National Health Program Research Articles

Identification and critical appraisal of evidence for interventions for refractive error to support the development of the WHO package of eye care interventions: a systematic review of clinical practice guidelines.

PurposeThe World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes. Interventions included in the PECI should be based on robust evidence where available. Refractive error is a leading cause of blindness and vision impairment and is a PECI priority condition. The aim of this study was to provide high‐quality evidence to support the development of the PECI by identifying and critically appraising clinical practice guidelines (CPGs), and extracting recommendations for refractive error interventions.MethodsWe searched for CPGs on refractive error published in the last 10 years. We conducted the searches initially in February and March 2019 and repeated them in March 2020. We evaluated the quality of potentially relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.ResultsWe identified 12 high‐quality CPGs relevant to refractive error, written by six organisations from three high‐income countries. Organisations used a variety of frameworks to assess the strength of recommendations based on available evidence, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) being most common. Vision screening for children aged 3 to 5 years was recommended consistently. Evidence for screening and eye evaluations at other ages was weaker, although ophthalmic professional organisations consistently recommended regular evaluations. Recommendations on optical and laser correction of refractive error were limited and did not consider implications for low resource settings. Interventions for slowing myopia progression in children were recommended, but these will need regular updating as new evidence emerges.ConclusionsCurrent high‐quality guidelines on refractive error have been formulated in high‐income countries. Recommendations focused on prevention and treatment of refractive error in low‐and middle‐income countries are lacking. Regular updating of systematic reviews and CPGs is essential to ensure that robust evidence is promptly appraised and incorporated into recommendations for eye health care practitioners.

Levels, trends and socio-demographic determinants of infant and under-five mortalities in and around slum areas of Dhaka city, Bangladesh

Infant and child mortality are often used to monitor the progress of national population health programs. The data for this study was collected from selected urban slums where icddr,b has maintained the Health and Demographic Surveillance System (HDSS). Using the HDSS database, 6,666 married women were selected and interviewed in 2018 to collect data on socioeconomic status, pregnancy history and safe motherhood practices. The study examined levels and trends of infant and under-five mortality for three periods: 1990–1999 (Period 1), 2000–2009 (Period 2), and 2010–2018 (Period 3) and examined socio-demographic differentials of infant and under-five mortality for Period 3. From Period 1 to Period 3, under-five mortality declined by 68.2%, with child mortality (1–4 years) declining more than infant mortality (84% vs. 65%). In the regression models for Period 3, infant and under-five mortality were higher for working than non-working mothers (infant: OR = 1.35*, CI: 0.98, 1.86; under-five: OR = 1.34*, CI: 0.99, 1.82), lower for girls than boys (infant: OR = 0.77*, CI: 0.57, 1.03; under-five: OR = 0.77*, CI: 0.58, 1.03), higher for small-size than normal/big-size babies (infant: OR = 4.11***, CI: 3.00, 5.64; under-five: OR = 3.68***, CI: 2.70, 5.02), higher for babies delivered vaginally than by caesarean section (infant: OR = 1.79**, CI: 1.14, 2.97; under-five: OR = 1.87***, CI: 1.21, 2.88), higher for babies delivered with complications than no complication (infant: OR = 2.16***, CI: 1.48, 3.15; under-five: OR = 2.21***, CI: 1.55, 3.18), and higher for babies born after a short (<24 months) birth interval (infant: OR = 1.71*, CI: 0.96, 3.05; under-five: OR = 1.63*, CI: 0.93, 2.86) than firstborns. While substantial progress has been made in reducing under-five and infant mortality, neonatal mortality have declined less slowly. Targeted population health interventions addressing the socio-demographic drivers of infant mortality, with a focus on the urban poor, will help Bangladesh achieve Sustainable Development Goal 3.

Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool.

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan. Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations. Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps. Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

School Health and Nutrition Monitoring: What Practitioners and Policy Makers Can Learn from China

School Health and Nutrition Monitoring: What Practitioners and Policy Makers Can Learn from China

Prevalence of and factors associated with dental service utilization among early elderly in Lithuania

BackgroundThere is no recent information about dental service utilization (DSU) among elderly in Lithuania. We examined DSU and its associated factors in Lithuanian early elderly based on the Andersen’s behavioural model.MethodsThe cross-sectional study conducted in 2017–2019 included a nationally representative stratified sample of 370 Lithuanian early elderly aged 65–74 years (response rate of 54.5%). Information on predisposing factors (age, sex, nationality and education), enabling factor (residence), need-based factors (status of teeth, oral pain or discomfort, and dry mouth), general health, personal health practices and perceived stress was obtained from a structured, self-administered questionnaire. Clinically-assessed need-based factors included number of missing teeth and dental treatment need. Multivariable Poisson regression with robust variance estimates was used.ResultsA total of 239 study participants (64.6%) reported a dental visit during the last year and 338 (91.4%) needed dental treatments. A higher level of education (adjusted prevalence ratio [aPR] = 1.21, 95% confidence interval [CI]:1.04–1.40), pain or discomfort in teeth/mouth (aPR = 1.35, 95%CI: 1.13–1.62) and lower number of missing teeth (aPR = 0.99, 95%CI: 0.98–1.00) were associated with DSU.ConclusionsEven though majority of early elderly needed dental treatments, only two-thirds visited a dentist during the last year. Predisposing and need-based factors were significant predictors of having a dental visit in the last year. A national oral health program for Lithuanian elderly with the focus on regular preventive dental check-ups is needed. More studies, both quantitative and qualitative, are warranted to investigate in depth the barriers for DSU among elderly in Lithuania.

A Review of the Coronavirus Outbreak and its Effects on India's Natural Environment

The phrase “coronavirus” was, without a question, the most googled and uttered phrase in the past three years. As the spread of the coronavirus (COVID 19) has increased, various countries had imposed a lockdown that restricted human mobility, and a ban on all types of social activities. This also influences various economic activities. With all the financial and health concerns, the influence of the pandemic lockout on the natural environment was something that the scientific community should be concerned about. The influence of many significant good and evil effects on the environment in several areas of India is reviewed and discussed in this paper. Different regions in India showed an improvement in air quality, a decrease in noise pollution, and wildlife more pleasant and relax than before. Aquatic ecosystems revealed indications of restoration. On the other hand, the rise in plastic waste like personal protective kits (gloves and masks), biomedical waste, disinfectants, and their mismanagement have long-term terrible impacts on the environment. However, as India gradually returned to pre-pandemic conditions, the positive environmental effects will fade as festivals, public transport, growing production, and agricultural activities may raise pollution to critical levels. Hence, Pollution Control Boards and National Health Programmes should integrate the approaches acquired during the pandemic to help foster social cognitive lifestyles, policy interventions, and the development of advanced smart cities that will safeguard individuals from pollution.

The Associations of the National Health and Productivity Management Program with Corporate Profits in Japan

The Associations of the National Health and Productivity Management Program with Corporate Profits in Japan

Application of modern approaches in the screening and early diagnosis programs for the orphan diseases

Orphan diseases have a prevalence ranging one patient per 10.000 population in the Russian Federation to one per 1500-2000 individuals in Australia and the USA. Many orphan diseases lead to a severe decrease in quality of life and high mortality. In this article, we discuss the problem of early diagnosis in orphan diseases in the Russian Federation, which has lagged behind global trends towards improved recognition and treatment of orphan diseases. We identify the need for improved focus at the level of national healthcare, while discussing relevant issues arising from the international experience. We review national and regional health programs and healthcare practices of Australia, Germany, Denmark, China, Norway, Slovenia, UK, and the United States, with a focus on screening and diagnosis of orphan disease. We also present a review on the state of affairs in the Russian Federation. Orphan diseases are amenable to current molecular-genetic and other diagnostic technologies, including targeted, whole exome and whole genome sequencing (targeted NGS, WES, WGS) using next generation sequencing technologies (next generation sequencing, NGS) and tandem mass spectrometry (TMS, MS/MS). We conclude with a call for major measures aimed at improving the diagnosis of orphan diseases, in particular through the expansion of the neonatal screening program, the creation of a network of orphan disease referral centers, and centralized management of patients registers.

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans.

In 2016, the California Department of Healthcare Services (DHCS) released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. We assessed fidelity through semi-structured interviews with MCP health educators (N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers' identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. In 2016, the California Department of Healthcare Services (DHCS) in California released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.

Public health dentists as nodal-officers for effective implementation of national health programs - A proposed model

Public health dentists as nodal-officers for effective implementation of national health programs - A proposed model

Changing Trends of Maternal Mortality in a Rural Medical College in Eastern India: A 23-Year Retrospective Study

Introduction: Maternal mortality in a region is a measure of reproductive health of women in that area. The direct causes of maternal deaths are largely preventable. A new era of more comprehensive, international development agenda-the Sustainable Development Goals (SDG 3.1) was launched by the United Nations General Assembly 2015, New York for ending preventable maternal deaths. Aim: To determine the causes and changing trends of maternal mortality in this rural centre. Materials and Methods: A retrospective observational study was carried out in the Department of Obstetrics and Gynaecology of Bankura Sammilani Medical College in West Bengal in Eastern India. Individual hospital records of all the maternal deaths, from January 1998 to December 2020 were collected. Data regarding demographic profile and reproductive parameters like gravida, parity, antenatal care and cause of death were collected. The records were divided into two four yearly periods, to compare the changing trends (1998-2001) vs (2017-2020) and three five yearly (2002-2006), (2007-2011), (2012-2016) periods. The first term (1998-2001) was taken as the reference period. Results: Comparison between first (1998-2001) and last term (2017-2020) shows significant declining trend of Maternal Mortality Ratio (MMR) (364 vs 148)/100000 live birth (p-value &lt;0.00001). Majority of deaths occurred in primigravida (57.5% vs 60.6%). Direct obstetric causes accounted for majority of the deaths, but with a declining trend (74.7% vs 66.7%). Eclampsia remained the leading direct cause (35.5% vs 32.2%) followed by haemorrhage (20.4% vs 18.8%) and sepsis (18.8% vs 15.7%) in the first term (1998-2001) vs last term (2017-2020). Jaundice 6.45% vs 10.3%, heart disease 2.15% vs 7.1%, embolism 4.3% vs 0.8%, anaemia 6.45% vs 1.6% and other diseases 5.91% vs 13.4% in the first vs last term were the indirect causes of maternal mortality. Conclusion: There is a declining trend of maternal mortality since 1998, which can be attributed to improvement at all levels of healthcare. Eclampsia/preeclampsia and its complications remain the leading cause of maternal mortality. Majority of these maternal deaths can be prevented by regular screening of highrisk cases, integrated antenatal and postnatal care, institutional deliveries, timely referral, and proper implementation of national health programmes.

COVID-19 and Unmet Medical Needs for People With Chronic Diseases: A Cross-Sectional Study.

Gaps between medical needs and health services accessibility are defined as unmet medical needs (UMN). Previous studies assessing UMNs during the coronavirus disease 2019 (COVID-19) pandemic did not account for factors such as the type of medical insurance or chronic disease. Therefore, this study investigated various factors, including medical insurance and chronic diseases, affecting self-reported UMN during the pandemic in Daejeon Metropolitan City, South Korea. This cross-sectional study was conducted using Daejeon Metropolitan City Health Surveys data from 2020. The weighted prevalence of UMN was estimated among participants (n = 1494) aged ≥18 years, while chi-squared and logistic models were used to assess the association between UMN and participant characteristics. The prevalence of UMN was 6.4% (n = 97). Female sex and low education levels were significantly associated with reporting UMN. Medical aid beneficiaries were less likely to report UMN than adults with National Health Programs coverage. Participants with chronic diseases, such as hypertension and arthritis, and those with depression, were more likely to report UMN than adults without these conditions. The findings highlight the need for targeted efforts to decrease UMN in the COVID-19 pandemic, especially for women and individuals with low education levels. The results also indicate that high-risk disease groups should be targeted with additional enabling services to support the management of chronic conditions.

Integration of TB into child health policies in Africa's high-burden countries: a normative analysis.

Integration of paediatric TB care into decentralised child health services has the potential to reduce the large proportion of childhood TB that remains undiagnosed. We performed a review of national guidelines and policies for TB and child health to evaluate the normative integration of paediatric TB into existing child health programmes in 15 high TB burden countries in Africa. While integration is addressed in 80% of the national strategic plans for TB, the child health strategies insufficiently address TB in their plans to reduce child mortality. Emphasis needs to be put on multi-sectoral collaboration among national health programmes.

Türkiye’de 25-64 yaş kadınlarda idrar kaçırma : kesitsel bir araştırma

Objective: The study aimed to determine the prevalence of urinary incontinence (UI) in a representative sample of women living in Turkey at the national level and to investigate predisposing factors. Methods: A cross-sectional study was conducted nationwide on women aged 25-64. Women were selected from Family Physicians' lists using random sampling. For data collection, a valid Turkish questionnaire; the international incontinence questionnaire - short form (ICIQ-SF) was used. An ICIQ-SF questionnaire is a form of inquiry that assesses the presence and severity of urinary incontinence and predisposing factors were Results: A total of 1,179 participants took part. The median age was 43±10.8 years. “Do you always leak urine?" the prevalence of UI was 43.9% in the answer to the question. Furthermore, the UI prevalence was 47.4% (559/1179) according to the ICIQ-SF survey. The prevalence of UI did not differ between regions, but the difference between increased vaginal births (≥3), advanced age, and low educational status was significant (p&amp;lt;0.05). Conclusion: The high rate of UI among women in Turkey indicates an important women's health problem that can be prevented by some studies. We believe it is important that this is taken into account in national preventive women's health programs. We recommend that the ICIQ-SF query form be included in national preventive women's health programs by taking routine practice as a screening tool to detect urinary incontinence in adult women.

Assessment of health-related quality of life among patients with non-communicable diseases

Non-communicable diseases (NCDs) are a global challenge towards diminishing quality of life. Health related quality of life (HRQoL) is a widely accepted measure of burden of disease for individuals with chronic conditions. Due to paucity of data in Western Rajasthan, India, this study was planned to assess the HRQoL due to NCDs in Jodhpur, India. A descriptive cross-sectional study was planned in government NCD center of Jodhpur. Convenience sampling was used to select 398 respondents and socio demographic data was collected. Short Form–36 (SF-36) questionnaire was used to measure perceived effects due to NCDs across eight domains of analyzed using descriptive and inferential statistics. High combined mean scores were obtained in domains of Social Functioning (77.87) and Mental Health (75.36%) and lowest scores for General Health (54.70%), Bodily Pain (60.06%) and Role Emotional (60.33%). Males recorded higher mean scores than females across all domains with high statistical significance for Bodily Pain, Vitality, Role Physical and Mental Health. Findings suggested worst and least affected domains of regular life functions due to NCDs. Greater focus on emotional distress, active inclusion of females in national health programmes and integration of NCD control program with Mental Health Program would aid to improve overall HRQoL in affected individuals.

THE REPRODUCTIVE HEALTH IN ROMANIA -CURRENT STATUS.

Currently, at national level, two representative actions could provide information for supporting policy making in the field of reproductive health, and these two public health actions need improvements in certain aspects: The Reproductive Health Study in Romania (RHS), and the National Health Programme for Mother and Child Health (NHP-MCH). After decades of sexual education and family planning interventions, reproductive health in Romania is still a matter of concern. The current image of this field in Romania is difficult to be precisely configured having few elements and data in this sense. Main available indicators highlight a low contraception use, a high rate of abortion and high birth rate among adolescents is mainly the consequence of insufficient information on contraception among all population strata. Implementation of an action towards the development of a health inequality monitoring system would be of great importance for getting timely information on this subject, and it is favoured by the increased political awareness on the topic after joining EU, the inequalities that should be reduced as mentioned by the National Health Strategy 2014-2020, the existence of structures needed to develop a health inequality monitoring system and the declared political will. Monitoring reproductive health inequalities would provide information on the necessary actions to be implemented towards reaching a better reproductive health, and would also serve as an action implementation evaluation tool. A special attention should be payed to vulnerable groups: young population in rural communities, low socio-economic and educational status, and persons with mental disabilities. Keywords: Reproductive health, monitoring, inequalities, Romania Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-ansi-language:EN-US; mso-fareast-language:EN-US;}

Assessment of Eating Habits and Perceived Benefits of Physical Activity and Body Attractiveness among Adolescents from Northeastern Romania

The purpose of this paper was to present the results of the evaluation of 1320 adolescents from 4 high schools in Iaşi, Romania regarding their eating habits and perceived benefits of physical activity and body attractiveness after they completed an anonymous questionnaire. The data analysis was performed using IBM SPSS version 18. The analysis of the nutritional status showed that over 70% of adolescents were of a normal weight. Most of them (63.56%) consumed 3–4 meals/day, with breakfast being the most skipped meal (60.53%). Compared with the boys, the girls consumed fewer whole grains, dairy products, and meat, but the girls consumed fruits and vegetables in approximately the same percentage. The adolescents studied consumed more fruits than vegetables, but the servings of fruits and vegetables consumed were not sufficient in the diets of many adolescents (39.31%). Among the adolescents, 5.68% consumed at least 2 alcoholic drinks daily, and 37.87% consumed caffeine products one or more times per week. Among the boys, 95.20% practiced regular physical activity, and 97.20% of the girls considered that the right nutrition plays a role in the prevention of obesity. The study of the self-perception profile showed that 89.8% of boys and 79.5% of girls considered that they had attractive bodies. According to the BMI, 86.7% of normal-weight adolescents and 84.8% of underweight adolescents considered themselves as having attractive bodies, while this was only considered by 73.5% of overweight and 56.7% of obese adolescents. It is necessary to introduce nutritional education in schools for the improvement of eating habits in children and adolescents. More studies are needed to appreciate the social behaviors (e.g., food intake, physical activity, and recreation time) and then develop interventions and national health programs to promote a healthy lifestyle, particularly healthy eating habits.

Effect of Behavior Change Communication on the Incidence of Pneumonia in Under Five Children: A Cluster Randomized Controlled Trial

Improving health education of the mother by providing community-based interventions is known to help control pneumonia. To determine the effect of behavior change communication (BCC) activities for mothers in reducing the incidence of childhood pneumonia. Open-label cluster randomized controlled trial. Urban slums and villages in two districs of Maharashtra. Under-five children and their mothers from households in the randomly selected 16 clusters out of total 45 clusters, stratified into Pune and Sangli districts and further into rural and urban areas before randomization. Three forms of BCC activities were imparted, viz., interactive sessions of education using pictorial mothers' booklet, screening of a audio-visual film, and virtual hand wash demonstration and use of flashcard. Routine care under the National health program was provided by the Accredited Social Health Activists (ASHA) workers in both the arms. The primary outcome was pneumonia as per the IMNCI criteria assessed during fortnightly visits of the ASHA/anganwadi workers to the houses of under-five children, who received at least one follow-up visit in a period of one year. The incidence of pneumonia in 1993 and 1987 under-five children in the intervention and control arm was 0.80 and 0.48 episodes per child per year, respectively (P=0.03). BCC for mothers is not sufficient to reduce the incidence of childhood pneumonia.

CURRENT SCENARIO OF WEALTH AND CHILD NUTRITION IN INDIA: MACRO AND MICRO LOOK

The level and relationship of child health, wealth, and basic amenities are changing fast in India. How strong are the relationships of state wealth, i.e., state Gross Domestic Product and basic household amenities like sanitation facilities with child health? Using the published National Family Health Survey 2015-16 at a macro level, the paper compares the change of stunting, underweight and under-five mortality over ten years (National Family Health Survey 2005-06 to 2015-16) and explores how far child health indices are associated with state Gross Domestic Product. Though wealth and child health are positively associated in India, the strength of the relationship is declining over time, indicating that wealth per se may not guarantee the betterment of child health. Undertaking a case study with 510 children in a low-income community of Mumbai, we further establish that the availability of basic facilities and recent infections play a stronger role in determining child nutrition status when household wealth is controlled. Higher-income, more years of schooling, less crowding in a household, covered drainage system, the non-occurrence of Gastro intestine, and infectious disease are significantly associated with better child nutrition status. Sincere attention to policy on improving basic facilities and living environment to address child health issues has become mandatory. National Health Mission or health programs like Swachh Bharat Abhiyan are good initiatives to focus on improving basic facilities and living environment to address child health issues.&#x0D; Key Words: Wealth, Child health, Stunting, Slum, Mumbai

Quality Compliance in a Remotely Located PHC in India

Background: As the rural Indian health care sector is providing patient care to the community at large, evaluating the quality of services gives an insight into the level of care provided. The primary health care chose the audit evaluation voluntarily.&#x0D; Objectives: The aim of the study was to assess the service quality provided in the primary health care Centre. The study was to help understand the skill set requirements in improving the quality of care and to identify the service quality gaps and to provide the best possible solutions for the gap closures by nominating the responsible personnel.&#x0D; Methods: The quality of care was evaluated in three ways: staff interview, record review, and observations conducted. Six departments were chosen for evaluation: the out-patient department, in-patient department, labor room, laboratory, National health programs, and general administration. By a prepared specific checklist comprised of standards and measurable elements, an evaluation was performed. The scoring was provided as 0, 1and 2, which implied noncompliance, partial compliance, and full compliance.&#x0D; Results: As per evaluation, national health program areas scored the least, whereas the inpatient departments scored the highest. There were multiple gaps in the service provision areas and manpower allocation. The average mean score was 77.48.&#x0D; Conclusion: Keeping the national standards and guidelines, an audit evaluation was performed. Quality has to be imbibed with the optimization of resource allocation and with the mindset to provide the best possible care in the interest of the individual's wellbeing.