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Archive for May, 2011

With greater education and wealth come greater risks for India’s unborn females

STEPHANIE NOLEN

NEW DELHI— From Tuesday’s Globe and Mail

Published Tuesday, May. 24, 2011 1:30AM EDT

In India, the practice of aborting female fetuses increases as women become better educated and wealthier, defying the predicted decline of a widespread cultural preference for sons.

And as many as 12 million girls have gone “missing” from the population since 1985 because of the practice, according to new research released Tuesday by the leading medical journal The Lancet.

“There is really no change in stated son preference over the last 10 to 15 years,” said Prabhat Jha, an epidemiologist at the University of Toronto who led the study. “Fertility has dropped substantially due to economic growth and increases in literacy, which are all very good things, but that has also meant that ultrasound use and access is increasing. Families appear to be saying, ‘If nature – or God, if they’re religious – gives us a first boy, then we will have one more child and that’s it, but if we have a first girl we will use ultrasound [and abortion] to ensure our second and last child is a boy.’ ”

Recently released data mean he and colleagues are able to study the trends since 1985, when ultrasound gender testing was introduced here. “And it isn’t slowing down.”

The researchers used census data, and 265,000 birth histories collected in India’s National Family Health Survey, to estimate differences in the girl-boy ratio for second births in families in which the first-born child had been a girl. They found that the girl-boy ratio fell from 906 girls per 1,000 boys in 1990 to 836 in 2005.

But in cases where the first child born was a boy, there was no drop in the girl-boy ratio for the second child: evidence that parents are selectively aborting girls if their first-born child is a girl, Dr. Jha said.

This difference in the ratio of girls to boys born was much sharper in mothers with 10 or more years of education than in mothers with no education; the difference is also greater in better-off households compared with poorer ones.

The study says that there is not yet clear evidence of the selective abortion of first-born female fetuses, as is common in China, where son preference is also strong and where state policy restricts families to only one child. But that may come as growing numbers of families choose to have only one child, particularly in urban areas.

Dr. Jha, who directs the U of T’s Centre for Global Health Research, said the study makes clear that the steps taken by the government to end sex-selective abortion have not been successful. The law banning prenatal sex determination is a good one, he said, but the private health-care sector in India is so minimally regulated that the law has had little impact.

To calculate the number of female fetuses aborted for sex selection since the introduction of ultrasound gender determination in 1985, the authors calculated the expected number of births of girls, based on the ratio of 950-975 girls born to 1,000 boys in societies without son preference, and compared it against the actual number of births of girls enumerated by the censuses, done every 10 years.

After adjusting for excess mortality rates in girls, the authors estimated that there were between zero and two million selective abortions of girls from about 1985 to 1990; 1.2 million to 4.1 million in the 1990s, and 3.1 million to six million in the 2000s – for a total of between four million and 12 million by 2010.

Before the release of 2011 census data last month, there was speculation here that rising income levels and education levels for women, combined with public education campaigns and efforts at enforcement by government over the past 15 years, would show a slowing of sex-selective abortion.

“I was quite surprised that the ratios had gone down further,” said Dr. Jha, who has worked on this subject for a number of years.

In an interview in Delhi, he noted, sounding rueful, that he and his colleagues “can’t really explain why” son preference is persisting with such dramatic consequences, as they were not studying causes. Analysts in the Indian media frequently cite the practice of paying dowry for brides, which has been illegal for decades but is still widespread, as one possible explanation.

A further finding of the research is that a majority of Indians now live in states where selective abortion of girls is common. Until this year’s census data, which showed a decline in sex ratios in a majority of states, it had been believed that the practice was largely confined to a handful of states with deeply rooted cultural aversions to female children.

Source: The Globe and Mail

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128 kids died after vaccine in 2010, govt can’t say why

CHENNAI: More children in India are dying every year soon after being vaccinated, and the government has no clue why. Union health ministry statistics obtained under the Right to Information Act show that 128 children died in 2010 due to adverse effects after immunization (AEFI). That count has risen in the past three years, with 111 such deaths in 2008 and 116 in 2009.

AEFI is a general term that covers various reasons, including bad vaccine quality due to breaks in the cold chain, contamination and complications due to pre-existing conditions of the child. Coincidentally, AEFI deaths in 2008, when the government closed down all three public sector vaccine units and began buying from private suppliers, were three times the figure for 2007. TOI first reported in March this year that up to 2009, the toll was moving upwards. The 2010 figures confirm the trend.

“We are very concerned,” Union health secretary K Chandramouli said, “but we can’t attribute all such deaths to one reason.” Asked specifically if the vaccines were responsible for the deaths, he replied: “I can’t say that offhand.”

Refusing to point out specific reasons, he said “lack of diligence at the field level and carelessness” could be among the reasons.

Of the 218 deaths last year, reasons for 72 have been categorized under ‘unknown’, 48 as ‘coincidental’, four as due to ‘vaccine reaction’ and two due to ‘injection reaction’ and ‘programme error’. Maharashtra registered the largest number of deaths (28), followed by Uttar Pradesh (18) and Andhra Pradesh (11). Tamil Nadu registered eight deaths.

“The number of deaths went up from 32 in 2007, the last year when the government procured vaccines from PSUs, to 111 in 2008. Out of the 140 crore doses of vaccine used in the post-PSU closure period, only 4.25 crore were procured from the Central Research Institute,” says Dr K V Babu, a physician from Kerala who filed the RTI.

Experts feel the actual number could be even more than what government statistics show. “Many vaccine deaths reported in the media do not find a mention in the government statistics,” says Dr Jacob M Puliyel, head of paediatrics at St Stephen’s Hospital, Delhi. He says the government doesn’t follow the Brighton Collaboration criteria on AEFI deaths adopted by WHO, under which the vaccine should be considered a “probable reason” for death if no other is established.

“The government tries to pass on every death as unrelated to vaccine. It sometimes merely does a culture of the vaccine in question. Just because a vaccine is not found to be contaminated, it doesn’t mean the vaccine has not caused the death,” says Dr Puliyel.

There is also an ethical issue. “We don’t know the exact cause of the deaths and the government is doing nothing to find the cause,” says Dr George Thomas, editor of Indian Journal of Medical Ethics. “Whenever there is a vaccination-related death, it’s ethically essential for the government to probe and find the reason.”

The government closed its three vaccine labs — Central Research Institute in Kasauli, BCG Laboratory in Chennai and Pasteur Institute of India in Coonoor — in January 2008, citing non-compliance of good manufacturing practices. To make up for the demand of 75 lakh doses of vaccines of six kinds needed for its universal immunization programme, the government has been procuring vaccines from private manufacturers. Now, it is working on plans to resume making the vaccines at its own facilities.

Source: TOI

India Third-Largest Market of the Deadliest Killer in the World – Tobacco

By Tarit Mukherjee
PIB Features

New Delhi, May 27, 2011 (Washington Bangla Radio) Tobacco products are made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed or snuffed. All contains the highly addictive psychoactive ingredient, nicotine.

Tobacco was introduced into India by Portuguese traders during AD 1600. Its use and production proliferated to such a great extent that today India is the second largest producer of tobacco in the world. Soon after its introduction, it became a valuable commodity of barter trade in India. Trade expanded and tobacco spread rapidly along the Portuguese trade routes in the East, via Africa to India, Malaysia, Japan and China. During this period, the habit of smoking spread across several South Asian countries. Virtually every household in the Portuguese colonies took up the newly introduced habits of smoking and chewing tobacco.

India is one of the biggest tobacco markets in the world, ranking third in total tobacco consumption. However, the per capita consumption in the country is 0.9 kg compared to the world average of 1.8 kg. Tobacco usages in India is contrary to world trends since chewing tobacco and beedi are the dominant forms of tobacco consumption, whereas internationally, cigarette is the dominant form of tobacco use.

In the late nineteenth century, the beedi industry began to grow in India.  The price differential from cigarettes favoured the use of beedis and this domestic product soon supplanted cigarettes as the major form of tobacco consumption. While tobacco chewing was practiced for many centuries, commercial production and marketing have been scaled recently, with the introduction of the gutka. The rate of growth of consumption of gutka has overtaken that of smoking forms of tobacco. As a result, oral tobacco consumption has opened a new and broader front in the battle between commercial tobacco and public health in India.

The Global Adult Tobacco Survey India report notes that Khaini is the most commonly used smokeless tobacco product. Gutkha is the second most common form. The consumption of smokeless tobacco in India is also prevalent in various other forms e.g. paan with tobacco, paan masala with tobacco, Gul, Mawa, Mishri, Bajjar, Gudakhu etc, which are used as dentifrice i.e. for application on teeth or gums. Evidence shows that smokeless tobacco contains more than 3000 chemical compounds of which 29 are proven carcinogens i.e. cancer causing substances.

One of the main risk factors for tobacco use is number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases. It is the single most  cause of disease, disability and death. Each year people die prematurely from smoking or exposure to secondhand smoking. Despite these risks people smoke cigarettes.

The harmful effects of smoking do not end with the smoker. Adults and children aged 3–11 years are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons as smokers. Secondhand smoke exposure causes diseases  including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. Each year primarily because of exposure to secondhand smoke nonsmoking people die of lung cancer, heart disease, and children younger than 18 months have lower respiratory tract infections. As per the recent Global Adult Tobacco Survey (GATS) India Report, 2010, the use of smokeless tobacco among adult males in India is as high as 32.9% and for females it is 18.4%. Overall, 26% of the adult population consumes smokeless tobacco. The Global Youth Tobacco Survey (GYTS)-India, 2009 similarly revealed that 12.5% (Boys = 16.2%, Girls = 7.2%) youth use tobacco products other than cigarettes.

According to ICMR, 50% of cancers among men and 25% among women in India are related to tobacco use. Nearly 90% of oral cancers are related to use of chewing tobacco. States with high prevalence of smokeless tobacco also face the challenge of high burden of oral cancer. Besides oral cancer, smokeless tobacco use is also associated with cancers of food pipe, pancreas, kidney, throat and stomach. There is also increased risk of death from cardiovascular diseases among smokeless tobacco users.

Recently an initiative has been taken and serious concern raised over growing Gutka/Pan Masala menace in India. India has the highest number of oral cancer in the world with 75,000 to 80,000 new cases of oral cancers being reported every year and chewing tobacco and gutka contribute to 90 percent of oral cancer cases in the country.

Cancer of oral cavity is frequent and common finding among the cancer patients show addiction to gutka and other tobacco products. It is observed that magnitude of tobacco related cancer in average is on an upward trend in Eastern and North Eastern India. This is largely due to high prevalence of tobacco consumption.

According to the Global Adult Tobacco Survey (GATS 2010) nearly one third of Indian population is addicted to smokeless tobacco. A large number of children and youth in India are addicted to smokeless tobacco. These preparations essentially have tobacco with or without supari and are well proven to be harmful for health.

Smokeless tobacco contains nicotine and direct consumption of which is highly addictive. Scientific evidence has established that tobacco chewing causes cancer of mouth, ocesophagus (food pipe), larynx and pharynx (throat), pancreas, stomach, kidney and lung. It can also cause high blood pressure and other life threatening cardiovascular conditions like myocardial ischemia, stroke etc.

Consumption of tobacco may be reduced by raising the price of tobacco. It has proven to be one of the most effective strategies for preventing and controlling tobacco use. Specifically the increasing cigarette prices would decrease the prevalence of tobacco use, particularly among youth and young adults, and that increases in cigarette excise taxes would lead to substantial long-term improvements in the nation’s health. A 10% increase in the price of cigarettes is estimated to reduce consumption by nearly 4% among adults, and the potential reduction among young people and low-income populations is even higher.

Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking. A comprehensive program is a coordinated effort to establish tobacco free policies, reduce the social acceptability of tobacco use, promote cessation, help tobacco users quit, and prevent initiation of tobacco use. This approach combines educational, clinical, regulatory, economic, and social strategies.  The World Health Organization (WHO) has chosen “The WHO Framework Convention on Tobacco Control” as the theme of the next World No Tobacco Day, which is on  31 May 2011. (PIB Features)

Source: Washington Bangla Radio

Off The Shelves! Belatedly, the govt bans risky medicines

Danger List…

  • Gatifloxacin: An antibiotic used for treating respiratory tract infections. Can cause diabetes.
  • Tegaserod: Used for constipation and irritable bowel syndrome. Increase risk of heart attack and stroke.
  • Cisapride: Used to increase motility in the upper gastrointestinal tract. Can cause serious cardiac problems.
  • Phenylpropanolamine: Decongestant that can also increase the risk of stroke
  • Human Placental Extract: Used for cosmetic skin treatments and female infertility. It can transmit diseases.
  • Sibutramine: Constituent of weight-loss pills. Said to cause heart problems.
  • lR-Sibutramine: Also a weight-loss medicine. Increases the chances of stroke and heart problems.
  • Nimesulide: Painkiller and antipyretic. Harmful to the liver.

***

In the last six months, the Union health ministry has suddenly adopted a proactive tack to banning drugs. After facing quite a lot of criticism internationally for the easy availability in India of suspect medicines—including drugs that have been banned abroad for many years—the ministry has come down heavily on the Drug Controller General of India (DCGI) to enforce bans and ensure that chemists do not stock or sell dangerous drugs.

In February, the ministry banned the manufacture, sale and distribution of gatifloxacin and tegaserod. The decision was taken on the Drug Technical Advisory Committee’s (DTAC) recommendation. Gatifloxacin is an antibiotic used for respiratory infections and is said to cause diabetes. Tegaserod is used for constipation and irritable bowel syndrome, but is said to increase the risk of heart disease and stroke.

In November last year, the drug controller announced a ban on weight-loss medication containing sibutramine and R-sibutramine, which are known to cause strokes. Several medical products containing the two drugs have been under the scanner but no action was taken until recently. One major problem with such products was that they were available without prescription.

India has been rather slow in banning drugs that have gone off the shelves abroad after research showed they were harmful. Nimesulide (paediatric), for instance, has been banned internationally, but health officials in India maintained that its use had shown no adverse effects in Indian children. It’s only after 10 years of safety assessment studies that it was finally banned this year. In all likelihood, the ministry has managed to fight off pressure mounted by pharmaceutical lobbies. “It is our responsibility to ensure that safe medicines are sold in the country,” says a senior health ministry official. “Even if it has taken a long time to come into effect, it’s never too late to take corrective steps.”

But not everyone is satisfied with the ministry’s actions. “The ban on several drugs has come under generic names but often the brand names are very different. Sometimes they are a combination or formulation of drugs, and this makes it difficult for doctors and consumers to know if they are banned,” says Dr Mira Shiva, a public health activist. “The ministry needs to make the names of these brands public and create more awareness. Otherwise the entire purpose is defeated.”

Earlier this week, the DCGI announced it has temporarily stopped giving marketing approval to new drugs in key therapeutic segments. The approvals will resume once a new approval system, in which the opinion of a 10-member panel of independent experts is taken into account, is streamlined. New drug advisory committees (NDACS) will be constituted for each therapeutic category, such as gastroenterology, oncology, urology etc. The committees will advise DCGI on both new drugs and on clinical trials of categories of medicines like antibiotics. India had approved 223 new drugs (including new combinations of already approved drugs) in 2010. There were 32 new drug approvals in January-March this year.

The new NDACS and the refusal of the ministry to approve drugs banned internationally may not go down well with pharmaceutical companies. But doctors and health ministry officials say it will be in the larger interest of the people. Patients can rest a bit more assured about their medication.

Source: The Outlook

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India Journal: Playing with Poverty Statistics

By Ranjani Iyer Mohanty

The poverty line for a given individual can be defined as the money the individual needs to achieve the minimum level of ‘welfare’ to not be deemed ‘poor,’ given its circumstances.”

This is how Martin Ravallion, director of the Development Research Group at the World Bank, defines the poverty line. In 2005, the World Bank revised the international poverty line up from $1 a day to $1.25 a day, but countries are allowed to set their own national poverty line. The Planning Commission has set India’s national line at 578 rupees a month, or the equivalent of 43 U.S. cents a day.

Even assuming only a charitable (to the government, that is) 30 days a month, that works out to less than 20 rupees a day. A half-litre packet of milk at Mother Dairy costs 10 rupees. One mango, those in season and heaped on carts by the side of the street, costs 10 rupees. And a cabbage …but no, your 20 rupees a day has already been spent. If you spend more than that, even on clothing or education or fuel, you cannot be termed as below the poverty line and therefore you are not eligible for BPL-related benefits and subsidies on food, shelter, and medical treatment. And note that the luxurious 20 rupees a day is for city dwellers; rural people have to spend less than 15 rupees a day in order to be below the poverty line.

The absurdity of such a low poverty line is astounding. Even the World Bank, which does not usually comment on national poverty lines, feels that India’s is too low and was hoping for a more realistic peg at $1.17 a day. Many concerned individuals have called India’s poverty line the “starvation line.” In fact, it is tending more toward the flat-line on a cardiac monitor.

The Multidimensional Poverty Index (developed by the Oxford Poverty & Human Development Initiative) puts the number of poverty-stricken Indians at 645 million. A recent report by the Asian Development Bank says rising food prices will push a further 30 million Indians below the poverty line of $1.25 a day. According to the National Family Health Survey (2006) by the Government of India, the child malnutrition rate is 46%, which human rights lawyer Colin Gonzalves says translates into a horrific 2,500 child deaths every day.

Are the members of the Planning Commission living in India in 2011? Why this total disconnect with reality?

Now I know some will argue and say: “Hey, stop picking on the Government of India! Can’t you see they’re trying to do their best … for themselves, that is? So what if they spend money on seemingly unimportant things (like the Commonwealth Games, unnecessary signs, and personal security guards) and remain impassive while some of their colleagues are filling their Swiss bank accounts and lining their own pockets with our tax dollars? Besides, the state governments are at fault, too. And I earn way more than 578 rupees a month anyways – in fact, I spend almost that much on a cup of coffee whenever I stop in at 360 at the Oberoi. So what do I care about what or where the poverty line is or who’s under it? Let them eat cake.”

I think I’ve heard those famous last words somewhere else before.

But a second look at this whole issue got me doing a re-think: If we can have a floating exchange rate and a floating gold price, why not a floating national poverty line? It could actually be a big advantage in lowering our poverty rates.

While having the international poverty line at $1.25 a day may show India as having some 600 million people below it, simply moving the national poverty line to 43 cents a day reduces those below the poverty line to about 440 million. In fact, if the Planning Commission revises the poverty line to 20 cents a day, they can reduce poverty yet again. Of course, they could drop the national poverty line to 1 cent a day and thereby eradicate poverty in India altogether.

Learning from the wisdom of the government, I’ve decided to adopt similar measures for a more personal problem. I’ll be turning 50 next month … but that sounds rather old. So instead of accepting that reality and taking practical steps – like putting aside funds for later years or taking better care of my health – I’m going to pretend I’m living on Mars and then, using the Martian measurement of time to calculate my age, I can say I’m just a sprightly 26 years. Of course, I may die before I’m 40, but at least I can live and die under a happy illusion.

Source:- India Journal

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Docs duck rural service bait

OUR SPECIAL CORRESPONDENT

New Delhi, May 25: Medical graduates have so far largely spurned the government’s novel offer of extra marks in the national postgraduate entrance test in return for rural service.

“This shows the total apathy of the (medical) fraternity to rural areas,” Union health minister Ghulam Nabi Azad said today, indicating the offer had had few takers.

“I’m very sorry to see the attitude of our (medical) students. It is said.”

The health ministry had announced the incentive in September 2009. Under the plan, junior doctors would work in rural areas for one to three years after doing their MBBS, and in return would receive 10 to 30 per cent extra marks in the entrance examinations for MD or MS degrees.

The unique offer had raised hopes of luring doctors to rural areas, after years of debate on how to do this and after abandoning an earlier proposal to make rural service mandatory for all MBBS graduates.

However, Azad indicated that the doctors were still keeping away from rural service. “I thought there would be a rush,” he said.

Health ministry sources said they could not immediately provide details of how many MBBS graduates had taken up the offer of rural service after the incentive was announced.

Over the past two years, the government has added 7,470 seats in postgraduate medicine.

Source:- Calcutta Telegraph

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Sharad Pawar wants shorter MBBS course

Pune: Union agriculture minister and Nationalist Congress Party chief, Sharad Pawar, on Sunday expressed his reservations about the long-drawn educational course in medicine and surgery. “It takes about 10 years before a medical student becomes a doctor and takes up practice. By this time students of other professions not only complete their education but also settle down in life. I would take up the issue of reducing the duration of medical courses with (Union health minister) Gulam Nabi Azad and the Medical Council of India,” he said. Pawar was addressing a gathering at Ganesh Kala Krida Manch during the one-day state-level conference of the doctors’ cell of the NCP. According to Pawar, due to such lengthy courses in medical education, hundreds of students are opting for other professional courses.Pawar also stressed the need to improve medical services in rural areas of the country, advocating that doctors working in rural areas be given tax benefits and incentives.

“To attract more medical practitioners to serve in rural areas there is a need to give them incentives like rebate in duties on medical instruments and medicines,” he said, adding that the NCP doctors’ cell needs to focus on women doctors’ participation. The state minister for medical education, Vijaykumar Gavit, said the state government has made bond mandatory for medical students seeking admissions in government medical colleges, to ensure that medical services are provided in a proper manner in rural areas.”We are now planning to permit doctors — who are not willing to work in health centres and hospitals in rural areas — to open nursing homes in rural areas. The government would not be averse to such an idea,” Gavit added. After addressing the gathering, Pawar left for New Delhi to attend an important meeting at the prime minister’s residence, on the occasion of the United Progressive Alliance government completing two years in office.

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