Sunday February 17, 2019

Dreary state of Maternal Health Care in Jharkhand

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By Prachi Salve

New Delhi: This week, as Prime Minister Narendra Modi announced – quoting the World Health Organisation (WHO) – that India was free of maternal and neo-natal tetanus, the state of maternal health in the eastern state of Jharkhand indicates the long road still ahead in the country’s dark spots.

Women_at_farmers_rally,_Bhopal,_India,_Nov_2005
Modi was speaking at the just-concluded 24-nation Call to Action Summit, which discussed how to end preventable maternal and infant deaths, particularly in high-risk areas globally, including Jharkhand.

Since its birth in March 2000, Jharkhand has seen its maternal mortality ratio (MMR), or maternal deaths per 100,000 live births, improve from 261 in 2007-09 to 219 in 2011-12 due to improved access to healthcare.

But this is 41 points higher than the national MMR average of 178 in 2011-12, worse than Myanmar and Nepal and about the same as Laos and Papua and New Guinea, according to WHO data.

Jharkhand is a part of a group of eight poor states, called the empowered action group (EAG), which includes Bihar, Chhattisgarh, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh. The EAG was formed by the central government following the 2001 Census to contain the population explosion in these states.

The real maternal and infant-health problems in Jharkhand are revealed when we compare the state’s health indicators with other EAG states, such as Chhattisgarh and Bihar.

Jharkhand does not fare well on any of the nine key indicators including government schemes, such as the Janani Suraksha Yojana (Mothers’ Protection Programme).

The JSY is fully sponsored by the central government and provides cash incentives, including out-of-pocket expenditure incurred by pregnant women: Rs 1,400 for rural women and Rs 1,000 for urban women.

Jharkhand has the lowest ante-natal care coverage with only 60 percentof women receiving such facilities. Compare that to Bihar with 85.4 percent and Chhattisgarh with 91.8 percent.

Mothers who opted for institutional deliveries in Jharkhand were also low at 23.6 percent, compared to 39.5 percent and 29.2 percent in Bihar and Chhattisgarh, respectively. The women who do use state-run health institutions receive poor quality care.

Seen from the view of those who provide healthcare, they work at substandard facilities and there are too few of them.

The gulf between targets and reality in India’s dark areas

At the Call To Action Summit, Prime Minister Modi talked about how India had achieved 75 percent institutional deliveries nationwide, a significant factor in improving maternal and infant healthcare.

But as Video Volunteers’ ground reports reveal, absolute numbers are not enough: The quality of healthcare is an important draw for women in remote, rural areas. If infrastructure is crumbling, centres lack medical staff and patients must pay out of their pockets-apart from being treated badly-they are unlikely to use institutions.

The idea behind the JSY is to encourage women to deliver babies at health facilities by making these services free and available, especially in rural areas.

Of Jharkhand’s 24 districts, there is a significant urban bias among the bottom five districts, based on maternal-health indicators.

In general, mothers in urban areas received better maternal care in Jharkhand, including facilities under JSY, emphasising the point that poor facilities attract fewer women.

(IANS/IndiaSpend)

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Know How Higher Intake of Sodium Can Treat Lightheadedness

Greater sodium intake is widely viewed as an intervention for preventing lightheadedness when moving from seated to standing positions.

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"Health practitioners initiating sodium interventions for orthostatic symptoms now have some evidence that sodium might actually worsen symptoms," Juraschek said. Pixabay

Higher sodium intake should not be used as a treatment for lightheadedness, say researchers challenging current guidelines for sodium consumption.

Lightheadedness while standing, known as postural lightheadedness, results from gravitational drop in blood pressure and is common among adults.

Greater sodium intake is widely viewed as an intervention for preventing lightheadedness when moving from seated to standing positions.

However, contrary to this recommendation, researchers at Beth Israel Deaconess Medical Centre (BIDMC) found that higher sodium intake, actually increases dizziness.

“Our study has clinical and research implications,” said Stephen Juraschek, researcher from BIDMC in Boston.

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Greater sodium intake is widely viewed as an intervention for preventing lightheadedness when moving from seated to standing positions. Pixabay

“Our results serve to caution health practitioners against recommending increased sodium intake as a universal treatment for lightheadedness. Additionally, our results demonstrate the need for additional research to understand the role of sodium, and more broadly of diet, on lightheadedness,” Juraschek said.

For the study, reported in The Journal of Clinical Hypertension, the team used data from the completed DASH-Sodium trial, a randomised crossover study that looked at the effects of three different sodium levels (1500, 2300, and 3300 mg/d) on participants’ blood pressure for four weeks.

While the trial showed that lower sodium led to decrease in blood pressure, it also suggested that concerns about lower level of sodium causing dizziness may not be scientifically correct.

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The study also questioned recommendations to use sodium to treat lightheadedness, an intervention that could have negative effects on cardiovascular health.

“Health practitioners initiating sodium interventions for orthostatic symptoms now have some evidence that sodium might actually worsen symptoms,” Juraschek said.

“Clinicians should check on symptoms after initiation and even question the utility of this approach. More importantly, research is needed to understand the effects of sodium on physical function, particularly in older adults.” (IANS)