From Research to Policy to Programme: Success Story of Seven State Iodine Deficiency Disorders (IDD) Survey in India

Iodine Deficiency Disorders (IDD) constitute the single largest cause of preventable brain damage worldwide. In India the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from it. Of these, an estimated 350 million people are at higher risk of IDDs as they consume salt with inadequate iodine. Every year nine million pregnant women and eight million newborns are at risk of IDD in India.On September 13, 2000, the Government of India lifted the ban at the national level on the sale of non-iodized salt (India Gazette 2000). Scientists, civil society, international agencies and other stakeholders joined ranks to fight against this retrograde step by the government of India. The four pronged approach to fight the removal of ban on non- iodized salt comprised of writing advocacy documents, meeting with stakeholders, media campaign and tracking of Universal Salt Iodization (USI) in states by state iodine status surveys.But effective advocacy and media campaign were hampered by lack of scientific data substantiating the magnitude of Iodine Deficiency disorders (IDD) in India. To address this lacuna, state level Iodine status surveys were planned in seven states of India and were executed over next five years in collaboration with various national and international stakeholders.State level IDD surveys were carried out in seven states (Kerala, Tamil Nadu, Orissa, Rajasthan, Bihar, Goa and Jharkhand) from 2000 to 2006 by International Council for Control of Iodine Deficiency Disorders (ICCIDD) in collaboration with state medical colleges, Micronutrient Initiative (MI) and UNICEF. The surveys were carried as per the recommended guidelines of WHO/UNICEF/ICCIDD and used 30 cluster into 40 children sampling methodology. Children in the age group of 6-12 years, women in the household, retail shop keepers and other community stakeholders constituted the study population. All three indicators viz. Total Goiter Rate (TGR), Urinary Iodine (UI) concentration and iodine content of salt (household and retail shop) were studied. TGR ranged from 0.9% in Jharkhand to 14.7% in Goa. The median urinary iodine excretion ranged from 76 µg/L in Goa to 173.2 µg/L in Jharkhand. The household level consumption of adequately iodized salt ( ≥ 15 ppm) ranged from 18.2% in Tamil Nadu to 91.9% in Goa. These state level IDD surveys are the only sub-national (state) level IDD surveys in India where all three indicators viz. iodized salt coverage, urinary iodine and TGR were assessed concurrently.These surveys provided valuable reliable scientific data to back up the need of urgency to re-instate the ban and aided in convincing wider scientific community and policy makers regarding the need for the same. These surveys also aided in capacity building at state level which will provide necessary impetus to sustain USI. The ban on sale of non-iodized salt was finally re-instated in May, 2005.Purpose of the study : To understand the complex policy environment in which National Health Programmes in India are operating.Basic Procedures : A case study approach applying the criteria of policy formulation and policy implementation to National Iodine Deficiency Disorders Control Programme (NIDDCP).Main Findings : The major limiting factor in the implementation of NIDDCP was that the community perceptions about IDD and iodized salt and their interests and beliefs (Values) were not explicitly considered as part of the implementation process. Addressing the values through sustained advocacy, development of partnerships among stakeholders, supply and demand side interventions and more research based on the programme needs helped in achieving sustainability in elimination of IDD.Conclusion : In formulating National Health Programmes in a policy environment, scientific inputs, political will and institutional structure for decision making are necessary but not sufficient. Pro-active recognition values of key stakeholders, continuous and dynamic generation of scientific information and development of partnerships are critical for sustainability of the National Health Programmes

The Discovery of Modern Anaesthesia – Contributions of Davy, Clarke, Long, Wells and Morton

While many may argue as to who deserves the most credit for the discovery of modern anaesthesia, events in the late 18 th and early 19 th centuries led to the introduction and development of modern anaesthetic techniques. English physicist and chemist Humphry Davy [1778-1829] first became aware of the sedative and analgesic properties of nitrous oxide in 1795. Although he never experimented with the drug during a surgical procedure, he was the first to suggest that it would be beneficial in relieving pain during surgical procedures. The mind-altering properties of nitrous oxide and ether were often abused for recreational purposes, and the term \u27ether frolics\u27 was coined to describe such use. While physician William Crawford Williamson Long [1815-1878] first used ether during general surgery, medical student William Edward Clarke [1819-1898] was the first to use ether for dental extraction in 1842. Dr. Long neglected to publicize his findings until 1849, thereby denying himself much of the credit he deserved. Dentist Horace Wells [1815-1848] successfully used nitrous oxide for dental procedures, but a public demonstration which he held in January 1845 turned out to be a fiasco. Medical student William Thomas Green Morton [1819-1868] was the first to publicly demonstrate the effectiveness of ether for general surgery on October 16, 1846. This article seeks to give rightful credit to each of these individuals for their unique contributions to the discovery of modern anaesthesia

Awareness about Reproductive Tract Infections among Rural Adolescent Girls in Haryana

Introduction: There are about 350 million adolescents comprising about 22% of the population in the countries of the South- East Asia Region (SEAR). Hygiene related practices of adolescent girls have health impact in terms of increased susceptibility to reproductive tract infections (RTIs) which affects productivity of young adolescents.Objective: The study was conducted to find out the magnitude and awareness of reproductive tract infections among adolescent girls in villages under the Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana.Methodology: A community based cross sectional study was done among adolescent girls aged 14-19 years. Using simple random sampling technique, 274 girls were interviewed using semi structured interview schedule. Analysis was carried out in Stata version 11.Results: All 274 participants had attained menarche and the mean age at attainment of menarche was 14.2 ±1.4 years. Almost half of the participants (47.1%) were not aware about the causes of RTIs. Seventy one girls (25.9%) reported symptoms of reproductive tract infections. Also, almost half of them did not seek any treatment for RTI.Conclusions: There is a concern that prevalence of untreated reproductive tract infections among adolescent girls is significant especially in rural India. Therefore, proper menstrual hygiene and correct perceptions and beliefs can protect the women from this suffering

Double burden of malnutrition among elderly population of Delhi

Background: Nutritional status is an important determinant for elderly, directly influencing their susceptibility to diseases, adversely affecting their quality of life.  Aim & Objective: To assess the nutritional status of elderly persons aged ?60 years residing in an urban resettlement colony of Delhi. Materials and Methods: A community-based cross-sectional study was conducted in a resettlement colony in Delhi. Cluster random sampling was used. Three out of ten blocks were selected randomly. All elderly persons present in the selected blocks were included.  Information on socio-demographic variables was collected. Arm span and weight were measured by trained investigators. Data was entered in MS Excel 2007 and analyzed in Stata 11.0. Multiple logistic regression was done to determine the association between nutritional status and socio-demographic variables Results: A total of 711 elderly persons were recruited. About half (53.2%) had normal nutritional status, 20.8% were underweight and 19.4% were overweight and 6.6% were obese. Under-nutrition was significantly associated with gender, while overweight/obesity was found to be significantly associated with age (p<0.001), gender (p<0.001), occupation (p<0.001) and economic dependency (p< 0.001). Conclusion: Dual burden of malnutrition was seen, so there is a need to promote healthy eating and lifestyle to address both spectrum of malnutrition

Prevalence of Household-level Food Insecurity and Its Determinants in an Urban Resettlement Colony in North India

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world\u2019s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean familysize being 5.5 (SD\ub12.5) and the mean monthly household income being INR 9,784 (SD\ub1631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p 640.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p 640.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem

From Research to Policy to Programme: Success Story of Seven State Iodine Deficiency Disorders (IDD) Survey in India

Iodine Deficiency Disorders (IDD) constitute the single largest cause of preventable brain damage worldwide. In India the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from it. Of these, an estimated 350 million people are at higher risk of IDDs as they consume salt with inadequate iodine. Every year nine million pregnant women and eight million newborns are at risk of IDD in India.On September 13, 2000, the Government of India lifted the ban at the national level on the sale of non-iodized salt (India Gazette 2000). Scientists, civil society, international agencies and other stakeholders joined ranks to fight against this retrograde step by the government of India. The four pronged approach to fight the removal of ban on non- iodized salt comprised of writing advocacy documents, meeting with stakeholders, media campaign and tracking of Universal Salt Iodization (USI) in states by state iodine status surveys.But effective advocacy and media campaign were hampered by lack of scientific data substantiating the magnitude of Iodine Deficiency disorders (IDD) in India. To address this lacuna, state level Iodine status surveys were planned in seven states of India and were executed over next five years in collaboration with various national and international stakeholders.State level IDD surveys were carried out in seven states (Kerala, Tamil Nadu, Orissa, Rajasthan, Bihar, Goa and Jharkhand) from 2000 to 2006 by International Council for Control of Iodine Deficiency Disorders (ICCIDD) in collaboration with state medical colleges, Micronutrient Initiative (MI) and UNICEF. The surveys were carried as per the recommended guidelines of WHO/UNICEF/ICCIDD and used 30 cluster into 40 children sampling methodology. Children in the age group of 6-12 years, women in the household, retail shop keepers and other community stakeholders constituted the study population. All three indicators viz. Total Goiter Rate (TGR), Urinary Iodine (UI) concentration and iodine content of salt (household and retail shop) were studied. TGR ranged from 0.9% in Jharkhand to 14.7% in Goa. The median urinary iodine excretion ranged from 76 µg/L in Goa to 173.2 µg/L in Jharkhand. The household level consumption of adequately iodized salt ( ≥ 15 ppm) ranged from 18.2% in Tamil Nadu to 91.9% in Goa. These state level IDD surveys are the only sub-national (state) level IDD surveys in India where all three indicators viz. iodized salt coverage, urinary iodine and TGR were assessed concurrently.These surveys provided valuable reliable scientific data to back up the need of urgency to re-instate the ban and aided in convincing wider scientific community and policy makers regarding the need for the same. These surveys also aided in capacity building at state level which will provide necessary impetus to sustain USI. The ban on sale of non-iodized salt was finally re-instated in May, 2005.Purpose of the study : To understand the complex policy environment in which National Health Programmes in India are operating.Basic Procedures : A case study approach applying the criteria of policy formulation and policy implementation to National Iodine Deficiency Disorders Control Programme (NIDDCP).Main Findings : The major limiting factor in the implementation of NIDDCP was that the community perceptions about IDD and iodized salt and their interests and beliefs (Values) were not explicitly considered as part of the implementation process. Addressing the values through sustained advocacy, development of partnerships among stakeholders, supply and demand side interventions and more research based on the programme needs helped in achieving sustainability in elimination of IDD.Conclusion : In formulating National Health Programmes in a policy environment, scientific inputs, political will and institutional structure for decision making are necessary but not sufficient. Pro-active recognition values of key stakeholders, continuous and dynamic generation of scientific information and development of partnerships are critical for sustainability of the National Health Programmes.</p