation: Foster active community participation in decision-making processes related to water infrastructure planning, implementation, and maintenance.
    • Empowering Local Water User Committees: Strengthen the role of local water user committees in monitoring and regulating water supply services, promoting their active involvement in decision-making.
    • Participatory Planning: Facilitate participatory planning processes, where water user associations actively contribute to the development of water management plans, considering local needs and priorities.

     

  • The story behind the Ban on 14 FDC Drugs

    fdc drug ban

    Central Idea: Exploring the recent ban on 14 fixed dose combination drugs in India and its rationale.

    What are FDC Drugs?

    • Definition: FDC drugs are combinations of active ingredients in a fixed ratio, commonly used in a single pill or syrup.
    • Benefits offered: FDCs can reduce pill burden, improve adherence to therapy, and lower costs.
    • Risks associated: Certain combinations can be pharmacologically incompatible, have abuse potential, and contribute to antibiotic resistance.

    Issue of Irrational FDCs

    • Licensed FDCs: FDCs introduced for the first time require prior approval, while many older FDCs were licensed without proper scrutiny.
    • Lack of safety: Lack of evidence on safety and efficacy led to the categorization of many licensed FDCs as irrational.
    • Legal challenges: A ban on 344 FDCs in 2016 was stayed by the Delhi High Court, prompting further review and subsequent ban on 329 FDCs in 2018.

    Government Action and Expert Review

    • Referral to Drugs Technical Advisory Board: The Supreme Court entrusted the review of FDC drugs to the government’s expert body.
    • Ban on 14 Pre-1988 FDCs: An expert committee recommended banning certain FDCs licensed before 1988.
    • Balancing Prior Approvals and Inquiry: The Supreme Court excluded 15 FDCs licensed prior to 1988 from the ban but allowed for an inquiry.

    Implications of the Ban

    • Impact on Drug Availability: The ban affects approximately 40-50 brands used for cough, fever, pain, and common infections.
    • Support from Pediatricians: Many pediatricians welcome the ban, citing harmful combinations in FDC drugs.
    • Call for Additional Scrutiny: Calls to consider banning Nimesulide for single-dose use due to liver risks.

    Cautions Regarding Cough Syrups

    • Conflicting Effects of Ingredients: Experts highlight how ingredients in cough syrups may work against each other, reducing their efficacy.
    • Limited Evidence on Cough Syrups: Weak evidence suggests cough syrups may not significantly reduce cough duration.
    • Caution for Cough Suppressants: Prescription-only use is advised, particularly for individuals with underlying lung conditions.

    Socioeconomic impact of the Ban

    • Economic Savings and Improved Quality of Life: The ban may lead to cost savings and enhanced well-being for individuals.
    • Importance of Safe Drinking Water: Access to clean drinking water is crucial for public health and overall quality of life.
    • Evidence-Based Decision-Making: Ensuring the safety and effectiveness of medical treatments through research and evaluation.
    • Addressing Emerging Health Challenges: Continuous monitoring and research are necessary to tackle evolving health risks.
    • Optimizing Healthcare Practices: Ongoing efforts to improve healthcare systems and practices for better patient outcomes.

    Conclusion

    • The recent ban on 14 fixed dose combination (FDC) drugs in India highlights the government’s commitment to ensuring the safety and efficacy of pharmaceutical products.

  • National Exit Test (NExT) for Medical Grads

    next

    Central Idea: The NExT examination, a common qualifying criterion for final-year undergraduate medical students will be introduced in the year 2024.

    National Exit Test (NExT)

    • Objective: The examination aims to bring uniformity in evaluation across the country, ensuring minimum common standards of education and training for medical graduates.
    • Two-Part Examination: The NExT exam will consist of two parts: NExT 1, which will be a theoretical examination, and NExT 2, which will include practical, clinical, and oral examinations covering seven clinical subjects or disciplines.
    • Mock Test: A mock test may be conducted to familiarize students with the procedure and alleviate any anxiety before the official examination is rolled out.

    National Medical Commission and Application of NExT

    • Role of NMC: The NMC is responsible for implementing the NExT examination and ensuring a common standard for medical education in the country.
    • Applicability: The NExT examination will also apply to institutes of national importance, including the All India Institutes of Medical Sciences (AIIMS), to maintain uniformity in medical education.

    Significance

    • Quality professionals: The NExT examination is seen as a means to ensure quality and produce well-trained Indian medical graduates.
    • Expert Perspectives: Experts in the medical field have welcomed the move, emphasizing the importance of uniform examination standards and the opportunity for interns to focus on their clinical training.

  • Addressing Antimicrobial Resistance (AMR) in the Pandemic Treaty

    antimicrobial resistance amr

    Central Idea

    • Pandemic Treaty: The latest version of the draft Pandemic Instrument, also known as the “pandemic treaty,” was shared with Member States at the World Health Assembly.
    • Removal of AMR Mentions: It became apparent that all mentions of addressing antimicrobial resistance in the Pandemic Instrument were at risk of removal.

    What is AMR?

    • Antimicrobial resistance (AMR) is the development of resistance in microorganisms to drugs that were once effective against them.
    • Microorganisms, including bacteria, fungi, viruses, and parasites, can become “immune” to medications used to kill or control them.
    • Misuse or overuse of antibiotics can contribute to the development of AMR.

    About the Pandemic Treaty

    • Initiation of Work: Work on the Pandemic Instrument began in December 2021.
    • Objective: The instrument aims to protect nations and communities from future pandemic emergencies under the WHO’s Constitution.

    Importance of Addressing Antimicrobial Resistance (AMR)

    • Calls for Inclusion: Civil society and experts, including the Global Leaders Group on Antimicrobial Resistance, have emphasized the inclusion of AMR in the Pandemic Instrument.
    • Not Limited to Viruses: Not all pandemics in the past or future are caused by viruses, with bacterial pandemics like plague and cholera being devastating examples.
    • Impact of Bacterial Infections: Bacterial infections cause one in eight deaths globally and contribute to the rise of drug-resistant infections.

    Need for Comprehensive Pandemic Preparedness

    • Wider Range of Threats: Planning and developing effective tools to respond to a broader range of pandemic threats, beyond viruses, is crucial.
    • Secondary Bacterial Infections: Even in viral pandemics like COVID-19, secondary bacterial infections become a serious issue, requiring effective antibiotics.

    Concerns over Potential Removal of AMR Measures

    • Risk to Future Pandemics: The removal of AMR measures from the Pandemic Instrument could hinder efforts to protect people from future pandemics.
    • At-Risk Measures: Measures at risk of removal include better access to safe water, infection prevention and control, integrated surveillance, and antimicrobial stewardship.

    Strengthening the Pandemic Instrument to Address AMR

    • Inclusion of AMR Measures: Measures to address AMR can be easily incorporated into the Pandemic Instrument.
    • Recommendations for Inclusion: Recommendations include addressing bacterial pathogens, tracking viral and bacterial threats, and harmonizing AMR stewardship rules.

    Efforts to Highlight AMR in the Pandemic Instrument

    • Involvement of Specialized Organizations: Civil society and research organizations participated in the WHO’s Intergovernmental Negotiating Body, providing analysis on AMR in the draft.
    • Publication of Special Edition: Leading academic researchers and experts published a special edition outlining the importance of addressing AMR in the Pandemic Instrument.

    Current State and Next Steps

    • Concerns over Removal: Insertions related to AMR are at risk of removal after closed-door negotiations by Member States.
    • Importance of the Pandemic Instrument: The instrument is vital for mitigating AMR and safeguarding antimicrobials for treating secondary infections in pandemics.
    • Global Political Action: Collaboration and collective efforts are needed to address AMR and support the conservation and equitable distribution of safe and effective antimicrobials.

    Safeguarding Antimicrobials for Future Pandemic Response

    • Undermining Goals: Missing the opportunity to address AMR in the Pandemic Instrument undermines its broader goals of protecting nations and communities.
    • Core Role of Antimicrobials: Antimicrobials are essential resources for responding to pandemics and must be protected.
    • Call for Strengthened Measures: Member States should strengthen measures to safeguard antimicrobials and support actions for conserving their effectiveness within the instrument.

  • Why is India rethinking its Anaemia Policy?

    Central Idea

    • Anaemia questions are excluded from National Family Health Survey (NFHS-6) due to concerns about accuracy, emphasizing the need for precise estimates to address India’s growing anaemia burden.
    • NFHS-5 data reveals a significant increase in anaemia prevalence in India, underscoring the urgency of accurate estimates to effectively tackle this public health challenge.

    National Family Health Survey (NFHS)

    • NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • The International Institute for Population Sciences (IIPS) Mumbai, is the nodal agency, responsible for providing coordination and technical guidance for the survey.
    • IIPS collaborates with a number of Field Organizations (FO) for survey implementation.
    • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health etc.

    Each successive round of the NFHS has had two specific goals:

    1.      To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and

    2.      To provide information on important emerging health and family welfare issues.

     Anaemia: A bigger menace

    • Anaemia is characterized by low red blood cells or haemoglobin levels, leading to symptoms like fatigue and weakness.
    • Iron deficiency is the primary cause, but deficiencies in folate, vitamins B12, and A also contribute.
    • Addressing nutritional deficiencies is crucial for prevention and treatment.

    Shift to DABS-I for Anaemia Assessment

    • The Health Ministry shifted anaemia assessment to Diet and Biomarkers Survey in India (DABS-I) for more accurate prevalence estimates.
    • DABS-I is a comprehensive dietary survey collecting individual data to assess food and nutrient adequacy nationwide.

    Reasons for Methodology Change

    • Concerns of Over-Diagnosis: Using WHO cut-offs may not suit the Indian population due to various factors that influence anaemia.
    • Inadequacy of WHO Cut-Offs: Country-specific cut-offs are needed as the WHO’s haemoglobin cut-offs may not reflect the Indian anaemia situation accurately.
    • Differences in Blood Sampling Methods: Venous blood sampling is more accurate than the capillary blood sampling used in previous surveys.

    Role of DABS-I Dietary Survey

    • DABS-I collects detailed dietary intake data to understand nutritional patterns and deficiencies contributing to anaemia.
    • It provides information on nutrient composition in foods from different regions, aiding targeted interventions.

    Prevalence of Anaemia in India

    • High Burden: Anaemia is a significant public health concern in India, with a high prevalence across different population groups.
    • Anaemia among Women: Data from national surveys indicate that a considerable percentage of women in India, particularly those in the reproductive age group, are affected by anaemia.
    • Anaemia among Children: Anaemia is also prevalent among children in India, with a substantial proportion experiencing this condition at a young age.

    Causes and Risk Factors

    • Nutritional Deficiencies: Iron deficiency is the primary cause of anaemia in India. Inadequate intake and absorption of iron, along with deficiencies in other key nutrients, contribute to the problem.
    • Socioeconomic Factors: Factors such as poverty, limited access to nutritious food, and inadequate healthcare contribute to the high prevalence of anaemia in certain socioeconomically disadvantaged populations.
    • Infections and Diseases: Certain infections, such as malaria and helminthiasis, and chronic diseases like kidney disease and cancer, can increase the risk of developing anaemia.

    Impact on Health and Well-being

    • Physical Symptoms: Anaemia can cause a range of physical symptoms, including fatigue, weakness, shortness of breath, and impaired cognitive function.
    • Maternal and Child Health: Anaemia in pregnant women increases the risk of complications during pregnancy and childbirth. It can also lead to low birth weight and developmental issues in infants.
    • Impaired Growth and Development: Anaemia among children can hinder their growth, development, and overall well-being. It may affect cognitive function, school performance, and future productivity.

    Government Initiatives and interventions

    • National Nutrition Programs: The Government of India has implemented various programs, such as the National Iron+ Initiative and the Pradhan Mantri Matru Vandana Yojana, to address anaemia and improve maternal and child health.
    • Supplementation and Fortification: Iron and other micronutrient supplementation programs, along with food fortification initiatives, aim to enhance iron intake and combat anaemia.
    • Awareness and Education: Public awareness campaigns and educational programs focus on promoting nutrition, especially among vulnerable groups, and raising awareness about the importance of addressing anaemia.

    Challenges and Future Directions

    • Access to Healthcare and Nutritious Food: Improving access to quality healthcare services, affordable nutritious food, and clean drinking water is crucial in addressing anaemia in India.
    • Multisectoral Collaboration: Addressing anaemia requires collaboration across various sectors, including healthcare, nutrition, education, and social welfare, to develop comprehensive strategies and interventions.
    • Monitoring and Evaluation: Regular monitoring and evaluation of anaemia prevalence, intervention effectiveness, and progress towards targets are essential to track improvements and identify areas that require further attention.

  • Mandatory Anti-Tobacco Warnings on OTT Platforms

    tobacco

    Central Idea

    • Over-the-top (OTT) streaming platforms must display anti-tobacco warnings similar to those seen in movies screened in theatres and on TV.
    • The requirement is based on a Union Health Ministry notification that amends the rules under the Cigarettes and Other Tobacco Products Act (COTPA), 2004.

    What is COTPA, 2004?

    Description
    Purpose Regulate production, sale, distribution, and consumption of tobacco products
    Prohibition of Smoking in Public Places Smoking prohibited in public areas like offices, restaurants, parks, public transport, etc.
    Health Warnings on Tobacco Products Mandatory display of health warnings on cigarette packages and other tobacco products
    Ban on Advertisement and Promotion Prohibition on direct and indirect advertising of tobacco products
    Prohibition on Sale to Minors Selling tobacco products to individuals below 18 years of age is strictly prohibited
    Packaging and Labelling Requirements Health warnings and pictorial representations of harmful effects on cigarette packages
    Powers of Enforcement Authorities empowered to enforce the act, conduct inspections, and seize contraband products

    New requirements for Anti-Tobacco Warnings

    • Publishers of online curated content displaying tobacco products or their use must show anti-tobacco health spots at the beginning and middle of the program.
    • When tobacco products or their use are displayed during the program, an anti-tobacco health warning must be prominently displayed as a static message at the bottom of the screen.
    • The warning message should be legible and readable, with black font on a white background.
    • The specified warnings are ‘Tobacco causes cancer’ or ‘Tobacco kills.’
    • Health spots, warnings, and audio-visual disclaimers should be in the same language as used in the show.

    Negative health impacts of tobacco

    • Cancer: Tobacco use is the leading cause of preventable cancer. It can cause cancer of the lungs, mouth, throat, larynx, pancreas, bladder, kidney, and cervix.
    • Respiratory diseases: It may cause chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. It can also worsen asthma symptoms.
    • Cardiovascular diseases: Consumption increases the risk of heart attack, stroke, and other cardiovascular diseases. It damages blood vessels and increases the risk of blood clots.
    • Reproductive health: Tobacco use can lead to infertility, premature birth, and low birth weight in babies.

    Socio-economic impact

    (1) On an individual level:

    • Decreased productivity: Smoking-related illnesses can result in absenteeism from work, decreased work performance, and increased medical expenses.
    • Decreased life expectancy: Tobacco consumption can lead to decreased life expectancy, which reduces the overall productive years of an individual.

    (2) On a societal level:

    • Healthcare cost: Tobacco consumption can lead to decreased economic development due to the increased burden of healthcare costs and decreased productivity.
    • Increased social expenditure: According to a study conducted by the World Health Organization (WHO), tobacco-related illnesses cost India about $22.4 billion in healthcare costs and lost productivity annually

    Why tobacco isn’t completely banned?

    • Revenue loss: The industry contributes a significant amount of tax revenue to the government. Banning tobacco would result in the loss of these tax revenues, which are used for various public welfare programs and initiatives.
    • Economic Impact: The tobacco industry provides employment to a large number of people, especially in the agricultural sector, where tobacco farming is prevalent.
    • Not a psychotropic substance: While the harmful effects of tobacco are well-documented, banning a legal product entirely requires careful consideration and legal processes.
    • Regulatory approach: Instead of a complete ban, the Indian government has adopted a regulatory approach to control tobacco use.

    Way forward

    • Strengthen tobacco control laws: Review and enhance existing laws to effectively reduce tobacco consumption.
    • Conduct public awareness campaigns: Educate the public about the health risks of tobacco use and the benefits of quitting.
    • Expand access to tobacco cessation programs: Increase availability of affordable and effective programs to support individuals who want to quit tobacco.
    • Implement sin taxes on tobacco products: Increase taxes to discourage consumption, especially among price-sensitive populations.
    • Enforce smoke-free environments: Strictly implement smoke-free laws in public places, workplaces, and public transport.
    • Support tobacco farmers: Provide alternative livelihood options and assistance for farmers transitioning away from tobacco farming.
    • Conduct research and surveillance: Invest in data collection and analysis to inform evidence-based policies and interventions.
    • Collaborate with international organizations: Partner with global entities like WHO to leverage expertise and resources in tobacco control.

     

     

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