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Objective To evaluate the sensitivity of the modified Brief Form of Bruininks Oseretsky Test in identifying motor differences secondary to malnutrition and poverty. Methods This longitudinal cohort study was conducted at Nowshero Feroze, Sindh from 2013 to 2014 and comprised data drawn from children who participated in a randomised controlled trial, that assessed responsive stimulation and nutrition interventions in the first two years of life. Outcome measures included motor development assessed using Brief Form of Bruininks Oseretsky Test, child anthropometry and household economic and demographic information. Data was analysed using SPSS 15 and STATA 12. Results Of the 1058 children, 570(53%) were boys. Moderate-severe stunting was reported in 171(16.12%) subjects, while moderate-severe underweight was reported in 117(11.1%). Also, 591(56%) subjects belonged to poor families, 343(32%) had illiterate mothers, and 392(37%) were food-insecure. Malnutrition, socio-economic status and maternal literacy were significantly associated with a 6-item motor composite of the Brief Form of Bruininks Oseretsky Test (p Conclusions The 6-item motor composite of the Brief Form of Bruininks Oseretsky Test was found to be a reliable tool to measure motor performance in Pakistani pre-school children.

PURPOSE: The aim of this study was to evaluate the feasibility and effectiveness of the Parent Empowerment Program (PEP) to help caretakers deliver a home program to promote developmental activities and gross motor function in their children with Down syndrome. METHODS: Parents attended a 14-month program with training sessions 1–4 times a month. Outcomes were measured using a change in the Gross Motor Function Measure (GMFM-88) at baseline and assessment one. RESULTS: Forty-eight families participated in the PEP. Children’s mean age was 16.2 ± 10.8 months. There were significant changes in GMFM-88 scores between baseline and assessment one; t (30) =-9.158, p< 0.001; 95% CI -14.6 – -22.9. Previous hospitalization significantly affected GMFM scores. CONCLUSION: This study describes a clinically applied research that focuses on program design, development and evaluation. Findings indicate that the PEP is effective in improving gross motor function in children with Down’s syndrome in Pakistan. Parents were satisfied with the program outcomes and were able to cope with the requirements at home. The PEP had favorable outcomes and may be an effective method to support PT services in resource poor countries.

Background:The proper, timely, adequate delivery of effective and high quality child health and reproductive (RCH) services is of greatest significance and utmost priority mainly because of situations erupting from current ongoing pandemic of covid-19 as well as other cofactors in state of Rajasthan, India. This significance and priority is particularly due to many factors such as huge as well as increasing population with limited qualified, skilled human resourcesObjective of study:The key objective is to find out effects of SARS-CoV-2/ Covid-19 pandemic on the Reproductive and Child Health Programme of Rajasthan in India over the 3 months after Lock down enforcement nationwide in March 2020.Settings & Design:Different indicators of RCH programme i.e. immunisation, maternal and child health, family planning) for Rajasthan were observed, studied, collected and compared with previous year 2019for the period of April/May/June -2019 and 2020. The percent increase and downfall is observed, calculated, presented, from the available data to find out the status of delivery of essential RCH health services. The need assessed and percent of achievement of assessed need is also compared and future achievement projected as per achievement. Materials & Methodology:To know the effect of pandemic era on RCH health programme of Rajasthan during the period from3 months after lock-down announced in the month of March 2020 i.e. April/May/June 2020 in Rajasthan the data observed, calculated and obtained from HMIS (Health Management Information System- of Ministry of Health and Family Welfare (MoHFW), Government of India for RC Health programme, (Reproductive and Child Health).Result: The results of data analysis for RCH services, functioning in the state of Rajasthan during the month during the period from April to June 2020 (during the period from lockdown) as compared to 2019(no lockdown, for same duration suggest that the immunisation services were badly affected during the period from the lockdown period in 2020. It is possible that newborn children and the older ones have been not delivered proper immunisation services during the period from the lockdown as evident from the data observation-analysis.Conclusion:India and different states has launched several plans and strategies to deal with covid-19 pandemic. However this study report found that insufficient attention have been given to very essential services of RCH in Rajasthan as evident from the results of this study. The problems in the delivery of healthcare services should be dealt properly added with a proper update latest dynamic plan to carry on essential health delivery services even in pandemics and other situations of emergencies. The Rajasthan should develop an exclusive updated latest dynamic plan to deal with situations to guarantee delivery of very essential services such as RCH during the period from pandemics or any other natural calamities-emergencies.The ongoing Covid-19 pandemic has disclosed the vulnerability of women and children’s and at the same time teaches us about importance of equity in healthcare. The children and women’s who are considered most vulnerable in emergencies and distress must have special supportive healthcare all the times especially during the period from pandemics-emergencies and other natural disasters.

BackgroundThe COVID-19 pandemic has triggered several underlying vulnerabilities with potentially far reaching consequences in low- and middle-income countries (LMICs) like India. Evidence of physical and socio-economic vulnerabilities caused by the pandemic are emerging rapidly, but one area that has received limited attention so far, is the financial vulnerability COVID-19 causes for households and the government. This paper aims to assess the financial burden imposed on governments and households and the ability of households to afford the required medical costs. Methods and FindingsUsing publicly available data, we computed per-episode mean costs for COVID-19 diagnosis and curative care by government and households. The curative costs included per-episode expenditure for (i) home isolation, (ii) hospital isolation and (i) ICU support. Expenditure was estimated based on mean costs derived from government capped package rates set for private facilities. Households’ affordability was assessed by comparing costs per episode to the estimated household income. The number of days required to pay for the cost of testing and treatment served as a proxy for households’ ability-to-pay. Work-days and wages/salaries for different types of workers were estimated based on Periodic Labor Force Surveys (PLFS, 2017-18) – a national level survey, with a sample size of 102,113 households and 433,339 persons, sampled through a stratified multi-stage random sampling approach. The mean cost for COVID-19 testing was Rs. 2,229 per test (Min-Max: Rs. 2200 – 2500) in a private facility and free in public facilities. The average cost of home isolation was Rs. 829 (Min-Max: Rs. 164 – 2743), while a 10-day episode of hospital isolation in a private facility was Rs. 67,470 (Min-Max: Rs. 2700 – 12600), and admission to the intensive care unit (ICU) cost Rs. 128,110 (Min-Max: Rs. 82500 – 200,000). To afford hospital isolation, regular employees would need to spend the equivalent of 124 days of wages while self-employed and casual workers would spend 170 days, and 257 days respectively. For ICU hospitalization, casual workers, regular employees, and self-employed workers would require 481 days, 318 days and 232 days of work respectively. Thus, affordability of COVID-19 services is far worse among casual workers, wherein annual wage falls short of ICU hospitalization cost for 90% of workers and hospital isolation costs for 48% of workers. Among self-employed workers, the proportions whose annual wages could not afford ICU hospitalization and home isolation were 66% and 27% respectively. For regular employees, we found that for 51% and 15% of them, their annual salaries could not afford to pay for ICU admission or hospital isolation respectively. ConclusionsBesides the financial burden associated with economic costs of COVID-19 lockdowns and other containment measures, the direct medical cost of seeking treatment by households is enormous and unsustainable. Our study has shown that households are subject to considerable financial burden rendering a sizeable segment unable to afford COVID-19 services. Future research must pay attention to measurements that can capture catastrophe and impoverishment inflicted by COVID-19 conditions. A deep dive to measure unaffordability must focus on what other basic needs are sacrificed while paying for COVID-19 conditions and treatments foregone.

Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

Objectives To assess the impact of Schedule H1 regulation notified and implemented in 2014 under the amended rules of the Drugs and Cosmetics Act (DCA), 1940 on the sale of antimicrobials in the private sector in India. Methods The dataset was obtained from the Indian pharmaceutical sales database, PharmaTrac. The outcome measure was the sales volume of antimicrobials in standard units (SUs). A quasi-experimental research design—interrupted time series analysis—was used to detect the impact of the intervention. Results We observed a substantial rise in antimicrobial consumption during 2008–18 in the private sector in India, both for antimicrobials regulated under Schedule H1 as well as outside the regulation. Key results suggested that post-intervention there was an immediate reduction (level change) in use of Schedule H1 antimicrobials by 10% (P = 0.007), followed by a sustained decline (trend change) in utilization by 9% (P > 0.000) compared with the pre-intervention trend. Segregated analysis on different antimicrobial classes suggests a sharp drop (level changes) and sustained decline (trend changes) in utilization post-intervention compared with the pre-intervention trend. Our findings remained robust on carrying out sensitivity analysis with the oral anti-diabetics market as a control. Post-intervention, the average monthly difference between antimicrobials under Schedule H1 and the control group witnessed an immediate increase of 16.3% (P = 0.10) followed by a sustained reduction of 0.5% (P = 0.13) compared with the pre-intervention scenario. Conclusions Though the regulation had a positive impact in terms of reducing sales of antimicrobials notified under the regulation, optimizing the effectiveness of such stand-alone policies will be limited unless accompanied by a broader set of interventions.

The objective of this research was to generate the evidence on the private sector's contribution to overall immunization coverage for selected pediatric vaccines in India. Using IMS Health's (now IQVIA) vaccine sales audit data and innovative methodological approach we estimated private-sector vaccine share in the total immunization coverage across selected pediatric vaccines in India. Our estimates suggest that private sector remains an important contributor to immunization services in India not only for Universal Immunization Program vaccines (Bacillus Calmette-Guerin [19.23%], HiB pentavalent [11.09%], hepatitis B [5.75%], oral poliovirus vaccine [5.48%], Diphtheria-Pertussis-Tetanus [2.66%], and measles [2.17%]) but also for newer vaccines (hepatitis A [4.2%], rotavirus [3.4%], typhoid [3.3%], and pneumococcal conjugate vaccine [2.5%]). As the private sector continues to remain an important access point for immunization services in the country, avenues for potential synergy between public and private sectors should be explored to improve the coverage and quality of immunization services.

The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health). We coded the diagnosis provided in the medical audit data to International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the prescribed antibiotics for the diagnosis to Anatomic Therapeutic Chemical (ATC) classification of World Health Organization (ATC index-2016). We calculated and reported antibiotic prescription rate per 1,000 persons per year, by age groups, antibiotic class and disease conditions. Our main findings are-approximately 519 million antibiotic prescriptions were dispensed in the private sector, which translates into 412 prescriptions per 1,000 persons per year. Majority of the antibiotic prescriptions were dispensed for acute upper respiratory infections (J06) (20.4%); unspecified acute lower respiratory infection (J22) (12.8%); disorders of urinary system (N39) (6.0%); cough (R05) (4.7%); and acute nasopharyngitis (J00) (4.6%) and highest antibiotic prescription rates were observed in the age group 0-4 years. To conclude our study reports first ever country level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-10 mapped disease conditions.

Objective The objective of this research is to generate new evidence on financial implications of medicines out-of-pocket (OOP) payments for households. Another objective is to investigate which disease conditions contributed to a significant proportion of households’ financial burden. Setting All Indian states including union territories, 1993–2014. Design Repeated cross-sectional household surveys. Data Secondary data of nationwide Consumer Expenditure Surveys for the years 1993–1994, 2004–2005 and 2011–2012 and one wave of Social Consumption: Health for the year 2014 from National Sample Survey Organisation. Outcome measures OOP expenditure on healthcare in general and medicines in specific. Results Total OOP payments and medicines OOP payments were estimated to be 6.77% (95% CI 6.70% to 6.84%) and 4.49% (95% CI 4.45% to 4.54%) of total consumption expenditure, respectively, in the year 2011–2012 which marked significant increase since 1993–1994. These proportions were 11.46% (95% CI 11.36% to 11.56%) and 7.60% (95% CI 7.54% to 7.67%) of non-food expenditure, respectively, in the same year. Total OOP payments and medicines OOP payments were catastrophic for 17.9% (95% CI 17.7% to 18.2%) and 11.2% (95% CI 11.0% to 11.4%) households, respectively, in 2011–2012 at the 10% of total consumption expenditure threshold, implying 29 million households incurred catastrophic OOP payments in the year 2011–2012. Further, medicines OOP payments pushed 3.09% (95% CI 2.99% to 3.20%), implying 38 million persons into poverty in the year 2011–2012. Among the leading cause of diseases that caused significant OOP payments are cancers, injuries, cardiovascular diseases, genitourinary conditions and mental disorders. Conclusions Purchase of medicines constitutes the single largest component of the total OOP payments by households. Hence, strengthening government intervention in providing medicines free in public healthcare facilities has the potential to considerably reduce medicine-related spending and total OOP payments of households and reduction in OOP-induced poverty.

Background & Objective: Pleomorphic xanthoastrocytoma (PXA) is a rare primary WHO Grade II astrocytic tumor comprising of < 1% of all astrocytomas. It is generally benign and slow growing however disease progression and malignant transformation with anaplastic features have been infrequently reported. Our objective was to assess clinicopathological characteristics of this rare tumor at our center. Methods: A retrospective study was conducted at Aga Khan University Hospital from January 1992 till January 2016. Data was entered on a proforma including patient demographics, clinical features, tumor location, histological features and follow-up, where available. Results: Forty Seven cases of PXA were retrieved during the study period. The mean age was 23.8 years (SD=15.1) and median age was 19 years. The most frequent symptom was head ache (n=31). Male were more frequently affected (n=26). The commonest location was temporal lobe. On microscopic examination, tumors were pleomorphic without mitoses or necrosis, however two cases showed increased mitotic activity, and one case revealed associated gliosarcoma. Follow-up of only 29 cases was available for a period ranging between 2 and 184 months (85 months +/- 56 months). Outcome was good in 27 patients with the last follow up showing no radiographic or clinical evidence of tumor recurrence. Conclusions: PXA is an infrequent tumor in our population also, with less than 50 cases identified in two decades study period. Due to its rarity and its bizarre histomorphology, it should be diagnosed correctly, as it has got better prognosis than other astrocytic tumors.

India was the largest consumer of antibiotics in 2010 in the world. Evidence suggests that countries with high per-capita antibiotic consumption have higher rates of antibiotic resistance. To control antibiotic resistance, not only reduction in antibiotic consumption is required, socio-economic factors like access to clean water and sanitation, regulation of private healthcare sector and better governance are equally important. The key objective of this research was to investigate the five year trends in consumption of major antibiotic classes in India and compare them with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) countries. We used Intercontinental Marketing Statistics (IMS) Health (now IQVIA) medicine sales audit data of antibiotic sales in the retail private sector (excluding the hospitals sector) in India. We then standardized dosage trends and assigned defined daily dose (DDD) to all formulations based on the ATC/DDD index. We expressed our data in standardized matrices of DDD per 1000 inhabitants’ per day (DID) to compare antibiotic use in India with ESAC-Net countries. The antibiotic use was plotted and reported by year and antibiotic class. Our main findings are—per capita antibiotic consumption in the retail sector in India has increased from 13.1 DID in 2008 to 16.0 DID in 2012—an increase of ~22%; use of newer class of antibiotics like carbapenems (J01DH), lincosamides (J01FF), glycopeptides (J01XA), 3rd generation cephalosporins (J01DD) and penicillin’s with beta-lactamase inhibitors has risen; and antibiotic consumption rates in India are still low as compared to ESAC-Net countries (16.0 DID vs. 21.54 DID). To conclude our study has provided the first reliable estimates of antibiotic use in the retail sector in India vis-à-vis ESAC-Net countries. In addition, our study could provide a reference point to measure the impact of interventions directed towards reducing antibiotic use.

There is a lack of information on supply-side determinants, their utilization, and the access to pneumococcal vaccination in India. The objective of this exploratory study was to document the perceptions and perspectives of practicing pediatricians with regard to pneumococcal conjugate vaccines (PCVs) in selected metropolitan areas of India. A qualitative study was conducted to generate evidence on the perspective of pediatricians practicing in the private sector regarding pneumococcal vaccination. The pediatricians were identified from 11 metropolitan areas on the basis of PCV vaccine sales in India through multilevel stratified sampling method. Relevant information was collected through in-depth personal interviews. Finally, qualitative data analysis was carried out through standard techniques such as the identification of key domains, words, phrases, and concepts from the respondents. We observed that the majority (67.7%) of the pediatricians recommended pneumococcal vaccination to their clients, whereas 32.2% recommended it to only those who could afford it. More than half (62.9%) of the pediatricians had no preference for any brand and recommended both a 10-valent pneumococcal conjugate vaccine (PCV10) and a 13-valent PCV (PCV13), whereas 8.0% recommended none. An overwhelming majority (97.3%) of the pediatricians reported that the main reason for a patient not following the pediatrician's advice for pneumococcal vaccination was the price of PCV. To reduce childhood pneumonia-related burden and mortality, pediatricians should use every opportunity to increase awareness about vaccine-preventable diseases, especially vaccine-preventable childhood pneumonia among their patients.

The Indian pharmaceutical industry accounts for 8% of global production and exports medicines to over 200 countries. Multinational enterprises (MNEs) enter the Indian market either directly through the establishment of subsidiaries or indirectly through licensing arrangements. However, evidence on MNE’s contribution toward development in India in terms of capability enhancement and linkages or through other spillover effects is limited. The purpose of this research was to generate evidence on (a) contribution of MNEs in the pharmaceutical market in India, (b) nature and impact of foreign direct investment (FDI) inflows in the Indian pharmaceutical sector, (c) contribution of MNEs in R&D and innovation in India, and (d) MNE’s contribution toward introducing new chemical entities (NCEs) and new biological entities (NBEs) in India through a mixed method research design. We conducted an in-depth quantitative analysis on multiple data sets and qualitative interviews of various stakeholders to generate a holistic understanding on the aforementioned research objectives. Our findings suggest that from the perspective of capability enhancement and linkages, the contribution of pharmaceutical MNEs in India is limited. We observed that majority of FDI investments are brownfield against desired greenfield investments. In addition, MNEs are investing far less of profit before tax (PBT) compared with Indian firms on research and development. However, MNEs are contributing significantly toward access to certain pharmaceutical segments like vaccines, hormones, and parenterals, which require sophisticated production facilities, advanced technology, and intellectual capital. Further, MNEs role in innovation and introduction of new medicines (new molecular entity [NME] and NBE New Chemical and Biological Entities (NCEs and NBEs)) in India is significant. We propose that creating a conducive policy environment and predictable regulatory environment can facilitate capability enhancement and linkages through MNEs. Some of the potential policy instruments include appropriate implementation of FDI policy and Intellectual Property Rights (IPR) policy to balance trade and public health.

ObjectiveThe objective of this study was to examine the impact of medicines price regulation (Drug Price Control Order, 2013) on the market share of atorvastatin in the Indian retail market for statins.SettingAll Indian states, January 2012 to December 2015.DesignQuasi-experimental—interrupted time series analysis.DataPharmaceutical sales audit data set from IMS Health (now IQVIA) for the 48-month period from January 2012 to December 2015.Outcome measureShare of atorvastatin (in percentage) in the Indian market for statins in terms of sales volumes.ResultsWe observed that the price regulation notification (Drug Price Control Orders, 2013) was associated with 0.12% (pConclusionsPrice control as a public intervention did improve the relative sales of atorvastatin in the statin market in India.

The Indian health care sector will double its size to US$ 100 billion by 2015 from the present US$ 50 billion. However, the government’s contribution on health care is minimal whereas Indian households spend a disproportionate share of their consumption expenditure on health care. The National Rural Health Mission (NRHM) intends to increase the public expenditure on health from 1.1 per cent of GDP to 2–3 per cent of GDP by 2011. This increased funding through the NRHM should be supplemented by efforts to improve efficiency in resource utilization. Health economics is increasingly recognized as a discipline that has much to offer in addressing these issues. However, the information about capacity building initiatives in terms of teaching and training in the field of health economics in India is limited. This article attempts to address this knowledge gap through a systematic research by identifying various institutions offering courses in health economics across India, their intake capacity, areas of specialization and accreditation standards. The article also attempts to estimate the demand for professionals having expertise in health economics and intends to stimulate the discussion around pertinent issues around need and demand mismatch.

Pharmaceutical management is a cross cutting domain across health care systems and the pharmaceutical industry. Also, higher education in pharmaceuticals lies at cross-roads between health and technical education. This has created enormous opportunities for developing synergistic and symbiotic relationships between academic institutions and the pharmaceutical industry for developing human resource trained in various domains of the pharmaceutical. However, there is limited information and data regarding educational institutions offering training in pharmaceuticals as well as supply of human resources trained in pharmaceuticals. This research article intends to fill the above mentioned research gap and stimulate discussion around various pertinent issues like regulation, accreditation and benchmarking of various educational programmes in pharmaceutical management.

The core functions of public health agencies at all levels of government are identified as assessment, policy development, and assurance. However, the public health agencies in India are struggling with issues of access, inefficiency, and inequity. There has been failure in terms of health service delivery by public sector. Health Policy is being increasingly recognized as a discipline that has much to offer developing countries in addressing the problems related to policy, governance, and regulatory failure. However, the information about skill-oriented courses on health policy especially from the context of translating public health science into policy action is incomplete and limited. This paper attempts to address this knowledge gap and stimulate discussion in this direction.

Objective Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. Setting 16 of 29 states in India, 2009–2012. Design Retrospective descriptive secondary data analysis. Data (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. Outcome measures State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. Results The overall private sector Hib vaccine coverage among the 2009–2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians’ prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009–2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. Conclusions If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services.

This presentation highlights the use of mathematical model to estimate burden of disease in absence of surveillance data. We estimated that in 2010, 3.57 million severe pneumonia cases and 0.45 million all cause pneumonia deaths occurred in children under age 5 years. Among these cases, the contribution of pneumococcal pneumonia was 15.8% to all cause pneumonia cases and 20.8% to all cause pneumonia deaths. Three states requires specific mention, Uttar Pradesh contributes (24% cases, 24% deaths), Bihar (16% cases, 17% deaths) and MP (9% cases, 10% deaths) to the national figures. They were top contributors to pneumococcal pneumonia burden also.

The most prevalent types of human papillomavirus in cervical cancer in India are HPV 16 and HPV 18, found in 60.7 per cent and 16 per cent of cases respectively. A comprehensive strategy with a judicious mix of interventions on health promotion, specific protection (vaccination), early diagnosis (screening), and treatment should be instituted to prevent and control cervical cancer in India. Proponents of vaccination and screening argue for enhanced investments on these interventions based on their relative cost-effectiveness. For policymakers, the major concerns about these interventions remain affordability and cost to government. Herein we try to review comprehensively the evidence on prevention and control interventions and to recommend appropriate policies to guide public health decision-making.

Diabetes demands early diagnosis, prompt treatment, continuous monitoring and follow up. Physicians play a pivotal role in diabetes management. However, evidence suggests that sub-optimal knowledge of guidelines and other issues may lead to ineffective management and poor patient outcomes. The aim of this research was to identify clinical diabetologist's perspectives on evidence based diabetes management, benefits of and barriers to the practice of evidence based guidelines in management of type 2 diabetes. Clinical diabetologists were administered a semi-structured questionnaire. Qualitative responses were analysed to identify key words, phrases and concepts from respondents. Majority of diabetologist (78.2%) preferred ADA guidelines alone or in combination with others guidelines where as 12.7% diabetologist follow all the guidelines on case by case basis. 27% and 25% diabetologists opined that guidelines ensure uniform standard of care across patient and achievement of diabetes management goals respectively. Poor awareness among physicians (22.7%), western guidelines being not applicable to Indian patients (22.7%), cost to patient (18.2%) were some of the barrier to practice of evidence based diabetes management. Some of the mechanism suggested to improve the practice of evidence based diabetes management included education of physicians in EBM (28.9%), making practice of evidence based guidelines legally binding (10.5%) and wider dissemination of existing guidelines (7.8%).

Rotavirus vaccines have been developed to prevent deaths resulting from severe diarrhea of rotavirus origin. The use of vaccines as an intervention at scale to prevent and control the burden of rotavirus diarrhea is supported by the argument that prevailing public health measures such as hygiene and sanitation, breast feeding and use of ORS have failed to prevent severe dehydration resulting from diarrhea. The article reviews the existing evidence on the rationale of using rotavirus vaccine as against the feasibility of scaling it up in developing countries like India. The vaccines currently available may not cover the strains circulating in Indian population. The diversity of Rotavirus infection in the country is tremendous and since the safety, immunogenicity and efficacy data has not been collected for India, there is first a need to conduct studies to measure the extent of protection and cross-protection provided by the available vaccines for local strains, before venturing into Rotavirus vaccination program. The potential benefits of immunization have to be first vetted against the risks involved by the policymakers and other stakeholders.

Background: In India, access to medicine in the public sector is significantly affected by the efficiency of the drug procurement system and allied processes and policies. This study was conducted in two socioeconomically different states: Bihar and Tamil Nadu. Both have a pooled procurement system for drugs but follow different models. In Bihar, the volumes of medicines required are pooled at the state level and rate contracted (an open tender process invites bidders to quote for the lowest rate for the list of medicines), while actual invoicing and payment are done at district level. In Tamil Nadu, medicine quantities are also pooled at state level but payments are also processed at state level upon receipt of laboratory quality-assurance reports on the medicines. Methods: In this cross-sectional survey, a range of financial and non-financial data related to procurement and distribution of medicine, such as budget documents, annual reports, tender documents, details of orders issued, passbook details and policy and guidelines for procurement were analysed. In addition, a so-called ABC analysis of the procurement data was done to to identify high-value medicines. Results: It was observed that Tamil Nadu had suppliers for 100% of the drugs on their procurement list at the end of the procurement processes in 2006, 2007 and 2008, whereas Bihar’s procurement agency was only able to get suppliers for 56%, 59% and 38% of drugs during the same period. Further, it was observed that Bihar’s system was fuelling irrational procurement; for example, fluconazole (antifungal) alone was consuming 23.4% of the state’s drug budget and was being procured by around 34% of the districts during 2008-2009. Also, the ratios of procurement prices for Bihar compared with Tamil Nadu were in the range of 1.01 to 22.50. For 50% of the analysed drugs, the price ratio was more than 2, that is, Bihar’s procurement system was procuring the same medicines at more than twice the prices paid by Tamil Nadu. Conclusion: Centralized, automated pooled procurement models like that of Tamil Nadu are key to achieving the best procurement prices and highest possible access to medicines.

Introduction: Essential medicines lists are a key instrument for improving quality and equitable access to health care. The National List of Essential Medicines of India 2011 is modeled on the WHO Essential Medicines List and Indian states (adopting the National List) are free to include other medicines as needed. Materials and Methods: National List of Essential Medicines of India 2011 contains a total of 287 medicines for provision at primary and secondary level of health facilities. The International Nonproprietary Name of these medicines was compared with the List of Essential Medicines (LEM) of three states, that is, Bihar, Rajasthan and Tamil Nadu for the inclusion patterns. Results: A large number of medicines from the National List of Essential Medicine (NLEM) were missing from the state LEM's, especially Bihar. The sections on Anticonvulsants, Diuretics, Psychotherapeutic, Antiallergics and Oxytocics were comprehensively included by both Rajasthan and Tamil Nadu. Furthermore, the analgesic and anti-infective medicines were largely included. However, the sections of antidotes, diagnostic agents and ophthalmological preparations were grossly deficient. Similarities were found across states in their patterns of both inclusion and exclusion of medicines. Conclusion: The analysis reveals that the extent of inclusion of NLEM medicines in state LEM's is deficient with variable patterns across states. This in turn has implications for drug availability, prescription patterns, and rational drug use. As some drugs are repeatedly there in NLEM but not included by states, a discussion based consultative approach for better coherence across the lists could lead to further optimization and utilization of LEM's which would aid in improved access to medicines.

The top 3 countries with the highest number of people living with diabetes are China, India and USA. Diabetes not only reduces the quality of life and life expectancy, but also imposes huge economic burden on the health system and families. For improved diabetes care and patient outcomes continuing medical education of the existing health work force in evidence based diabetes care is essential. Patient’s education in diabetes self-management is also essential. This article reviews the existing literature on evidence based practice in diabetes care and barriers at physician-patient level to suggest that there is legitimate need of competency based training in diabetes management. The article also attempts to identify some of these existing educational programmes in diabetes management in India and their key strengths.