Scaling-up microfinance for India's rural poor

This paper reviews the current level and pattern of access to finance for India's rural poor and examines some of the key microfinance approaches in India, taking a close look at the most dominant among these, the Self Help Group (SHG) Bank Linkage initiative. It empirically analyzes the success with which SHG Bank Linkage has been able to reach the poor, examines the reasons behind this, and the lessons learned. The analysis draws heavily on a recent rural access to finance survey of 6,000 households in India undertaken by the authors. The main findings and implications of the paper are as follows: India's rural poor currently have very little access to finance from formal sources. Microfinance approaches have tried to fill the gap. Among these, the growth of SHG Bank Linkage has been particularly remarkable, but outreach remains modest in terms of the proportion of poor households served. The paper recommends that, if SHG Bank Linkage is to be scaled-up to offer mass access to finance for the rural poor, then more attention will need to be paid toward the promotion of high quality SHGs that are sustainable, clear targeting of clients, and ensuring that banks linked to SHGs price loans at cost-covering levels. At the same time, the paper argues that, in an economy as vast and varied as India's, there is scope for diverse microfinance approaches to coexist. Private sector microfinanciers need to acquire greater professionalism, and the government can help by creating a flexible architecture for microfinance innovations, including through a more enabling policy, legal, and regulatory framework. Finally, the paper argues that, while microfinance can, at minimum, serve as a quick way to deliver finance to the poor, the medium-term strategy to scale-up access to finance for the poor should be to"graduate"microfinance clients to formal financial institutions. The paper offers some suggestions on what it would take to reform these institutions with an eye to improving access for the poor.Banks&Banking Reform,Financial Intermediation,Environmental Economics&Policies,Financial Crisis Management&Restructuring,Public Sector Economics&Finance

Diagnostic accuracy of transabdominal ultrasound in respect to transvaginal ultrasound in diagnosing ectopic pregnancy in a tertiary care hospital of Kolkata taking histopathology as gold standard: a prospective study

Background: Ectopic pregnancy (EP) represents an important cause of acute pelvic pain in women of reproductive age. Initial evaluation consists of appropriate history and clinical examination followed by pelvic ultrasonography (US) and hormonal assays. Objective of the study was to measure diagnostic accuracy of TAS in respect to TVS in detecting ectopic pregnancy.Methods: This prospective cross sectional study was done for 1 year duration in Nilratan Sircar Medical College and Hospital, Kolkata. 50 patients with suspected ectopic pregnancy were transferred from Gynae emergency ward and trans-abdominal, transvaginal ultrasound were subsequently performed on each. The results were corroborated with histopathology reports..Results: Diagnostic parameters of TAS in respect to HPE:sensitivity 75.5, specificity-80,PPV-97.1, NPV-26.6 (all in percentages). Diagnostic parameters of TVS in respect to HPE:sensitivity 86.6, specificity-80, PPV-97.5, NPV-40 (all in percentages).Conclusions: Sonography by transvaginal route stood way ahead of trans abdominal scan in terms of all diagnostic parameters to correctly evaluate ectopic pregnancy

The scope for mdb leverage and innovation in climate finance

This note, prepared as background for the G20 submission, explores the potential for Multilateral Development Banks (MDBs) to increase the volume of climate financing by leveraging and intermediating resources, through two main avenues: leveraging shareholder capital through the MDBs non-concessional windows, by raising debt from capital markets to finance climate investment; and mobilizing and 'pooling' concessional flows to support climate investment beyond the MDBs own balance sheets. The note is organized along these two lines, with the aim of providing some insights into the feasibility for MDBs to mobilize resources to leverage a significantly larger volume of climate financing assistance. The next section of this note provides information on how MDBs can support concessional flows to climate investments through pooling of external concessional flows beyond traditional balance-sheet capital. Leveraging shareholder capital and mobilizing and-pooling concessional flows are two potential avenues through which MDBs can leverage and intermediate resources to ultimately increase the volume of climate financing. The experience gained by the MDBs and their clients and donors from implementing these financing arrangements should provide helpful lessons for the development community as it considers how to develop the green climate fund and other future climate change initiatives. Document type: Boo

Corticotrophin-Releasing Hormone Type 1 Receptor Gene (CRHR1) Variants Predict Posttraumatic Stress Disorder Onset and Course in Pediatric Injury Patients

Posttraumatic stress disorder (PTSD) is a common and disabling anxiety disorder that may occur in the aftermath of exposure to potentially traumatic life events. PTSD is moderately heritable, but few specific molecular variants accounting for this heritability have been identified. Genes regulating the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone type 1 receptor gene (CRHR1), have been implicated in traumatic-stress related phenotypes but have yet to be studied in relation to PTSD. The present study sought to examine the relation between 9 single nucleotide polymorphisms (SNPs) in the CRHR1 gene and posttraumatic stress symptoms in a prospective study of pediatric injury patients (n = 103) who were first assessed in the acute aftermath of their injury at the hospital. Results indicated that multiple SNPs were associated with acute symptoms at a univariate level, and after correction for multiple testing, rs12944712 was significantly related to acute PTSD symptoms. Longitudinal latent growth curve analyses suggest that rs12944712 is also related to both acute symptom level and trajectory of symptoms over time. The present study adds support for the role of CRHR1 in the stress response following potentially traumatic event exposure in youth. It should be noted that the sample size in this study was small, and therefore statistical power was low; following, results from this study should be considered preliminary. Although results are not definitive, the findings from this study warrant future replication studies on how variation in this gene relates to response to traumatic event exposure in youth

Corticotrophin-Releasing Hormone Type 1 Receptor Gene (CRHR1) Variants Predict Posttraumatic Stress Disorder Onset and Course in Pediatric Injury Patients

Posttraumatic stress disorder (PTSD) is a common and disabling anxiety disorder that may occur in the aftermath of exposure to potentially traumatic life events. PTSD is moderately heritable, but few specific molecular variants accounting for this heritability have been identified. Genes regulating the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone type 1 receptor gene (CRHR1), have been implicated in traumatic-stress related phenotypes but have yet to be studied in relation to PTSD. The present study sought to examine the relation between 9 single nucleotide polymorphisms (SNPs) in the CRHR1 gene and posttraumatic stress symptoms in a prospective study of pediatric injury patients (n = 103) who were first assessed in the acute aftermath of their injury at the hospital. Results indicated that multiple SNPs were associated with acute symptoms at a univariate level, and after correction for multiple testing, rs12944712 was significantly related to acute PTSD symptoms. Longitudinal latent growth curve analyses suggest that rs12944712 is also related to both acute symptom level and trajectory of symptoms over time. The present study adds support for the role of CRHR1 in the stress response following potentially traumatic event exposure in youth. It should be noted that the sample size in this study was small, and therefore statistical power was low; following, results from this study should be considered preliminary. Although results are not definitive, the findings from this study warrant future replication studies on how variation in this gene relates to response to traumatic event exposure in youth

Prevalence of refractive errors in children in India: a systematic review

Uncorrected refractive error is an avoidable cause of visual impairment which affects children in India. The objective of this review is to estimate the prevalence of refractive errors in children ≤ 15 years of age. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed in this review. A detailed literature search was performed to include all population and school‐based studies published from India between January 1990 and January 2017, using the Cochrane Library, Medline and Embase. The quality of the included studies was assessed based on a critical appraisal tool developed for systematic reviews of prevalence studies. Four population‐based studies and eight school‐based studies were included. The overall prevalence of refractive error per 100 children was 8.0 (CI: 7.4–8.1) and in schools it was 10.8 (CI: 10.5–11.2). The population‐based prevalence of myopia, hyperopia (≥ +2.00 D) and astigmatism was 5.3 per cent, 4.0 per cent and 5.4 per cent, respectively. Combined refractive error and myopia alone were higher in urban areas compared to rural areas (odds ratio [OR]: 2.27 [CI: 2.09–2.45]) and (OR: 2.12 [CI: 1.79–2.50]), respectively. The prevalence of combined refractive errors and myopia alone in schools was higher among girls than boys (OR: 1.2 [CI: 1.1–1.3] and OR: 1.1 [CI: 1.1–1.2]), respectively. However, hyperopia was more prevalent among boys than girls in schools (OR: 2.1 [CI: 1.8–2.4]). Refractive error in children in India is a major public health problem and requires concerted efforts from various stakeholders including the health care workforce, education professionals and parents, to manage this issue

Computational Refinement of Functional Single Nucleotide Polymorphisms Associated with ATM Gene

gene are the most common forms of genetic variations that account for various forms of cancer. However, the extent to which SNPs interferes with the gene regulation and affects cancer susceptibility remains largely unknown. gene. gene function can aid in better understanding of genetic differences in disease susceptibility

Decreased severity of disease during the first global Omicron variant COVID-19 outbreak in a large hospital in Tshwane, South Africa

INTRODUCTION : The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponen- tial increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. METHODS : 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admis- sions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occu- pancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. RESULTS : For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p < 0.0 0 0 01), and 1% vs 4.3% (p < 0.0 0 0 01) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. CONCLUSION : There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.The South African Medical Research Council.http://www.elsevier.com/locate/ijidam2023Critical CareInternal MedicineObstetrics and GynaecologyPaediatrics and Child HealthSchool of Health Systems and Public Health (SHSPH