Respond to Public Health Emergencies and The Law Preparedness Challenges and Solutions

Laws are a very powerful tool for defending human rights. These could be parliamentary enactments, local panchayat regulations, international conventions, or constitutions. Every facet of the emergency and public health response is based on law and policy. Laws made it possible to establish lockdowns, declare states of emergency, and, more recently, speed the clearance process for vaccines. The removal of antiquated laws, regulations, and backup plans frequently revealed them to be insufficient or out-of-date, necessitating the quick creation of new legislation. Never before have so many laws concerning one incident been passed in so many nations in such a short period of time. Communities are kept safe and lives are saved by domestic legal preparedness for catastrophes, which includes public health emergencies. The cornerstones of disaster risk management are law and policy, which establish guidelines for the who, what, and when of emergency response operations. When preparedness and response efforts lack a solid legal foundation, they may be disorganised and ineffectual, which frequently causes the most vulnerable individuals to wait longer for critical assistance. This essay suggests that there is a general deficiency of robust public health emergency legislation as well as a lack of legal readiness for such situations

The use of periphyton and macro-invertebrates and their susceptibility to changes in river flow characteristics and nutrient composition as an indicator of river health.

Master of Science in Geography. University of KwaZulu-Natal, Pietermaritzburg 2016.Freshwater systems are a valuable resource under increasing threat due to pollution from activities such as agriculture, industry, mining and domestic use which can pose a risk to human and animal health and may lead to eutrophication. In South Africa, river ecosystem management has shifted from the improvement of water quality to that of the creation of ecological reserves, ecological health and the improvement of biological integrity. This shift has allowed for the increased use of bio-indicators to determine ecosystem health. Macro-invertebrates, riparian vegetation and fish have been used in the suite of bio-monitoring mechanisms and the setting of environmental reserves. However, there is an increasing need to include periphyton as a tool in river ecosystem monitoring due to their absorptive nature and ability to indicate change environmental conditions. In South Africa research suggesting algae as bio-indicators has been primary based on the use of diatoms as a bio- monitoring tool. This study aims to determine patterns and trends in periphyton communities in the summer rainfall region of KwaZulu-Natal, South Africa. This is achieved through five sampling sites aimed at determining the relationship between changes in nutrient and flow regimes on periphyton communities. Two sites on the Msunduzi River are comparable as they have similar flow but different nutrient levels, whilst on the Umgeni River the two sites are comparable as they have differences in flow regimes with similar nutrient conditions. The fifth site on the Hlatikhulu River, Kamberg, is used as a reference site. Sampling occurred over the period June 2014 to June 2015 on a monthly basis to collect algal and invertebrate samples and physico-chemical data. Trends and relationships between physico-chemical and algal biomass were evident. Trends indicated the role rainfall played in increasing river depth and velocity which in turn influenced algal biomass growth and species composition and the effect that seasonality changes had on periphyton communities. Peaks in algal biomass was as a result of increases in nutrients within a particular system while decreases in algal biomass occurred due to an increase in invertebrate grazers. Sloughing events resulted due to increases in flow and velocity. General trends at all five sites showed peaks in algal biomass in early summer and a lesser algal biomass peak in early autumn. This research suggests that if better understanding of periphyton patterns and trends are established, periphyton can be used as an important bio-monitoring tool and aid in the creating and setting of ecological reserves

CURRENT TREATMENTS FOR TYPE 2 DIABETES, THEIR SIDE EFFECTS AND POSSIBLE COMPLEMENTARY TREATMENTS

Diabetes mellitus is a chronic metabolic disorder in the endocrine system and characterized by a varied and complex pathophysiology. World-wide there is a dramatic increase in the number of patients for type 2 diabetes, and hence it is becoming a serious threat to the health of mankind. Commercially a large number of drugs belonging to different classes such as biguanides, sulfonylureas, meglitinides and thiazolidinediones are available to control and treat the type 2 diabetic patients. However, none of these drugs are known to completely cure the diabetic phenotype. On the other hand, a long term usage of these drugs exhibits several side effects and complications to different organs of the body which ultimately lead to cardiovascular problems, liver disease, kidney disease and weight gain too. Like many other drugs, these anti-diabetic drugs are also known to interfere and interact with other non anti-diabetic drugs, if the patient is taking them for a long time. To combat the side effects of these drugs, complementary treatments may be found as a preventive measure and more promising in the management of disease phenotypes in these patients. As per reports available from a large number of studies, these complementary therapies may include physical exercise, dietary supplements and Nutraceuticals.Â

Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication and low compliance, is likely to contribute to gaps and delays in the provision of emergency obstetric care

Transport of pregnant women and obstetric emergencies in India: an analysis of the '108' ambulance service system data.

BACKGROUND: The transport of pregnant women to an appropriate health facility plays a pivotal role in preventing maternal deaths. In India, state-run call-centre based ambulance systems ('108' and '102'), along with district-level Janani Express and local community-based innovations, provide transport services for pregnant women. We studied the role of '108' ambulance services in transporting pregnant women routinely and obstetric emergencies in India. METHODS: This study was an analysis of '108' ambulance call-centre data from six states for the year 2013-14. We estimated the number of expected pregnancies and obstetric complications for each state and calculated the proportions of these transported using '108'. The characteristics of the pregnant women transported, their obstetric complications, and the distance and travel-time for journeys made, are described for each state. RESULTS: The estimated proportion of pregnant women transported by '108' ambulance services ranged from 9.0 % in Chhattisgarh to 20.5 % in Himachal Pradesh. The '108' service transported an estimated 12.7 % of obstetric emergencies in Himachal Pradesh, 7.2 % in Gujarat and less than 3.5 % in other states. Women who used the service were more likely to be from rural backgrounds and from lower socio-economic strata of the population. Across states, the ambulance journeys traversed less than 10-11 km to reach 50 % of obstetric emergencies and less than 10-21 km to reach hospitals from the pick-up site. The overall time from the call to reaching the hospital was less than 2 h for 89 % to 98 % of obstetric emergencies in 5 states, although this percentage was 61 % in Himachal Pradesh. Inter-facility transfers ranged between 2.4 % -11.3 % of all '108' transports. CONCLUSION: A small proportion of pregnant women and obstetric emergencies made use of '108' services. Community-based studies are required to study knowledge and preferences, and to assess the potential for increasing or rationalising the use of '108' services

Pregnant women who requested a '108' ambulance in two states of India.

We studied the pregnant women, who requested a '108' ambulance in two Indian states (Andhra Pradesh (AP) and Himachal Pradesh (HP)). We conducted a cross-sectional telephone survey to study the characteristics and outcomes of those who (1) were transported using '108' ambulance, (2) were sent '108' ambulance but did not use it and (3) were not assigned a '108' ambulance. We conducted interviews within 24 hours of clients' call and followed them up at 48 hours, on the 7th and 28th day. 90% of pregnant women callers in AP and only 16% in HP were from poorer socioeconomic circumstances. 22.5% of women who were not provided an ambulance in HP lived in tribal areas. A higher proportion of women who were transported using '108' reported either a high-risk condition (AP, 22%; HP, 27%) or an early complication in pregnancy (AP and HP, 16%), compared with the other groups (AP, 18% and 8%; HP, 19% and 16%). In AP, women who were sent an ambulance but did not use it had higher prevalence of obstetric emergency (9.8%) compared with the other groups (ambulance used, 7.4%; not assigned, 4.1%). One-fifth of women in AP and one-seventh in HP delivered by caesarean section. One woman who called, but was not transported by '108', died in AP. Ten stillbirths and 22 neonatal deaths were reported in AP and 17 and 16, respectively, in HP. Strategies are required to improve '108' service for tribal areas in HP. The '108' services should be improved to reduce non-use of ambulance, especially for women who report obstetric emergencies

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India.

OBJECTIVE: To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India. DESIGN: A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'. MAIN OUTCOMES: Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. RESULTS: The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. CONCLUSION: Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT

Micropropagation And Antimicrobial Activity Of Callicarpa Macrophylla (Priyangu) Against Medically Important Pathogens

Callicarpa macrophylla (Priyangu) a medicinally important plant, represents a class of herbal drug with very strong conceptual and traditional base. In present study extract of leaf, stem showed less antimicrobial activity than seed. They showed antimicrobial activity against three bacterial strains Staphylococcus aureus, Bacillus subtilis, Escherichia coli and Pseudomonas and three fungal Strains Aspergillus fumigatous, Rhizopus oryzae and Aspergillus awamori. Maximum activity was observed in ethanol extract of leaf and stem, Methanol extracts of seed. Phytochemical analysis of the plant extract revealed the presence of phenol, reducing sugar, coumarin and saponins.  Micropropogation of C.macrophylla was done using stem as a explant material on MS and Woody media. Which revealed that woody media containing BAP (6-amino benzyl purine) NAA(α-napthaleneacetic acid) gave maximum proliferation  response in comparison to MS media. Plant extract (leave, stem and seed) have provide protection against RBC haemolysis and protein denaturation may act as anti-arthritic agent. We propose antiarthritic and antimicrobial activity of C.macrophylla

Management and referral for high-risk conditions and complications during the antenatal period: knowledge, practice and attitude survey of providers in rural public healthcare in two states of India.

BACKGROUND: Appropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers' perspectives on management and referrals of antenatal women with high obstetric risk, or with complications. METHODS: We surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications. RESULTS: Staff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers. CONCLUSION: The Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India.

BACKGROUND: Hand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems. METHODS: We conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization's concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate. RESULTS: We included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility. CONCLUSION: Observed compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units. TRIAL REGISTRATION: Retrospectively registered with Clinical Trials Registry- India ( CTRI/2018/04/013014 )