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   2013| October-December  | Volume 57 | Issue 4  
    Online since December 18, 2013

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Measles outbreak among the Dukpa tribe of Buxa hills in West Bengal, India: Epidemiology and vaccine efficacy
Satinath Bhuniya, Dipankar Maji, Debasis Mandal, Nilanjan Mondal
October-December 2013, 57(4):272-275
DOI:10.4103/0019-557X.123273  PMID:24351391
Although measles is a vaccine preventable disease, its occurrence and outbreaks are common in India. Four remote and inaccessible hamlets, inhabited by the Dukpa tribe, at Buxa Hills under Kalchini Block of Jalpaiguri District, West Bengal experienced a measles outbreak during the months of April-June, 2011. The authors conducted an investigation to assess vaccine coverage, vaccine efficacy (VE) and to describe the patterns of measles outbreaks in this community. The over-all attack rate was 14.3%; that among males and females were 12.6% and 16.0% respectively (P = 0.189). Attack rate was highest (40%) in 0 to <5 years followed by that in the 5 to <15 years (36.5%). VE was 66.3% (95% of the confidence interval 46.9-78.6%). There is an urgent need to increase the vaccination coverage through special tactics for reaching the unreached.
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Use of insecticide-treated bednets in an urban coastal area of Puducherry, India: A cross-sectional study
Suman Saurabh, S Ganesh Kumar, Swaroop Kumar Sahu, Suresh Thapaliya, S Sudharsanan, T Vasanthan
October-December 2013, 57(4):276-279
DOI:10.4103/0019-557X.123269  PMID:24351392
Use of Insecticide-Treated Bednets (ITNs) has been shown to reduce the incidence of mosquito-borne diseases. However, the impact of ITNs depends on its community acceptance. We studied the ITN usage and factors influencing it, following the distribution of one ITN to each family in an urban area of Puducherry. Around 93.6% of the 157 respondents surveyed were aware of mosquito-borne diseases. Coils and vaporizers were used in 91.1% of the families. Around two-fifths (41.3%) of the 116 families who received the ITNs used it regularly with another 5.1% using it irregularly. Majority of the users (85%) reported reduced mosquito bites and pleasant sleep after use. Small size of ITNs was the most common reason for non-use (46.3%). Families not using normal bed nets at the time of distribution of ITNs were unlikely to use ITNs at present (odds ratio = 5.22, P < 0.001). Therefore, ITN size should be increased and distribution in urban settings should accompany behavior change communication.
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Factors associated with the preference for delivery at the government hospitals in rural areas of Lucknow district in Uttar Pradesh
Manas Pratim Roy, Uday Mohan, Shivendra Kumar Singh, Vijay Kumar Singh, Anand Kumar Srivastava
October-December 2013, 57(4):268-271
DOI:10.4103/0019-557X.123271  PMID:24351390
For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to find out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odd's ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.
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Toward a community-centered public service system for universal health care in India
Ritu Priya
October-December 2013, 57(4):193-196
DOI:10.4103/0019-557X.123237  PMID:24351377
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Overuse of non-evidence based pharmacotherapies in coronary heart disease in India
Rajeev Gupta, Krishna Kumar Sharma, Shiva Ahuja, Raghubir Singh Khedar
October-December 2013, 57(4):280-281
DOI:10.4103/0019-557X.123241  PMID:24351393
  - 880 162
Etiology of non-typical suicide patterns essential
Thomas Iain Lemon
October-December 2013, 57(4):281-282
DOI:10.4103/0019-557X.123246  PMID:24351394
  - 757 136
Author's reply
Harshal Salve, Rakesh Kumar, Smita Sinha, Anand Krishnan
October-December 2013, 57(4):282-283
  - 761 107
Status of reporting at health sub-center level in Bihar
Tukaram Narayan Khandade, Rajeev Kamal Kumar, Shyama P Chattopadhyay
October-December 2013, 57(4):283-284
DOI:10.4103/0019-557X.123258  PMID:24351395
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Obituary: Dr. Deoki Nandan

October-December 2013, 57(4):285-285
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Dimensions of nutritional vulnerability: Assessment of women and children in Sahariya tribal community of Madhya Pradesh in India
Suparna Ghosh-Jerath, Anita Singh, Aruna Bhattacharya, Shomik Ray, Shariqua Yunus, Sanjay P Zodpey
October-December 2013, 57(4):260-267
DOI:10.4103/0019-557X.123268  PMID:24351389
Background: Tribal communities are "at risk" of undernutrition due to geographical isolation and suboptimal utilization of health services. Objectives: The objective of this study was to assess the nutritional status of Sahariya tribes of Madhya Pradesh (MP), India. Materials and Methods: A cross-sectional study was conducted in villages inhabited by Sahariya tribal community (specifically women in reproductive age group and children under 5 years) in three districts of MP. Dietary surveys, anthropometric and biochemical assessments were carried out and descriptive statistics on the socio-economic and nutritional profile were reported. Association between household (HH) food security and nutritional status of children was carried out using the logistic regression. Strength of effects were summarized by odd's ratio. Results: Chronic energy deficiency and anemia was observed in 42.4% and 90.1% of women respectively. Underweight, stunting and wasting among under five children were 59.1%, 57.3% and 27.7% respectively. Low food security was found in 90% of HHs and the odds of children being underweight and stunted when belonging to HHs with low and very low food security was found to be significant (P = 0.01 and 0.04 respectively). Calorie, fat, vitamin A, riboflavin, vitamin C and folic acid intake among women was lower than recommended dietary allowance. Infant and young child feeding practices were suboptimal. Awareness on nutritional disorders and utilization of nutrition and health services was poor. Conclusion: A high prevalence of undernutrition and dietary deficiency exists among Sahariyas. System strengthening, community empowerment and nutrition education may play a pivotal role in addressing this.
  - 5,010 1,130
Medical technology in India: Tracing policy approaches
Indira Chakravarthi
October-December 2013, 57(4):197-202
DOI:10.4103/0019-557X.123240  PMID:24351378
Medical devices and equipment have become an indispensable part of modern medical practice. Yet these medical technologies receive scant attention in the Indian context, both at the health policy level and as an area of study. There has been little attempt to systematically address the issue of equipment based medical technologies and how to regulate their use. There is paucity of primary data on the kind of medical equipment and techniques being introduced, on their need and relative usefulness, reliability, patterns of utilization, on their production, procurement, distribution, costs, and accessibility. This article reviews some of the policy issues relating to equipment based medical technology in India, in light of the specific choices and policies made during and after the colonial period in favour of modern medicine and a technology-based public health system, attempts at self-sufficiency and the current international environment with respect to the medical equipment and health-care industry.
  - 3,028 528
Medical equipment industry in India: Production, procurement and utilization
Indira Chakravarthi
October-December 2013, 57(4):203-207
DOI:10.4103/0019-557X.123242  PMID:24351379
This article presents information on the medical equipment industry in India-on production, procurement and utilization related activities of key players in the sector, in light of the current policies of liberalization and growth of a "health-care industry" in India. Policy approaches to medical equipment have been discussed elsewhere.
  - 19,284 1,802
Challenges for regulating the private health services in India for achieving universal health care
Rama V Baru
October-December 2013, 57(4):208-211
DOI:10.4103/0019-557X.123243  PMID:24351380
Commercial interests pose a serious challenge for universalizing health-care. This is because "for-profit" health-care privileges individual responsibility and choice over principles of social solidarity. This fundamentally opposing tendency raises ethical dilemmas for designing a health service that is universal and equitable. It is an inadequate to merely state the need for regulating the private sector, the key questions relate to what must be done and how to do it. This paper identifies the challenges to regulating the private health services in India. It argues that regulation has been fragmented and largely driven by the center. Given the diversity of the private sector and health being a state subject, regulating this sector is fraught with the technical and socio-political factors.
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Aren't technological choices central to designing health systems?
Ritu Priya
October-December 2013, 57(4):212-218
DOI:10.4103/0019-557X.123245  PMID:24351381
This paper argues that delivery of technology-based preventive, promotive and curative care is one of the central tasks of any health-care system and therefore it forms one of the central pivots for rational structuring/re-structuring of a health-care system. The development of our public health system has, historically, adopted health technologies (HT) uncritically and thereby not explicitly developed institutional mechanisms to assess them for rational choice. Determinants of HT policy choices and structuring of a service delivery system based on that are discussed with examples of modern low cost HT, technologies of codified health knowledge systems other than the modern and local health traditions. Various forms of institutional structures for HT assessment and R and D using a comprehensive primary health-care approach are suggested.
  - 5,119 285
Developing a public health cadre in 21 st century India: Addressing gaps in technical, administrative and social dimensions of public health services
Ritu Priya, Anjali Chikersal
October-December 2013, 57(4):219-224
DOI:10.4103/0019-557X.123247  PMID:24351382
This paper presents a possible framework for designing a public health cadre in the present context, with lessons from health services development of the last six decades. Three major gaps that the public health cadre is meant to bridge have been identified. These are capacities within the system to address the technical requirements (epidemiological and health systems analysis); administrative/managerial dimensions; and the social determinants of health. Therefore, it argues that the cadre must not only have a techno-managerial structure, but also create a specific sub-cadre for the social determinants of health.
  - 4,403 720
Universal health care in India: Panacea for whom?
Imrana Qadeer
October-December 2013, 57(4):225-230
DOI:10.4103/0019-557X.123249  PMID:24351383
This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State's responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all.
  - 3,125 675
Contradictions of the health-care system in India and a strategy for health-care for all
Anant Phadke
October-December 2013, 57(4):231-235
DOI:10.4103/0019-557X.123256  PMID:24351384
The contradiction between the socialized nature of the modern health-care system (inclusive of both clinical and social medicine) versus the narrow control over it is obvious in private health-care. However, this contradiction is present to some extent, in its own way, even in the public health facilities in India. To formulate a program for health-care for all in India, it is necessary to grasp these contradictions in both private and public health-care and accordingly conceptualize a strategy to overcome, resolve these contradictions.
  - 1,614 386
Universal health care: The changing international discourse
Ramila Bisht
October-December 2013, 57(4):236-241
DOI:10.4103/0019-557X.123257  PMID:24351385
Nearly 34 years ago, in 1978 in the face of a looming crisis in the health of the world's populations and rising health inequality, 134 countries came together to sign the historic Alma Ata Declaration where the idea of primary health care as the chosen path to "Health for All" was formulated. However even before the declaration and more so since, countries have diverse interpretations of Universalism, each setting it in the context of its own health care model. These have ranged from the minimalist to the more comprehensive welfare state. Today, as health statistics reveal, the crisis has deepened, not only in the developing world but also in the developed world. It is important to debate the nature of the crisis and understand current policy initiatives and their ideological legitimations. The paper attempts to trace, clarify and account for the shifts in international discourse on universal health care (UHC). It argues that the idea of UHC is still with us, but there have occurred substantial shifts in discourse and meaning, shaped by changing international and national contexts and social forces impinging on health systems. The current concept of universal health coverage has only a notional allusion to universality of Alma Ata and disregards its fundamental principles. It concludes that the shifts are detrimental and its value in promoting health for all is likely to be severely limited.
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Universal health care: Pathways from access to utilization among vulnerable populations
Sanghmitra S Acharya
October-December 2013, 57(4):242-247
DOI:10.4103/0019-557X.123260  PMID:24351386
The present paper discusses universal access to health-care in the light of the barriers faced by some vulnerable individuals and groups due to caste based identities. Factors such as perception of self, availability of services, sensitivity of the providers determine access and consequently affect utilization among vulnerable populations. The paper examines the inter-linkages between these factors. Efforts, which create enabling environment have been discussed to highlight impeding and enhancing factors, Field based research has been used to reflect on some of these factors and possible best practices.
  - 2,101 531
Universalizing health services in India: The techno-managerial fix
KR Nayar
October-December 2013, 57(4):248-253
DOI:10.4103/0019-557X.123262  PMID:24351387
The non-universal nature of health services in India can also be the result of many reforms and milestones the health services had passed through since independence. The reform era during the post-nineties is replete with many new trends in organizational strategies which could have led to crises in health services. The salient crises need to be dissected from a larger societal crisis and the specific crises in the health services system. It is evident that non-accessibility and non-availability and the sub-optimal functioning of the primary health centers are perennial issues which could not be addressed by indigenous, imposed or cocktail reforms (such as National Rural Health Mission) and by targeting as these only tinker with the health services. Needless to reiterate that there is a need to address the social dimensions which fall outside the technical sphere of health services. This paper based on an analytical review of relevant literature concludes that any efforts to universalize health and health-care can not only focus on technical components but need to address the larger social determinants and especially the societal crisis, which engender ill-health.
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Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India: A comprehensive analytic view of private public partnership model
Sunita Reddy, Immaculate Mary
October-December 2013, 57(4):254-259
DOI:10.4103/0019-557X.123264  PMID:24351388
The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on officially available data and media reports has been undertaken from a public health perspective to understand the nature and financing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital association's in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profits are privatized and losses are socialized.
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