Niti Ayog's (Tech assi. of World Bank + consultation from MoHFW) Annual Health Index - Based on 23 parameter major weightage given to mortality rate, total fertility rate, and sex ratio.

Kerla topped followed by AP and MH. Worst being UP followed by Bihar.

Devided in Large (Kerla topped), UT (Chandigarh topped) and Small (Mizoram topped)

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* Celiac decease evry 1 in 140 person in India also called wheat allergy

Is chronic inflammation in small intestine (damage villi ,small fingerlike projection that line the small intestine n promotes nutrients absorption) caused by gluten(general name for protien found in wheat,rye,barley n triticale - gluten acts as glue that binds the food together giving it's shape) and usually present genetically predisposed individual.

Celiac decease people are at 2 times greater risk of developing artery desease n 4 times greater risk of small bowel desease.

Only treatment is lifelong gluten free diet. Cereal such as wheat is high source of fibre n avoiding it can increase heart risk

* National strategic plan to eliminate TB by 2025 - to eliminate TB from India by 2025 with measures such as provide financial incentive to private sector care provider for reporting n ensuring TB patients complete the course, Direct benifit transfer to patients, n nikshay program.

GOI has signed 400$ deal with world bank to eliminate TB by 2025 with maturity period of 19 yrs n 5 year grace period.

Need for strategic plan - TB kills half mn people in India. Drug resistant TB is major health issue in India, millions are missing n undetected,low adherence to treatment, unregulated private sector n delayed care seeking by suspected TB patients.

TB types - MDR - TB & XDR - TB.

GLOBAL BURDEN - as per WHO 2018 GLOBAL TB REPORT - nearly half of the world's MDR-TB (24%) are in India. SDG 2030 to end TB.

* Vaccines included in the programme are for diseases including Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea

* WHO guidelines for self care in response to a report which says in By 2035 world will have short of 13 million people n currently around 400 million people don't hv access to healthcare.

In first volume it mention guidelines for sex n reproductive health which mention for self health check for HIV n other etc

Significance - right to health,autonomy n immediate intervention, accessibility.

* ICMR - “India: Health of the Nation’s States” report mentions, contribution to Death in india due to NCD's (Diabetese, hypertension Heart, and cancer) is 61.8% in 2016 than 37.9% in 1990.

Reason - Unhealthy diet, lack of physical activity, high blood pressure, high blood sugar, high cholesterol and overweight.

Govt steps - National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented under the National Health Mission (NHM), Jan Aushdhi Store, PM Swasthya suraksha yojna, Affordable Medicines and Reliable Implants for Treatment (AMRIT) in 159 hospitals/institutions.

* WHO guidelines to eliminate transfatty acid by 2023.

India has set target to eliminate the same by 2022. currently the limit for artificial trans fatty acid set by FASSAI is 2%.

According to WHO still many country has not put trans fatty acid limit which increases heart decease in millions of people.

In 2018 WHO has Launched REPLACE program for Industrially produce transfatty acid by 2023.

* Special laboratories for genetic disorder - under Human genetics n genome analysis program under DBT under min of science and technology.

As per Health min , 80% of rare health decease are genetic. Half of new cases n 35% death in children are below 1 yr, 15% btwn 1-5 n 10% btwn 5 to 15 yrs. According to govt report genetic decease is 2nd most responsible for child mortality.

* Immune Thrombocytopenia - Intas Pharmaceuticals (Indian drug maker) has launched an affordable drug Romiplostim (Romy) at 1/5th price of drug available in the market which was available internationally since 2008.
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder characterized by abnormally low levels or decrease of platelets (paletes keeps check on bleeding by clotting of blood)
Symptoms - Skin rash n that bruises easily, Red dots on skin, Bleeding of gums,nose and from urine,fecus etc, prolonged menstuation etc.
Cause - Genetic cause is still unclear, with no early symptoms unless the paletes count is very low. Own Immune system malfunction and attack body tissue and organs.
over 42k patients every year but only 10% have access to medication due to cost associated to maintain paletes

Laqshya scheme - Min of women & child dev = Program to reduce Mother (no of death per 1 lac women) and child mortality (per 1K) by providing proper labour room and infrastrucure with adequate staff. Quality is administered by National quality standard assurance.

India has reduced maternal mortality ratio (death of regnant women or within 42 days after pregnancy termination) from 167 in 2013/14 to 130 in 2014/16 by 22%.

* Rotavirus vaccine - govt is set to release rotavirus vaccine in many states from Sept 2019 (as per WHO 1st dose should be given to children btwn 4-6 weeks)

Rotavirus decease - diorrhea (dehydration), vomit, Severe dillemma, stomach pain & fever.

It is very contagious n can spread from child to child. Can spread if a child come in contact with fecus of child infected from rotavirus.

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The Rotavac has been introduced in India’s Universal Immunisation Programme (UIP) including Inactivated Polio Vaccine (IPV), Measles, Rubella (MR) vaccine, Adult Japanese Encephalitis (JE) vaccine, Tuberculosis, Diphtheria, Pertussis, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib)

Currently 2 vaccine are available Monovalent vaccine and Pentavalent vaccine.

* UN report, The State of Food Security and Nutrition in the World 2019 – More than 821 million people suffered from Hunger worldwide in 2018. Report Prepared by FAO + WHO.

Undernourishment – Undernourishment unchanged in last 3 years at slightly below 11% and posing great challenge in achieving SDG 2 .hunger on rise in Africa with 20% and despite great effort in south asia it is at 15%. It is projected that undernutrition will reduce GDP by upto 11% in Africa and Asia.

Breastfeeding – Only 40% which is well below SDG goal of 70% of children below 6 months age.

Low Birthweight – No progress in mreducing this since 2012. 1 in 7 live birth or 20 million babies suffered low weight in 2015.

Stunting – Declined by 10% in past 6 years. Africa & Asia accounted for more than 9 out of 10 globally stunted children.

Food insecurity – 2 billion people experience severe or moderate food insecurity. Women food insecurity is higher globally than men and gap is higher in Latin America.

Obesity – 40 million children under age 5 suffered from obesity in 2018 due to unhealthy diet (Fast food n coke etc.)

Anemia – 33% women in reproductive age which is double of target of 15% of SDG goal.

India Specific – Undernourishment declined from 22.2% in 2004-06 to 14% in 2016-18. However food insecurity increased from less than 11% in 2017 to 14% in 2018 (Himalayan region more vulnerable due to natural resource depletion which impacted food production and purchase power parity)

Suggestions- Reducing gender inequalities, creating synergy btwn poverty reduction, hunger and malnutrition. Support breastfeeding by policy, Healthy diet and awareness & counteract effect of economic slowdown.

* Ebola Virus Disease – Natural Host are Fruit bats of the Pteropodidae family

Recently WHO has declared Ebola (Democratic republic of congo) one of the 10 diseases as “threat of global health in 2019” to have technical and financial help globally.

Animal to human transmission trough blood, secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest.

Human to Human Trans – via direct contact (Blood or body fluids of sick dead person by ebola, Body fluid such as vomit, blood and Fecus)

Symptoms – Fever, Fatigue, muscle pain, headache, vomiting, diarrhea, impaired kidney/liver function and internal/external bleeding.

It is very difficult to distinguish Ebola from other deseases such as malaria, typhoid fever and meningitis but can be dignosed using Virus isolation, ELISA, Electron Microscopy, serum neutralization test, antigen capture and RT-PCR.

* National Action Plan for Drug Demand Reduction (NAPDDR) for 2018-2025 by min of social justice and empowerment - Focus on prevention, Treatment n rehabilitation and high vulnerable district.

Drug De-addiction Programme (DDAP) was initiated in 1988 under the Ministry of Health and Family Welfare.

Globally 3 approaches to Address the drug abuse - supply reduction, demand reduction n harm reduction.

* ICMR has Developed A strain for ades aegypti mosquito into which naturally occurring bacteria "Wolbachia" (commonly found abt 60% bacteria in vector species n safe for human n animals) is introduced to control the cases of chikungunya n dengue. This will reduce the replication of viruses which will prevent transfer of virus to human or animal n inturn will reduce the dengue cases N population decline which will replace the ades aegypti to Wolbachia called population replacement strategy.

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* Colistin Antibiotic – It is used for therapeutic purpose in veterinary but has been misused in Poultry industry as a growth promoter for prophylactic purpose by Health n welfare min under Drug and cosmetic act 1948 advised by DTAB.

It is last resort antibiotic for several critical care units but now they have become anti resistant to this drug. 95% are imported from China so it will be easy to regulate them. China is largest manufacturer of Colistin and it has banned this antibiotic to be used in poultry within its country.

* Trauma care center along national highways to bring down preventable deaths due to road accidents by developing pan india trauma care network.

WHO’s Global burden decease Project – According to this project Road Traffic accidents cause over 1.27 million deaths a year and can become 5th leading cause of death by 2030 if no precaution is taken.

90% of road traffic accidents happen in Low and middle income country which has only 48% of worlds vehicle.

In india road accident mortality n morbidity is highest having only 1% of total worlds vehicle cause 6% of total accidents.

* Kan sikul Kan huan (my school,my Farm ) in mizoram's Lawngtlai district has been role model to fights with shortage of fruits n vegutables in children.

* As per report from NATURE SCIENTIFIC REPORT South Asian are at more risk of developing diabetes type 2 than their European counterparts (even if they migrated to Europe and after 4 or 5 generations) considering present unhealthy diet. South Asian Hunter n gatherer had lean body mass n it unchanged after they migrated to Agriculture around 9k years ago.

Diabetes- diabetes happens when body INSULIN (which manages body glucose properly) does not manage body sugar properly (type 1 diabetes) or when body does not respond to INSULIN (type 2 diabetes called insuline resistance).

* Non-pneumatic Anti shock Garment ( used for pnemonic mother to prevent death after child born due to postpartum haemorrhage - excessive bleeding)

Successfully working in Gujrat where maternal death due to PPH was 30%

NASG applies pressure to the lower body and abdomen, thereby forcing the blood that was getting accumulated in the pelvic area to other essential organs of the body. Thus, NASG quickly stabilizes patient and gives enough time to doctors for treatment.

NASG is part of a local initiative named Sahara, by the district’s development officer (Arun Mahesh Babu) of Ahmedabad district in Gujarat. The officer has started the initiative in November 2018.

* Thyroid disease is a common problem that can cause symptoms because of over or under function of the thyroid gland. 10% local with thyroid n 8% with diabetes. https://www.drishtiias.com/images/uploads/158image2.webp

Hypothyroidism - underactive n less Prod of thyroid harmones.

Hyperthyroidism - overproduction of thyroid harmones

* Cataract - more women are to have cataract decease than men due to their social n economic condition.

Govt intervention - 'national program to prevent blindness n visual impairment in 1976 fully centrally sponsored.

Cataract - blury eyes , less colour vision, seeing 2 pics rather than 1, colour seems yellow.

* Cancer cases in india - As per study cancer cases in India will double by in next 20 years. It can be due to epidemiological transition level (ETL) as life expectancy is increase.

Significance- Healthcare, genetic screening n evolution puzzle.

Concern- discrimination while hiring, ownership of data n control, fair use.

Bhore n mudliar committee recommendation on creating multidisciplinary cancer treatment unit in all medical college n stand alone cancer speciality hospitals for Cancer prevention.

* Iodine - very vital micronutrients to human daily food which help in physical n mental growth n many other things.

Tamil Nadu being least consuming iodine state whereas j&k n NE being best among all states.

First of it's kind all India survey was conducted by Nutrition International (a not for profit agency based in Canada) in collaboration with the All India Institute of Medical Sciences (AIIMS) and the Indian Coalition for the Control of Iodine Deficiency Disorders (ICCIDD).

Survey says 73.6% population use inadequate iodine (less than 15 ppm in salt) in daily diet.

Govt in 1992 mandated use of iodine in daily human diet. Even SC in 2011 directed the same.

* TB India report 2019 - 21.5 lakhs people notified in Revised National TB control program (RNTCP) in 2018 - 16% increase from 2017.

Min of health n family welfare has launched TB Harega, Desh jeetega program.

Launched All oral regiment kit for MDR patients where they don't need painful injection which has side-effects too. Along with world bank collaboration of $400mn credit For 9 states.

* Bombay blood group - 1 in 4 million hv this type of blood group n in India 1 in 7600 to 10k (Asia having more due to its interbreeding n close group marriage)

Normally there are 4 types of blood group which is recognized if RCB having different antigen( A hvng A antigen, B hvng B, AB having both A n B n O doesn't have A or B but have H type) this is the only difference btwn O n H where O have H antigen bt Bombay blood deficient of H n can donate blood to all type.

* India joined Global anti microbial resistance and research dev hub which is supported by Secretariat in Berlin, Germany. Work of global AMR R&D hub is alligned to -

WHO, FAO and OIE (World org of animal health) to enforce One health approach.

* A report released by GLOBAL PREPAREDNESS MONITORING board (independent bodycreated in 2017 and Secretariat in Geneva) - global pandemic deseases may be growing & world isn't prepared for it.

Co convened by world bank and WHO. report titled "A world risk" has been authored by 15 global scientists and public health leaders, including India’s principal scientific advisor, Dr K Vijay Raghavan

- WHO tracked 1,483 epidemics in 172 countries between 2011 and 2018

- decease such as Ebola, Influenza, yellow fever, plague and Zika.

Reason - urbanization, Migration, climate change, widespread faster travel, Population and Conflict.

Possible Impact: A pandemic equivalent to the 1918 Spanish Flu could kill 80 million and wipe out nearly 5% of the global economy, devastating health systems and hitting low-resourced communities the hardest.
Indian Context: Handled Nipha & Zoonotic Influenza very well, but it is very vulnerable.

Solution - country preparedness improvement through money, research n health facility, global fund availability etc.

* Karnataka designated necotine as class A poison which is used in e ciggaretts.

Necotine is both SEDATIVE & STIMULENT. Nicotine use direct substance in e-cigarette and content range upto 36 mg/ml although regular cigarette contains 1.2 to 1.4 mg/ml.

Chewing n snorting Tobacco products releases more necotine in body than smoking.

Nicotine causes irritation, burning sensation in mouth n throat, increase salivation, nausea, abdominal pain, committing, diarrhea, cancer, increase blood pressure n pulse rate.

* As per WHO there should be 44.4 health Care staff for 1000 people.

National sample survey office records - 4.5 doctors in every 10k in private sector n 1 in 11k in public healthcare.

Nurses are 1.7 and required no is 3:1. 2.5 Midvives are required but only 1.3 million available

* Hepatitis B - mostly get transferred from mother to child, or when come in contact with blood or fluids.

Infect Liver n causes liver cancer n cause around 1lc premature deaths annually.

Recently Bangladesh, Bhutan,Nepal n Thailand is declared to have controlled hepatitis B. Which is there is 1% cases of hepatitis B cases among children below 6 years.

India - universal coverage program launched in 2002 n scalping up Nationwide in 2011 but around 1 mn gets infected to this chrnic annually.

Coverage is 60% as per health min due to unawareness of notification of WHO that vaccine can b used upto 28 days after opening.

Vaccine should be given to child b4 24 hours after delivery to avoid vertical infection.

* Shahariya tribe of MP have requested govt for treatment of silicosis instead of Tuberculosis.

Silicosis is common in Mining area due to exposure of dust particle of silica.

Silicosis is odourless, non irritant n doesn't cause immediate health issue N is incurable n can cause permanent physical problem.

Govt steps - Factories Act and Employees Compensation Act, which mandates employers must pay compensation to workers who are afflicted.

Factory Act of India (1948) mandates a well-ventilated working environment, provisions for protection from dust, reduction of overcrowding and provision of basic occupational health care.

Silicosis is notified decease under mines act 1952, Factories act 1948.

* National nutrition survey - 1st ever comprehensive national nutrition survey has been conducted by min of health n family welfare along with UNICEF by taking urine, blood sample as well.

Survey records not only micronutrients deficiency but also non communicable deceases such as heart attack, kidney n hypertension etc.

Report finding- co existence of obesity n undernutrition side by side among school going children.

- 10% children Among age group between 5 to 19 years are prediabetic.

- 5% Have overweight n another 5% have blood pressure issues.

-4% have cholesterol n 7% chronic kidney decease.

The National Nutrition Survey is different from the National Family Health Survey (NFHS) as,

NFHS collects data to measure the prevalence of stunting, wasting and underweight and household dietary intake to measure deficiencies.
Moreover, the survey collects data only for the age groups of 1-5 years and adults, and not for school going children between the age of 5 and 19 years.

Govt steps-

- mid day meal

- POSHAN Abhiyan launched in 2017-18 to reduce stunting, wasting n undernutrition etc.

- Pradhan mantri matru Vandana yojna - 6k transfer to pregnant women for nutritional support.

- national Food security act 2013 - food security for vulnerable community.

* penicillin - is cheapest option used for Rheumatic heart decease. Indians stopped manufacturing the drug due to high cost of manufacturing n low price for sell decided by govt.

Penicillin is first anti biotics drug discovered in 1924 by Alexander and still used as first line drug by many Western countries.

Drug was used to test wounded American souldiers during WWII.

Rheumatic fever n heart decease goes undignosed and cause many maternal deaths in India. It is endemic to india happens to be one of the major cause of heart decease accounting to 20 to 25% of heart decease.

2/1000 Maternal dealths due to this decease.as per ICMR report of children between 6-15 years - 6/1000 children have rheumatic deseases.

Cause: Rheumatic fever can occur after an infection of the throat with a bacterium called Group A streptococcus n is very common among 5-15 years old.

Govt steps - to boost the production of penicilin drug, govt has announced to procure the drug centrally for 3 years which will in turn encourage manufacturer.

* Intensified Mission Indradhanush 2.0, to mark the 25 years of Pulse polio programme. Aims to cover 90% immunization by 2022.

Mission Indradhanush was launched in 2014 n has increased immunization Coverage significantly to 87% From 67% in 2014.(official data of national family health survey - 4 reported 64% coverage of immunization)

Mission targets children below 2 yrs. provides vaccination against 12 Vaccine-Preventable Diseases (VPD).

* National health profile report by min of health n family welfare states that acute respiratory infection accounts for 69.47% of total morbidity.

It is highest in communicable decease accounts 27.21% mortality rate. Pregnant Women , children n old people are more prone to decease

* It is 1st tym new subtype of the Human Immunodeficiency Virus (HIV) called HIV-1 Group M, subtype L is discovered.

There r 2 type of HIV, type 1 n type 2. Type 1 is pandamic n mostly prevelant whereas type is is found in central n west African states.

* Lancet global health report observed that 23.5% of me in India are anaemic between 15 to 54 age group.

Globally 27% men are anaemic and 93% of them are from middle n low income countries.

Prevelance of anaemia on the scale of mild (18%) , moderate (5%) n severe (0.5%). This differ in states as well from 9% in Manipur to 33% in Bihar.

- geographical n economic cause is same for both women n men.

Anaemia - due to iron deficiency or vitamin B12 n A, chronic inflammation, genetic prob. Here red blood cells reduce or their oxygen carrying capacity decrease.

* world’s first multi-targeting and carbohydrate-based drug GV-971 for Alzheimer’s disease by China.

Made from brown algea can treat moderate to high Alzheimer decease.

- Alzheimer is progressive n irreversible brain disorder which slowly destroy memory n thinking ability to perform simple task. Mostly in old age people.

- China has highest population of this decease.

* World tuberculosis report by WHO annually since 1997 - India account 27% of total TB Burgen followed by China 9% n Indonesia with 8%.

TB cause 4k death everyday with highest death count desease.

MDR TB - highest burden with India 27%, China 14% n Russia 9%.

World tuberculosis report by WHO annually since 1997 - India account 27% of total TB Burgen followed by China 9% n Indonesia with 8%.

TB cause 4k death everyday with highest death count desease.. MDR TB - highest burden with India 27%, China 14% n Russia 9%.

* Aflatoxin-M1 - found in processed milk in India.

Aflatoxins are toxins produced by certain fungi which are generally found in agricultural crops like maize, peanuts, cotton seed and others. They are carcinogenic in nature.
Aflatoxin m1 in milk causes stunting in children

According to WHO food containng 1mg of aflatoxin in 1kg or above can cause Aflatoxicosis which can cause liver failure, lethargy, jaundice, nausea eventually leading to the death

Aflatoxin-M1 - found in processed milk in India.

Aflatoxins are toxins produced by certain fungi which are generally found in agricultural crops like maize, peanuts, cotton seed and others. They are carcinogenic in nature.
Aflatoxin m1 in milk causes stunting in children

According to WHO food containng 1mg of aflatoxin in 1kg or above can cause Aflatoxicosis which can cause liver failure, lethargy, jaundice, nausea eventually leading to the death

* National Diabetes & Diabetic Retinopathy Survey India 2015-19’ and on ‘National Blindness & Visual Impairment Survey India 2015-19’ were released.

Major findings of the survey in India are:
- One in eight persons above 50 years is Diabetic,
- One in every 46 diabetics is Blind; and
- One in seven suffers from some form of visual impairment due to high blood sugar levels.

* National Health Mission seeks to ensure the achievement of the following indicators:

Reduce Maternal Mortality Rate (MMR) to 1/1000 live births
Reduce Infant Mortality rate (IMR) to 25/1000 live births
Reduce Total Fertility Rate (TFR) to 2.1
Prevention and reduction of anaemia in women aged 15–49 years
Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases
Reduce household out-of-pocket expenditure on total health care expenditure
Reduce annual incidence and mortality from Tuberculosis by half
Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
Annual Malaria Incidence to be <1/1000
Less than 1 per cent microfilaria prevalence in all districts
Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

* Antibiotics- antibiotics is chemical produce by microorganisms which inhibits it's growth or could destroy it.

Narrow spectrum antibiotics - which targets only certain organism n do not affect the normal microbial Flora.

Bacterial antibiotics - which multiplies itself effectively n affect the normal life of organism.

* Lancet global health report mention Different states are having different reasons for premature death. With 9.7 million premature death in the country due Years lost to Life.

1. Suicide- most common in southern states such as tamilnadu j kerla accounting 15% of it's deaths burden

2. Cancer - northern states such UP, HP etc accounts 44% of YLL.

3. Road traffic n related injuries - again mother states like UP accounts for 33%.

4. Liver n alcohol - north east n Bengal Bihar etc accounts for 18%.

DALY and YLL

DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences
Simply, it can be written as DALY= YLL+YLD.

* Lancet report - it states that children will bear the most burden of climate change due to mulnutrition caused by high prices of food n lower production if it is not kept well below 2 degree celcius.

- Wheat n rice production is already declined by 2% since 1960.

- Vibrio bacteria may increase which causes Cholera rising 3% a year due to warm climate.

- diarrhea may spread deadly n heat wave will become norm. Can reverse the Govt gain in last 50 years.

* Fluorescence n GeneXpert (also tells if bacteria can resist Rifampicin drug) is used for TB bacteria diagnostic.

CLR SeeTB will now b used since it finely Saperated the sputum which gives better result in diagnosing the bacteria than other 2.

India has largest number of TB patients in the world n target to eliminate TB by 2025. WHO target for same is 2035

* International diabetes federation released diabetes Atlas.

Accounts for 10% of health expenditure.

1 in 6 diabetes person are in India with 2nd largest diabetes patient country in world after China till 2045.

TYPES OF DIABETES

Type 1 - Insulin stops working which is a harmones made by pancreas n it transfer glucose from our food to cells for energy. Insulin needs to b taken everyday.

Type 2 - Insulin stop performing it's tsk n this contains 90% all diabetes.

Women while pregnancy which go eventually after baby is born. But they are prone to develop type 2 later in future.

* Scizophernia - desease which impacts people's ability of thinking n act n lose touch with reality.

Causes r unknown n treatment consist of Eliminating the symptoms.

* Min of health and family welfare has launched campaign social awareness and action to nutrilise pneumonia (accounts 15% death if children under 5 annually) in gujrat.

Drug Amoxycilin will b given to child and Pulse oxymeter device to check if oxygen is less in blood of children.

Steps taken by govt - Target of reducing child death to 3 in 1000 by 2024.

- Integrated Action plan for prevention n control pneumonia n Diarrhea (IAPPD) in 2014 to reduce both under 5 children.

- vaccination program of 13 vaccine include pneumonia as well.

* Water quality report analysed by Beauro of Indian standard n published by min of Consumer affairs, food n distribution.

This analyse the Tap water quality based on few parameter. This is in line with mission jal Shakti which aims to provide tap water to all household by 2024.

- Mumbai tap water is safest while Delhi is worst failing in 19 out of 29 Parameters.

Way forward

1. Legally binding to have all parameter checked

2. Integrated view by state govt over housing, sanitation, waste mgt n drinking water etc.

3. Scientific approach for water conservation.

4. Separate agengy to test water quality regular basis

5. Regular data release same as air quality on water.

Recent Study shows that more than 2/3rd of Surface water (Rivers) are contaminated by heavy metal and doesn’t meet BIS standards. Iron is leading in all river and Zinc in no water System.

* National Institute of Sowa-Rigpa at Leg, ladhakh - Autonomous National institute under Min of Ayush will act as an Apex body in the country for all other existing or new Sowa rigpa institute. Currently Sowa rigpa works under min of culture.

Sowa - Rigpa - it is science of healing practiced in Himalayan belt n majority of theory n practice same like Ayurveda. Originated in Tibet and practiced in India, Nepal,China, Mangolia,Russia n Bhutan.

Yuthog Yonten Gonpo from Tibet is believed to be the father of Sowa Rigpa.

* UNICEF solution 2 reduce child stunting-

1. Mother education

2. Remove open dedication n sanitation

3. Rich diet

* Bhartiya POSHAN krishi kosh ( BPKK 2019) launched by MoWCD with Bill and milinda gates foundation.

Divided India into 15 Zones (128 climate zones) based on agro climatic region to have better nutition level in the country.

MS swaminathan 5 points

1. Ensure awareness abt nutrition specially mother with child less than 100days.

2. Ensure calories Rich diet to mother, expecting mother n children.

3. Ensure Protien rich food intake such as pulses.

4. Eradicate hidden hunger due to deficiency of Vitamin A, B, Zinc n Iron. - SDG 2

5. Ensure clean drinking water and sanitation. - SDG 6

* TB research finding of Anti drug resistance TB bacteria by Bengaluru scientist - Microphages (type of white blood cells) when get infected by pathogens ( virus or bacteria) as a first line of defence reduces pH level in body I.e making pH acidic.

Under this circumtances few bacteria survive in and around Microphages which multiplies the bacteria against the previous notion that only non replicating n weak bacteria are resistant to TB drug.

Solution - researcher suggested that with combination of Cloroquine (nutralize the pH level which doesn't protect bacteria from Oxidative stress - used for TB removal ) with Isoniazid (eliminate the TB after Cloroquine effect) in Microphages. It can eliminate TB in 2 months instead of usual 6 months.

* Measels and rubella - 10 mn cases in the world n 142k death. WHO recommend 95% n above coverage whereas coverage in 2018 was 86% for 1st dose n 69% for 2nd. India has reported 72k cases of Measels in 2018-19 making it 3rd largest country in the world. India has 2nd highest unvaccinated children only after Nigeria with 2.3 mn unvaccinated childrens.

Recent study says children of 3 months are susceptible to Measels than what was though earlier of 6 months.

Measels happens only among human n not animal. It is respiratory decease N is enveloped RNA virus of family Morbillivirus.

* World maleria report by WHO - globally maleria cases has been reduced from 71 cases per 1000 population to 57 per 1k. Deaths also decreased.

India also has seen reduction.

Global steps - Global technical strategy for maleria, 2016-2030.

High burden to high impact in countries where maleria cases are high.

India's step- national strategic plan for maleria elimination (NSPME 2017-22)

2. National framework for maleria elimination 2016, which is in line with WHO's global technical strategy for maleria, 2016-2030.

3. ICMR's Maleria elimination research alliance India (MERA India) initiative.

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