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Indias public health and nutrition efforts are differentiated by an enterprising early start going as far back as 1975 with the beginning of Anganwadi centres and Integrated Child Development Services (ICDS). Lauding this strong, continued focus on maternal and child nutrition, experts specialising in India’s nutrition space prescribe integration of three key factors like quality of services, convergence of healthcare services at the household level, and strategic use of data at various levels to improve program implementation, that could further advance public nutrition service delivery in India.
Committed to a malnutrition-free India, the country’s robust public health and nutrition infrastructure has positioned dedicated frontline workers as its pillars, making it one of the few countries to achieve this scale and intensity of human resource support. For every 1000 population, there is one Accredited Social Health Activist (ASHA), one Anganwadi Worker (AWW) and one Anganwadi helper, and one Auxiliary Nurse Midwife (ANM) for approximately every 5000 population. Under the Poshan Abhiyaan, key public programs and outreach schemes make nutrition-based interventions to lift nutritional well-being for all.
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“India has a well-funded program for various nutrition-specific and sensitive interventions covering the entire country. During the POSHAN Maah (Nutrition Month) there was reiteration to continue focusing on the basics of prevention of maternal and child undernutrition and focus was also brought on new areas, such as children with Severe Acute Malnutrition (SAM) and promotion of locally-sourced nutrient-rich foods grown in kitchen gardens. Food fortification, too, has gained good momentum in India over the last few years. I feel a larger number has been added to the people consuming fortified products in the world from India, than any other country in the last few years. India has almost everything (policies, human resource, funding and political will) in place in terms of what needs to be driven and the focus now more than ever before has to be on strengthening the implementation,” shares Dr Alok Ranjan, Country Lead (Nutrition), Bill and Melinda Gates Foundation.
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Setting foundations of health and cognitive development in a child, the first 1000 days (from pregnancy to first two years of life) are often neglected, visible in the abysmally low levels of minimum adequate diet received by children between 6-23 months of age, as shown by the 2016-18 Comprehensive National Nutrition Survey (CNNS). Failure to nourish the mother-child dyad in accordance with the five components of Poshan — the child’s first 1000 days, anaemia prevention, diarrhoea management, nutritional foods and WASH (water, sanitisation and hygiene) — can set back the healthy physical and cognitive development of a child. At the macro level, undernutrition impairs public health levels and the future of a nation.
Highlighting the multi-sectoral aspect of nutrition, Dr Ranjan builds on his experience like the Polio, Routine Immunization and Vitamin A supplementation work in states like Bihar and Uttar Pradesh, and points out that the nutrition program implementation can borrow few key factors from successful public health programs like polio, routine immunization and vitamin-A that could aid transforming India’s nutrition landscape – such as improving the quality of services and using data for improving program implementation, along with ensuring the convergence of service delivery for the core target of mother and child.
“In the maternal and child health program, globally as well as in India, quality of intervention is already a priority focus area. There’s no similar momentum around quality of nutritional intervention globally or in India. As the coverage numbers are increasing with the Poshan Abhiyaan, we need to start looking at it, right from the quality of training frontline workers, to quality in food supplementation as well as quality of the counselling sessions at anganwadi centers or during home visits. Thus, focus on improving the quality at all levels would go a long way in helping us achieve our nutrition targets,” says Dr Ranjan. As an instance, the expert points to ensuring quality of counseling the mother receives, from the day her registration is done under both Health and ICDS systems for various Antenatal services.
“Community and household counselling, if not done properly, will not lead to the kind of impact we are aiming for. For instance, if iron and folic acid (IFA) supplementation tablets have been made available till the last mile in a village and are distributed to pregnant women then they must also be counselled adequately around how and when to consume those tablets, what side effects they should be aware of, what is the benefit of these tablets for them and their next generation. Just the way we expect focused and detailed counselling when we take any of our family members to a private practitioner, similarly in the public health setup, just ensuring supply is not enough. Counselling with time and quality can have a profound impact,” he shared.
Want to read more in Hindi? Checkout: डीडीएलजे के 25 साल पूरे होने पर शाहरुख ने कहा कुछ ऐसा
According to Thomas Forissier, Director Programs, South Asia, Alive & Thrive (FHI 360), increasing the coverage of nutrition-related services and benefits is often the first step, but increasing the coverage of high quality services and benefits is the necessary second step.
“There is no alignment on a simple definition of quality. Most experts would agree that quality involves the right inputs: infrastructure, training of frontline workers, commodities, etc.; the right processes: providing key advice to families on how to nourish pregnant women and children, weight and height measurements, provision of various foods and micronutrients, etc.; and the right outputs: starting with client satisfaction. But none of those experts are likely to agree today on how all of those items fit together, which ones are more important. It is critical for the nutrition community to define what is the quality of nutrition services and benefits and how to measure it as soon as possible. And then to start using those measures in the field,” says Thomas Forissier.
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Dr Ranjan also emphasises on strategic use of data, such as data from supervisor’s field visit, regular MIS systems of various departments, national surveys like National Family Health Survey etc. and to use these data for identifying actionable next steps at various levels like at national, state, district, project, village and household level. Also given the fact that most of the nutrition focused messaging is around behaviour change (like breastfeeding, diet diversity, IFA consumption etc) it is important to go beyond one-time messaging for high impact and effective social-behavioural change. “The same messaging needs to be delivered repeatedly to the household, through all touchpoints – mass media, radio, advertisements, local newspapers, self-help groups, opinion leaders, Anganwadi workers, helpers, ASHAs, and ANMs.”
For convergence of health and nutrition services at the household level for the mother-child, Dr Ranjan suggests the dyad should get easy access to services like including immunisation, take-home ration, PDS ration, IFA tablets, safe drinking water, proper hygiene, counseling on maternal diet and best feeding practices, during the golden 1000-day window of opportunity (from conception to her second birthday). “For improved nutritional status and to meet Sustainable Development Goal 2: ï¿½Zero Hunger’, it is crucial to converge all efforts at the household level. The convergence action plans at national, state, district, block and even community levels, must put convergence at the household level of all mother-child nutrition services at the centre of these plans. If we do all this with quality, we’d have an accelerated improvement in the nutrition indicators and reduction in undernutrition.”
“Convergence of services starts to matter when you look at it from the perspective of households. Did they get all the nutrition-related services and benefits that they are eligible for? Did they get antenatal care services from health, take-home rations from ICDS, nutrition counseling from both, food from the PDS, employment benefits from MNREGA, IFA from Health or at school? Do they have running water and hygiene facilities? Today, few families get the full set of nutrition-related services and benefits they should receive. The only way to change that is to stop thinking about services, and start thinking about families. In mature states, measuring and acting on household convergence should be prioritized at all administrative levels. In less advanced states, involving Panchayat Raj Institutions or other groups to drive accountability of the system to collectively service individual families is a good start,” opines Dr Forissier.
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Another expert, Dr Shailesh Jagtap, Senior Technical and Program Advisor with Alive & Thrive, concurs that a paradigm shift on use of data for decision making for systems improvement at each level of system, would be a game changer.
“There is an important saying that – that which gets measured gets implemented. There was a time when data on nutrition was scarce and now with investments in POSHAN Abhiyaan we are moving towards abundance. Administrative data from ICDS and Health departments presents real time data on POSHAN Abhiyaan program interventions and HMIS (Health Management Information System) from the health department having nutrition indicators provides an opportunity for improving the nutrition program service delivery. Apart from the routine data collection systems which focuses on outcome data it is important to have data on the quality components of service provision through regular Quality Assessments of the POSHAN Abhiyan program which provide valuable insight for service delivery improvements. The system now needs to gear up on how this data is being used,” Dr Jagtap shares.
Under the POSHAN Ke 5 Sutra’, the focus has been on the absolute critical components for prevention of undernutrition. And one cannot overemphasize the need to prevent mother and child from getting undernourished, because once they become undernourished we will always be busy treating them rather than fixing the problems that led them to become undernourished in the first place. Unless we fix those underlying factors mother and child will continue becoming undernourished. Giving the example of an open tap, our first focus has to be to close the tap first (prevent mother and children from becoming undernourished) or else we will keep mopping the floor for years to come (keep treating those who have become undernourished) as more and more mother and child will keep getting undernourished unless we prevent them from getting to that stage, concludes Dr Ranjan of BMGF. (IANS)
There will be no chief guest at the Republic Day parade this year also as the plan to host state heads of five Central Asian countries -- Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan -- seems to have been cancelled due to the Covid situation in India as well as in the respective nations. Though the Ministry of External Affairs is yet to confirm this officially.
If the guests arrive, then this would be the second time when India hosts a group of state heads as the chief guests on the Republic Day. In 2018, state heads of ASEAN countries graced the occasion with their presence. Apart from Kazakhstan, none of these countries' state heads had been invited as the chief guests on the Republic Day. In 2009, Kazakhstan's then president Nursultan Nazarbayev was the Chief Guest.
The Government of India is in no mood to take any risk to invite any foreign guest. Mitul Gajera / Unsplash
As per sources, due to the corona situation, the Government of India is in no mood to take any risk to invite any foreign guest, so the plan seems to have been cancelled. Last year, British Prime minister Boris Johnson was invited for the same, but later cancelled due to rising corona cases in the UK.
In the past, there have been occasions when the Republic Day ceremony was celebrated without any foreign guest. In 1966, there was no foreign chief guest in the Republic Day parade ceremony as the then Prime Minister Lal Bahadur Shastri had passed away in Tashkent in January, and Indira Gandhi took oath as Prime Minister on January 24. (IANS/SP)
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A team of scientists from the Banaras Hindu University (BHU) have found a cure for those suffering from chronic wounds, particularly with diabetic foot ulcers. The team led by Prof Gopal Nath of the department of Microbiology, Institute of Medical Sciences, said that wounds that took months and years to heal, could now be cured in days or months. The findings of study have been published in the National Centre for Biotechnology Information, National Institutes of Health, US.
Prof Nath said that a wound is defined as a breach in the skin or body tissues due to injury. An acute wound is defined as a "recent break that is yet to progress through sequential stages of healing". The wounds where normal healing process is stalled due to underlying pathology (vascular and diabetes) or infection beyond three months is defined as chronic wound. While chronic wounds always get infected, the contaminated wounds are reasonably susceptible to infection.
A significant improvement could be achieved in the form of complete wound epithelization within a few weeks.Towfiqu barbhuiya / Unsplash
Infection with antibiotic-resistant bacteria and biofilm formation halt healing progress. These wounds cause significant psychological and physical morbidity. The traditional treatment strategies often succeed in healing wounds, he said adding that many wounds have been observed recalcitrant to them, leading to persistence and recurrent infections. Search for alternatives to antibiotics has now become a compulsion. Fortunately, bacteriophage therapy is a re-emerging solution to antibiotic-resistant bacteria.
Prof Nath's team carried out phage therapy of acute and chronic infected wounds in animals and clinical studies. It showed efficacy against Pseudomonas aeruginosa in a mice wound model. Furthermore, they evaluated the efficacy of phage cocktails in animal models' acute and chronic osteomyelitis caused by methicillin-resistant Staphylococcus aureus. They also observed biofilm eradication from K wire in rabbits' wound infection model. Clinical trials of phage therapy initiated by the BHU have reported the efficacy of topical phage in healing chronic wounds in three prospective exploratory studies and no adverse events mimicking the results in vivo animal models.
Scientists have found a cure for those suffering from diabetic foot ulcers. Unsplash
A clinical study by Gupta demonstrated the significant role of bacteriophage therapy in the chronic wounds associated with antibiotic-resistant bacteria. The study employed a total of twenty patients with chronic non-healing ulcers for more than six weeks duration. A significant improvement could be achieved in the form of complete wound epithelization within a few weeks. Another study, employing 48 patients having a minimum of one eligible full-thickness wound that did not heal in six weeks with convention wound management, showed the promising result, and significant improvement was observed in the wound healing.
The study projected that specific phage therapy is equally effective regardless of the diabetic or non-diabetic status of the patient though the healing was relatively delayed in diabetic patients. Another successful study has shown encouraging results on healing process of infected acute traumatic wounds. The average number of days required for complete granulation of wounds and attaining sterility and healing was half compared to conventional therapy. (IANS/SP)
(Keywords : scientists, cure, chronic, wound, suffer, ulcer, diabetes, healing, pathology, health, infection, bacteria, study, patient, therapy, successful.)
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By Anna Melnikova
The Indian cricket lovers have been waiting for a ton from Virat Kohli for a long time, and he finally has made it. However, not in the batting as most fans expect, but in catching balls.
The second day of the 3rd Test in Capetown between local Proteas and the Men in Blue was rich for interesting occasions. Thus, South Africa was waiting for a good scoring result after stopping all Indian batters on the first day. Their opponents, however, have been looking for nice bowling not to lose the game just in the first innings. And while Bumrah added five wickets to his score, one of the dismissals should go to Virat Kohli. By the way, if you want more cricket news in India, we recommend subscribing to the specified site using the link.
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The legendary captain was great in batting but now can not score a ton for more than two years. But the three-digit result came from another side, where he is also quite successful. And while most of his catches came from opponents' misses, he proved he can be effective in the outfield parts of the pitch. According to experts, Kohli has a unique ability to be energetic on the pitch and still be concentrated for long shots by opponents, which rarely come in Test format.
Kohli has a unique ability to be energetic on the pitch. Unsplash
Even a legendary Gavaskar, who was the first Indian with such a result, praised the ability of the recent captain to catch. He admitted the ability to grab slipping balls, which are hard to cope with. Interestingly, Virat became only the sixth Indian to achieve a milestone in this component in the Test format. Kohli needed 99 games to find the needed number, although he is focused on making the 28th century first of all.
Another three-digit achievement can happen just today. He opened the 3rd day of the Test in Capetown along with Pujara and stayed alive at the moment of writing this article. If you are fond of sports betting, we recommend that you go to the rating of sports betting sites in India and choose a reliable bookmaker.
(Disclaimer: This is a sponsored article and includes some commercial links.)
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