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Coverpage
October-December 2017
Volume 61 | Issue 4
Page Nos. 231-314

Online since Wednesday, December 6, 2017

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EDITORIAL  

Maternal mortality: An equity issue Highly accessed article p. 231
Umesh Chandra Sarma, Swapna D Kakoty
DOI:10.4103/ijph.IJPH_323_17  PMID:29219125
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ORIGINAL ARTICLES Top

Impact of nutritious meals on the nutritional status of the tribal students: A comparison between centralized kitchens (Annapurna) and regular kitchens in government tribal residential schools from two Districts of Maharashtra, India p. 233
Rajagopal Devara, Devika Deshmukh
DOI:10.4103/ijph.IJPH_293_17  PMID:29219126
Background: Tackling undernutrition is a global priority. It is the single largest risk factor influencing the burden of disease estimates at the global level. The Annapurna Project was undertaken by Government of Maharashtra to provide nutritious meals to Ashram/residential tribal school students through a centralized kitchen for achieving optimal growth and development and to prevent morbidity. Objectives: The primary objective of our work was to ascertain whether the provision of nutritious meals through centralized kitchens improves the proportion of underweight and stunted children. Methods: We used a cluster trial with parallel intervention and control arms. The allocation ratio was 1:1 for participants in the intervention and control areas. The pilot was undertaken between 2015 and 2017. Tribal dominant Nashik and Palghar districts in Maharashtra were selected by the state government to implement the centralized kitchen plan. Results: At the baseline, the percentage of underweight children in the intervention group was 36.9% and 31.9% in the control groups. The percentage of stunting in the intervention group was 30.0% and 38.2% in the control group. At the endline, 21.9% and 26.3% of the children were underweight. Both groups showed an improvement as compared to the baseline. However, the difference in reduction between the intervention and the control group was insignificant. Similarly, stunting also reduced to 12.9% and 14.6% in the intervention and control groups, respectively. Conclusion: The provision of regular nutritious meals, through centralized and local kitchen in government tribal residential schools of Maharashtra is effective and important in tackling undernutrition in Tribal children.
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Dengue fever in a municipality of West Bengal, India, 2015: An outbreak investigation Highly accessed article p. 239
Falguni Debnath, Manickam Ponnaiah, Pralay Acharya
DOI:10.4103/ijph.IJPH_309_16  PMID:29219127
Background: In November 2015, death due to fever and increased number of fever cases were reported from Baranagar Municipality of North 24 Parganas district of West Bengal. Objectives: The episode was investigated with the objective to (1) confirm the existence of an outbreak, (2) describe it in terms of time, place, and person, (3) determine the cause of outbreak, and (4) recommend control measures. Methods: Monthly incidence of dengue from 2012 to 2014 was calculated and compared with 2015 to confirm the outbreak. We used Integrated Disease Surveillance Programme definition and searched for suspect dengue cases going door-to-door in ward number one of Baranagar Municipality. Active case search was done in health facilities also. Information on date of onset, symptoms, sociodemographic, serological reports, and clinical outcome for suspected and confirmed dengue cases was collected. Blood specimens were collected for NS1 ELISA/monoclonal IgM antibody capture-ELISA test. Environmental and entomological surveys were done. Results: Six hundred and seventy-one dengue cases (Overall attack rate = 3/1000), two deaths (Case fatality = 3/1000) were reported during September 14, 2015, till December 12, 2015. Out of 34 wards, attack rate was highest in ward number 1 (0.7%) and was 3 per 1000 among females. All age groups were affected. Thirty-two percent required hospitalization. NS1 ELISA was positive for 612 cases. Out of interviewed 31 dengue cases, 94% had headache, 90% had myalgia, followed by arthralgia, rash, and retro-orbital pain. Only in ward number 1, house index was >5%. Conclusion: We confirmed dengue outbreak. All age groups got affected. Deaths occurred in this outbreak. Potential breeding sources were present in ward number 1.
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Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia p. 243
Aniza Ismail, Leny Suzana Suddin, Saperi Sulong, Zafar Ahmed, Nor Azmi Kamaruddin, Norlela Sukor
DOI:10.4103/ijph.IJPH_24_16  PMID:29219128
Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. Objective: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. Methods: A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. Results: Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting.Conclusions: Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.
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Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal p. 248
Ditipriya Bhar, Sharmistha Bhattacherjee, Abhijit Mukherjee, Tapas Kumar Sarkar, Samir Dasgupta
DOI:10.4103/ijph.IJPH_345_16  PMID:29219129
Background: With the rapid expansion of urban population, provision of safe water and basic sanitation is becoming a challenge; especially in slums. This is adversely affecting the health of the people living in such areas. Objectives: The study was conducted to measure the proportion of households using improved drinking water and sanitation facilities and to determine the association between diarrhea in under-five children with water and sanitation facilities. Methods: A community-based, cross-sectional study was conducted among 796 slum households in Siliguri from January to March 2016 by interviewing one member from each household using a predesigned and pretested questionnaire based on the WHO/UNICEF Joint Monitoring Program Core questions on drinking water and sanitation for household surveys. Results: A majority 733 (92.1%) of slum households used an improved drinking water source; 565 (71%) used public tap. About two-thirds (65.7%) household used improved sanitation facilities. About 15.8% households had reported diarrheal events in children in the previous month. Unimproved drinking water sources (AOR = 4.13; 1.91, 8.96), houses without piped water supply (AOR = 4.43; 1.31, 15.00), and latrines located outside houses (AOR = 3.61; 1.44, 9.07) were significantly associated with the diarrheal events in children. Conclusion: The utilization of improved drinking water source was high but piped water connection and improved sanitary toilet used was low. Association between diarrheal events and type of drinking water sources and place of sanitation might suggest fecal contamination of water sources. Awareness generation through family-centered educational programs could improve the situation.
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Effects of health education tool on select epidemiological factors associated with adult obese urban slum women p. 254
Deepika Pradeep Vora, Pallavi S Shelke
DOI:10.4103/ijph.IJPH_99_16  PMID:29219130
Background: National Family Health Survey-3 (2005–2006) India, found that 14.8% of Ever-Married Adults (age 15–49 years) had Body Mass Index (BMI) in the ranges of overweight and obese; compared to 10.6% in the National Family Health Survey-2. These figures highlighted the fact that India already faces a dual burden of chronic malnutrition, i.e., obesity, besides undernutrition. Higher BMI, especially, increased abdominal fat is an important determinant of the development of diabetes. Objective: This study aims to understand the effect of health education on obesity status of adult women above the age of 20 years in an urban slum area. Methods: Community-based, interventional study, to assess select epidemiological factors associated with obesity-including measurement of anthropometry and assessing random blood sugar level; followed by an intervention (health education to only obese women by means of flip-chart); followed by a follow-up 6 months later. Results: About 22.6% women were found to be obese. Almost, all dietary and physical activity parameters as well as weight improved for the better after the intervention, and the change was statistically significant. Conclusions: This community based interventional study was able to understand certain factors associated with pathophysiology of obesity in slum dwelling adult women, and effectively documented a reduction in weight along with a change in their obesogenic practices postintervention.
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Status of early childhood education under integrated child development services scheme in bankura municipality, West Bengal p. 261
Sumana Samanta, Subhra Samujjwal Basu, Dibakar Haldar, Aditya Prasad Sarkar, Asit Baran Saren, Gautam Narayan Sarkar
DOI:10.4103/ijph.IJPH_369_16  PMID:29219131
Background: Early childhood education (ECE) is an important service provided by Integrated Child Development Services (ICDS). It is largely responsible for developing school readiness in children. Objective: The objective of this study is to assess ECE component of ICDS services through measurement of school readiness and find out other correlates. Methods: A cross-sectional evaluation study was carried out among Anganwadi centers (AWCs) under Bankura Municipality, West Bengal, India from July to November 2015. AWCs were selected by 30 cluster sampling. From each selected center Anganwadi worker (AWW), 7 randomly selected children of 5 years of age and their caregivers were included in the study. Data were collected by assessment of children, interview of AWWs and caregivers of children, observation of ECE activity and record review using ECE Program Evaluation Package developed by World Bank and predesigned schedule. Mean, standard deviation, proportions were estimated for description and correlation, unpaired t-test, analysis of one-way variance, multivariable linear regression were performed to find out correlates of school readiness using SPSS 22.0 version. Results: Average duration of ECE activity was 66.0 min/day which was far less than the norm. Overall average score of school readiness of 210 children was 14.0 out of 40. Inadequate physical facility, poor classroom performance acted as deterrents for school readiness. Help in the study at home was revealed to be a determinant of school readiness. Conclusion: For the preparation of formal schooling of children most important needs of the hour are physical facility of AWCs, supportive supervision of AWWs, and creation of congenial environment at home.
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Assessment of the performance of community-directed treatment with ivermectin strategy for the control and elimination of onchocerciasis in Edo State, Nigeria p. 267
Amenze Oritsemofe Onowhakpor, Obehi Hilda Okojie, Victoria A Wagbatsoma
DOI:10.4103/ijph.IJPH_236_16  PMID:29219132
Background: Community-directed treatment with ivermectin (CDTI) was developed in the mid 1990's as a solution for the control and elimination of onchocerciasis. It requires that ivermectin be administered continuously over a period of at least 14 years with community involvement before elimination can be achieved. Objectives: The objective of this study is to assess the performance of CDTI strategy for control and elimination of onchocerciasis in endemic Local Government areas of Edo State. Methods: A descriptive evaluation in a cross-sectional, descriptive study design was conducted among 720 community members selected from six communities using multistage sampling technique, 11 Community directed distributors (CDDs), and 17 health workers involved in the implementation of the CDTI strategy in Edo State. Primary data were collected using an interviewer's administered questionnaire while secondary data were obtained from the State Ministry of Health. IBM SPSS version 21 software was used for data analysis. Results: The highest therapeutic coverage (95.5%) was observed in Aden II community while the least therapeutic coverage (56.6%) was observed in Imeke community. Regarding the performance indicators, ivermectin supply, work of CDDs, training, monitoring and supervision, finances by communities had scores ≥2.5 and were therefore considered as having satisfactory performance. However, community participation and ownership and health education and mobilization had scores <2.5 and as such considered as having unsatisfactory performance. Conclusion: Sustainability of the CDTI program in the study area is likely but not guaranteed as there is need for improvement in areas regarding community mobilization, participation, and ownership.
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Caregiver burden on wives of substance-dependent husbands and its correlates at a Tertiary Care Centre in Northern India p. 274
Bharat Singh Shekhawat, Shreyance Jain, Hariom Kumar Solanki
DOI:10.4103/ijph.IJPH_396_16  PMID:29219133
Background: Substance dependence is well recognized as a complex biopsychosocial phenomenon. Complications arising out of it not only impairs life of substance-dependent patient but also causes enormous burden on their caregivers. Little attention has been paid to the relationship between caregiver burden and substance use. Objectives: The study was conducted to assess and compare the quantum of burden on wives of alcohol and heroin-dependent patients and also to determine the correlation between sociodemographic factors and caregiver burden. Methods: A cross-sectional study was conducted at a tertiary care center of North India to compare burden on wives of alcohol and heroin dependent husbands. Burden was assessed using burden assessment schedule (Sell et al.). Data obtained were analyzed using SPSS software. Results: Wives of both alcohol and heroin dependent patients had moderate-to-high burden of caregiving (Score of 38.1 out of maximum 60), those of heroin dependent patients perceived more burden in the factors of “impact on marital relationship,” “appreciation of caregiving,” “impact on relation with others,” and overall burden as compared to wives of alcohol-dependent patients. Significant negative correlation was found between “impact on marital relationship,” “appreciation of caregiving,” and “impact on relation with others” scores and patients' education status as well as between “appreciation of caregiving” score and wives' age where higher score denotes more burden. Conclusion: Significant burden exists on wives of substance-dependent patients; thus management plans must be devised aiming not only patients but also wives so as to reduce burden.
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Does infant feeding method influence the incidence and pattern of morbidities among human immunodeficiency virus-exposed uninfected nigerian infants? p. 278
Olusoga Babatunde Ogunfowora, Tinuade Adetutu Ogunlesi, Abiodun Folashade Adekanmbi, Victor Ayodeji Ayeni
DOI:10.4103/ijph.IJPH_142_16  PMID:29219134
Background: Human immunodeficiency virus (HIV)-exposed infants enrolled into the prevention of mother-to-child transmission of HIV program generally receive antiretroviral therapy (ARV), but the feeding methods differ based on several socioeconomic and cultural differences. Objective: The objective of the study was to examine the incidence and pattern of morbidities among HIV-exposed uninfected (HEU) Nigerian infants and determine any relationship with infant feeding methods. Methods: A review of the hospital records of all HEU infants attending the Virology Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between July 2013 and June 2015, was done. The recorded data included biodemographic profile, social parameters, feeding methods, anthropometry, and morbidities. The feeding method groups were statistically compared in relation to the various morbidities. Results: Out of 119 children, 81.5% were exclusively breastfed, whereas 18.5% had exclusive breast milk substitute feeding. About half had various morbidities which included upper airway infections (UAIs) (16.8%), malaria (15.9%), malnutrition (8.4%), diarrhea (8.4%), and pneumonia (2.5%). The frequencies of these conditions were similar among infant groups irrespective of feeding method. The infants with and without morbidities were comparable in terms of the frequency of exclusive breastfeeding (80.3% vs. 82.8%). Low family socioeconomic status (SES) (odds ratio [OR] = 7.7) and ARV use (OR = 0.4) among infants were predictors of morbidities among HEU infants. Conclusion: The incidence and pattern of morbidities among HEU infants showed no relation to the mode of feeding. Rather, family SES and the use of antiretroviral drugs were predictors of morbidities among HEU infants.
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Waiting time of inpatients before elective surgical procedures at a State Government Teaching Hospital in India p. 284
Shreyasi Ray, Jyotirmay Kirtania
DOI:10.4103/ijph.IJPH_210_16  PMID:29219135
Background: Abundant published literature exists addressing the issues of outpatient waiting lists before surgery. However, there is no published literature on inpatient waiting time before elective surgical procedures. Objectives: This study aims to measure the inpatient waiting time, identify the factors that affect the inpatient waiting time, and recommend the ways of reducing the waiting time of inpatients before elective surgical procedures, at a state government teaching hospital in India. Methods: Descriptive research methods and quality control tools were used for this prospective observational study. Descriptive statistics, Shapiro–Wilk test of normality, Wilcoxon-Mann–Whitney Test, and Kruskal–Wallis test were used. Pareto charts were used to highlight the most important modifiable factors among the set of factors causing increased waiting time. We also applied the M/M/c model (Erlang – A model) of queue theory to analyze the traffic intensity and system congestion. Results: The median waiting time of inpatients before elective surgery was 12 days (interquartile range = 11.5 days). The waiting time was influenced significantly (P < 0.05) by the patient's age, physical status, and the financial status. The surgical specialty, blood product booking and procurement, cross-specialty consultation before surgery, and Intensive Care Unit booking were the other important factors. Conclusion: Modifiable and nonmodifiable factors affecting the inpatient waiting time of surgical patients were identified. Control measures that can reduce the waiting time of inpatients before elective surgery were identified.
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Assessment of village health sanitation and nutrition committees of Chandigarh, India p. 290
Reetu Passi, Sonu Goel, Sangeeta Ajay
DOI:10.4103/ijph.IJPH_244_16  PMID:29219136
Background: Village Health, Sanitation and Nutrition Committees (VHSNCs), one of the key interventions introduced by National Rural Health Mission, are an important mechanism to ensure community participation and ownership for decentralized health planning. Objectives: To assess the implementation status of VHSNCs and analyze the issues regarding their implementation in the villages of Chandigarh. Methods: A cross-sectional mix method study was conducted in the year 2015 in all 22 VHSNCs of Chandigarh. The data of VHSNCs' members were obtained using interview schedule and in-depth interview checklist, while record review checklist was used to assess functioning of VHSNCs. A scoring sheet was developed based on sociodemographic profile, public services monitoring, training status, untied funds utilization, and regularity of monthly meetings. The comparison of VHSNC indicators was done between villages under Panchayat and Municipal Corporation (MC). Results: Most VHSNCs' members are trained (except medical officers) and had their joint bank account (95.4%). Maximum fund is utilized for administrative purposes, leaving less for health and nutrition-related activities. Most villages (68.9%) got 25–30 score depicting that implementation status of VHSNCs under these villages is “promising,” while one and six villages were “low performing” and “good performing,” respectively. Public service monitoring indicator's implementation was better in villages under Panchayat as compared to those under MC. Conclusion: The performance of most villages having VHSNCs under Chandigarh was satisfactory. Few areas such as training of medical officers and supportive supervision of VHSNCs needs strengthening for achieving mandate of National Rural Health Mission regarding community ownership and decentralizing health sector.
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COMMENTARY Top

Bridging miles to achieve milestones: Corporate social responsibility for primary health care p. 297
Ruchie Gulati
DOI:10.4103/ijph.IJPH_259_16  PMID:29219137
Sustainable Developmental Goals aim to provide “Good health for all”. The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for “basic health services” may bridge the gap arising out of inadequate funding and facilitate “Good Health for all” in India.
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Organ donation in India: Scarcity in abundance p. 299
Sandeep Sachdeva
DOI:10.4103/ijph.IJPH_230_16  PMID:29219138
In modern era, India witnessed its first successful corneal, kidney and cardiac transplant in the year 1960, 1967 and 1994 though the reverberations for organ donation and transplantation (ODT) existed since time-memorial with roots existing in Hindu mythology along with vivid example of Guru Dadheech and lord Ganesha. No country in the world is able to meets its organ requirement. Government of India promulgated Transplantation of Human Organ and Tissues Act in 1994 and with the view to enlarge its scope and promote organ donation government has brought new amendments as of year 2014 and 2017. In the background of this journey many new developmental milestones have been achieved in the country however organ donation which has assumed public health significance has been consistently lower than expectations. This manuscript highlights the current status of ODT in the country; legislative environment, limitations, challenges, health education activities, and newer initiatives.
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BRIEF RESEARCH ARTICLES Top

A point source outbreak of acute gastroenteritis among school students in Kerala, India p. 302
PS Rakesh, Rajeswaran Thiagesan, Rakesh Ramachandran
DOI:10.4103/ijph.IJPH_431_16  PMID:29219139
An outbreak investigation was initiated following an outbreak of acute gastroenteritis among schoolchildren in Kottarakara. Steps included active search for cases at schools, describing the outbreak in terms of person, place, and time, generating hypothesis based on the findings from descriptive study, environmental observations, and testing the hypothesis using a case–control design. The final line list consisted of 871 children from different schools who attended a Republic Day parade. Having consumed the lemon juice near railway station (odds ratio [OR] 29.14; 95% confidence interval CI 9.06–93.67) during Republic day parade was associated with the outbreak. The time frame of the disease occurrence, laboratory results, and the results of the analytical study indicated the point source of acute gastroenteritis outbreak as the contaminated water used for lemon juice distributed during the parade. The findings warrant effective food and water safety surveillance, especially during mass gatherings.
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“Near-Miss” Obstetric events and maternal mortality in a Tertiary Care Hospital p. 305
Shravya Tallapureddy, Revathi Velagaleti, Himabindu Palutla, Chaitanya Venkata Satti
DOI:10.4103/ijph.IJPH_268_16  PMID:29219140
Obstetric near-miss or severe acute maternal morbidity is gaining interest internationally as a new indicator of the quality of obstetric care. This is a retrospective study conducted using “The WHO Near-Miss Approach” to provide insight into obstetric emergencies, near-miss cases, and maternal deaths in our hospital. The maternal near-miss ratio was 8.4/1000 live births, maternal near-miss to mortality ratio was 5.3:1. Hemorrhage was the leading cause (43.7%) of morbidity in near-miss cases while hypertensive disorders were the leading cause in maternal deaths (66.6%). Among women with potentially life-threatening conditions, severe preeclampsia was the most common complication (50.54%). The near-miss approach helps to evaluate and improve the quality of care provided by health system by identifying the pattern of severe maternal morbidity and mortality, strengths and weakness in the referral system and the clinical interventions available and the ways in which improvements can be made.
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Biochemical iodine deficiency in selected schools of aligarh p. 309
Mohammad Athar Ansari, Zulfia Khan
DOI:10.4103/ijph.IJPH_224_16  PMID:29219141
The goiter prevalence reflects the iodine deficiency in past while urinary iodine excretion levels (UIEL) gives the current status of iodine nutrition. The study was conducted to assess the status of biochemical iodine deficiency in school children of 1st–5th standard (6–12 years). A total of 907 students of seven schools were included using probability proportional to size method. About 10% of urine samples from total children were tested for UIEL. Statistical analysis was done using SPSS version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). UIEL values lower than 100 μg/L were observed in 23.3% of samples. The proportion of children with UIEL of <20 μg/L was nil in 6 years. Out of 13 students who were consuming salt with nil iodine content, 46.2% had <20 μg/L UIEL. The prevalence of iodine deficiency, calculated by the proportion of children having UIEL of <100 μg/L, was 23.3%. Based on UIEL values, the area would be categorized as having “no biochemical iodine deficiency.”
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LETTERS TO EDITOR Top

Inappropriate classification of body mass index of adolescent girls under SABLA scheme p. 312
Malvika Sharma, Saurav Basu, Bratati Banerjee
DOI:10.4103/ijph.IJPH_181_17  PMID:29219142
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The utility of gamification in public health p. 314
Connor S Qiu
DOI:10.4103/ijph.IJPH_393_16  PMID:29219143
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