Barriers to healthcare utilization among married women in Afghanistan: the role of asset ownership and women's autonomy.

Women face multiple socio-economic, cultural, contextual, and perceived barriers in health service utilization. Moreover, poor autonomy and financial constraints act as crucial factors to their healthcare accessibility. Therefore, the objective of the present study is to study the association between health care utilization barriers and women empowerment, including asset ownership among currently married women in Afghanistan. Data of 28,661 currently married women from Afghanistan demographic health survey (2015) was used to carry out this study. Barriers to access healthcare were computed based on problems related to permission, money, distance, and companionship, whereas women empowerment and asset ownership were computed as potential covariates along with other socio-economic risk factors. Bivariate and logistic analysis was carried out to study the association and odds of explanatory variables. Our results confirm the significant and strong association between the barriers to access healthcare and various explanatory variables. Women having any decision-making autonomy are less likely to face any odds [(AOR = 0.56, p < 0.001), CI: 0.51-0.61] among the currently married women than those who don't have any decision-making authority. Similarly, women who justify their beating for some specific reasons face the greater difficulty of accessing health care [(AOR = 1.76, p < 0.001), CI: 1.61-1.93]. In terms of asset ownership, women having any asset ownership (land or household) are less likely to face any barriers in health services utilization given the lower odds [(AOR = 0.91, p < 0.001), CI: 0.90-0.98]. Accessing maternal health is a crucial policy challenge in Afghanistan. A substantial proportion of women face barriers related to approval, money, distance, and companionship while accessing the health services utilization in Afghanistan. Similarly, women empowerment and asset ownership are significantly associated with health service accessibility. This paper therefore suggests for some policy interventions to strengthen the healthcare needs of women and ensure healthcare accessibility by scaling down these potential barriers like poor autonomy, asset ownership and domestic violence.

Health insurance support on maternal health care: evidence from survey data in India.

BACKGROUND: Maternal health care financing is key to the smooth functioning of health systems in a country. In India, maternal health care still persists as a major public health issue. Adequate health insurance could transform the utilization of maternal health care services. Therefore, we aim to examine the health insurance policies that cover maternal health and their performance in India. METHODS: The unit-level data of social consumption on health by the National Sample Survey Organizations, conducted in India (2017-18), are used. Bivariate analysis, logistic regression and propensity scoring matching are applied. RESULTS: About 14.1% women are covered by health insurance support at the national level. Uninsured women are less likely to receive full antenatal care (ANC) services and institutional delivery. Socio-economic characteristics play a significant role in utilizing maternal health care benefits through health insurance support. CONCLUSIONS: Our study concludes that the health insurance coverage is the most significant contributor to the better utilization of full ANC and institutional delivery at the national level and hindrances in accessing them. There is a need for proactive and inclusive policy development by the Government of India to incentivize public financing through health insurance, which can shrink the challenges of public health burden and reduce the health risk.

Genetic Susceptibility of DCC Gene in Gallbladder Cancer in Kashmir and Meta-Analysis.

Deleted in colorectal carcinoma (DCC) A > G (rs714) is the most widely studied SNP of tumor suppressor DCC gene found to be associated with increased risk of various cancers. Therefore, the aim of present case control study was to investigate the role of DCC A > G (rs714) in gallbladder cancer (GBC) in Kashmir and to conduct a meta-analysis of DCC A > G (rs714) polymorphism to demonstrate the more accurate strength of these associations. Genotyping was done by PCR/RFLP and confirmed by sequencing in 100 GBC cases, and 150 controls. We also performed a comprehensive meta-analysis of 2223 subjects (1118 cases and 1105 controls) to evaluate the association between DCC A > G (rs714) polymorphisms and cancer. In present case control study DCC A > G (rs714) genotypes did not modulate the GBC cancer risk. Meta-analysis results showed that DCC A > G (rs714) is associated with increased overall cancer risk. DCC A > G (rs714) polymorphism conferred significant risk for cancer in dominant model but in recessive model P-value was at borderline. DCC A > G (rs714) genotype was associated with increased risk of cancer in Asians and Kashmiri population whereas no such association was observed in Europeans. The evidence in this meta-analysis supports a modest involvement of DCC A > G (rs714) tumoursupressor pathway genes in cancer susceptibility.

Multimorbidity and its associated risk factors among older adults in India.

BACKGROUND: Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above. METHODS: Using the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks. RESULTS: Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282-1.401) as compared to men among the older adults in India. CONCLUSION: Our results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.

Fabrication of metal incorporated polymer composite: An excellent antibacterial agent.

US Food and Drug Administration (FDA) allowed for direct addition of castor oil for human consumption as food and most recently FDA approved castor oil as over-the-counter (OTC) for laxative drug. The present article highlights the green route phosphorylation of castor oil (COL) via condensation polymerization. Further, the incorporation of metal ions Cu (II)) and Zn (II) into the polymer matrix have been carried out at elevated temperature using catalyst p-toluene sulphonic acid (PTSA). The modification of the said material has been confirmed by FT-IR, UV-VIS, and 1H and 31P-NMR spectroscopy. Further, the in vitro antibacterial activities of the metal incorporated-COL has been performed by standard methods against B. cereus (MCC2243) (gram-positive) and E. coli (MCC2412) (gram-negative) bacteria. The results revealed that the incorporation of metal ions into the polymer matrix increases the antibacterial activity largely. This may be governed by the electrostatic interaction between metal ions and microbes, also the generation of free active oxygen hinders the normal activity of bacteria. These results suggest that the synthesized material may act a potential candidate for low cost, environment friendly antibacterial agents and may find their application in clinical fields. Herein we are also proposing mechanism of antibacterial activity.

Role of Glutathione-S-Transferases in Gallbladder Cancer and Cholelithiasis Susceptibility and Meta-Analysis.

Glutathione-S-transferase T1 (GSTT1) and glutathione-S-transferase M1 (GSTM1) genes are associated with increase susceptibility to developing different types of cancers. The aim of present study was to investigate the role of genetic variants of GSTM1 and GSTT1 in gallbladder cancer (GBC) and cholelithiasis in Kashmir valley. Genotyping was done by multiplex polymerase chain reaction in 100 GBC, 100 cholelithiasis, and 150 controls adjusted by age and sex. We also performed a meta-analysis of published studies on GSTM1 and GSTT1 to evaluate the association between the GSTM1 and GSTT1 polymorphisms and GBC. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random- or fixed-effects model. In the present study, no association was observed between GSTM1 null and GSTT1 null genotypes and GBC and cholelithiasis. Meta-analysis results showed that GSTM1 null genotype was associated with GBC risk (P = 0.042). Subgroup analysis by ethnicity showed that GSTM1 null (P = 0.024) and GSTT1 null genotype (P = 0.037) were significantly associated with risk of GBC in Asians. This is the first study to investigate the role of genetic variants of GSTM1 and GSTT1 in GBC in Kashmir valley and cholelithiasis in the world.

S-benzyldithiocarbazate imine coordinated metal complexes kill Candida albicans by causing cellular apoptosis and necrosis.

Development of new chemotherapeutic agents and strategies are urgently needed to curb and halt the growing menace caused by hard-to-treat microbes. Coordination of metals to bioactive organic ligands is now considered to be an efficient strategy for delivering bioactive compounds inside the microbial cell membranes. Metal complexes have been effectively used to treat many dreadful diseases were other treatment modalities had failed. Use of metal complexes to treat microbial infections is now conceived to be an alternative and efficient strategy. Towards this, some new homoleptic transition metal complexes, obtained by coordination of metal ions to bioactive S-benzyldithiocarbazate Schiff-base ligands were evaluated for their anti-Candida activity and their potential to disrupt the membrane architecture. The complexes displayed remarkable antifungal activity against a wide spectrum of fluconazole susceptible and resistant Candida albicans isolates, with Ni complex (dtc3) being highly active with minimum inhibitory concentration (MIC) values ranging from 1 to 32 µg/mL. Cell viability assay confirmed the fungicidal activity of these metal complexes, especially the complex dtc3. These metal complexes kill Candida albicans by inducing cellular apoptosis and necrosis thereby causing phosphatidylserine externalization as revealed by Annexin V-FITC and propidium iodide staining assays.

Probing the antibacterial and anticancer potential of tryptamine based mixed ligand Schiff base Ruthenium(III) complexes.

Development of new chemotherapeutic agents to treat microbial infections and recurrent cancers is of pivotal importance. Metal based drugs particularly ruthenium complexes have the uniqueness and desired properties that make them suitable candidates for the search of potential chemotherapeutic agents. In this study, two mixed ligand Ru(III) complexes [Ru(Cl)2(SB)(Phen] (RC-1) and [Ru(Cl)2(SB)(Bipy)] (RC-2) were synthesised and characterized by elemental analysis, IR, UV-Vis, 1H, 13C NMR spectroscopic techniques and their molecular structure was confirmed by X-ray crystallography. Antibacterial activity evaluation against two Gram-positive (S. pneumonia and E. faecalis) and four Gram-negative strains (P. aurogenosa, K. pneumoniae, S. enterica, and E. coli) revealed their moderate antibacterial activity with MIC value of ≥250 µg/mL. Anticancer activity evaluation against a non-small lung cancer cell line (H1299) revealed the tremendous anticancer activity of these complexes which was further validated by DNA binding and docking results. DNA binding profile of the complexes studied by UV-Visible and fluorescence spectroscopy showed an intercalative binding mode with CT-DNA and an intrinsic binding constant in the range of 3.481-1.015× 105 M-1. Both the complexes were also found to exert weak toxicity to human erythrocytes by haemolytic assay compared to cisplatin. Potential of these complexes as anticancer agents will be further delineated by in vivo studies.

Genetic variants associated with primary open angle glaucoma in Indian population.

Glaucoma is a very common disorder of the eye wherein the disturbance of the structural or functional integrity of the optic nerve causes characteristic atrophic changes in the optic nerve, which may lead to specific visual field defects over time. Primary open angle glaucoma (POAG) is most frequent among the three principle glaucoma subtypes. With well-established role of genes like Myocilin (MYOC), Optineurin (OPTN) and WD repeat Domain 36, (WDR36), at least 29 genetic loci have been found till date to be linked to POAG. Moreover, association studies have found 66 loci with 76 genes associated to POAG till date with conflicting results. This particular study is to summarize the current knowledge regarding the change in glaucoma prevalence worldwide and in India from 1993 onwards and compiles all the studied genes that are involved in POAG pathogenesis in Indian population.

Design, synthesis and spectroscopic characterization of metal (II) complexes derived from a tetradentate macrocyclic ligand: Study on antimicrobial and antioxidant capacity of complexes.

The paper presents the synthesis of Co(II), Ni(II) and Cu(II) complexes of macrocyclic Schiff base ligand derived from 1, 4-dicarbonyl-phenyl-dihydrazide and ethyl 3-oxobutanoate (2:2). The synthesized ligand and its metal complexes were characterized by elemental analyses, magnetic susceptibility measurements, FTIR, UV-Vis., mass 1H NMR and X-ray diffraction. The Cu(II) complex exhibit distorted octahedral geometry, whereas an octahedral geometry is suggested for other complexes. The synthesized compounds were screened in vitro for their antimicrobial activities to evaluate their inhibiting potential against bacterial species Pseudomonas aeruginosa, Escherichia coli, Salmonella typhimurium, Staphylococcus aureus and fungal species include Aspergillus flavus, Aspergillus fumingatus, and Candida albicans. The complexation led to a remarkable increase in antimicrobial activity. In addition, the antioxidant activity of the compounds was also investigated through scavenging effect on DPPH radicals. The obtained IC50 value of the DPPH activity for the copper complex was higher than other compounds.

Design, synthesis, characterization and antimicrobial/antioxidant activities of 1, 4-dicarbonyl-phenyl-dihydrazide based macrocyclic ligand and its Cu(II), Co(II) and Ni(II) complexes.

Mononuclear transition metal complexes of Cu(II), Co(II) and Ni(II) with a newly synthesised macrocyclic ligand derived from 1, 4-dicarbonyl-phenyl-dihydrazide and 1,2-diphenylethane-1,2-dione (2:2) have been synthesised. The synthesised compounds were characterised by various physical and spectroscopic techniques including elemental analysis, FTIR, Uv-Vis., 1H NMR, mass spectra, magnetic moment and XRD. The investigation of these macrocyclic complexes established that the stability of metal-ligand coordination through N atoms as tetradentate chelates. The metal/ligands ratio of 1:1 was proposed to afford octahedral geometry for the complexes. The antimicrobial activity of the compounds against some bacterial and fungal species were done by well diffusion method and the results shows that the metal complexes have a promising biological activity comparable with the parent ligand against all bacterial and fungal species. The antioxidant activity of the compounds was also studied through scavenging effect on DPPH radicals with the copper complex showing enhanced activity than other compounds. Additionally, the docking studies predicted the high antimicrobial activity due to the interaction of ligand with the protein.

Epigenetic regulation of human retinoblastoma.

Retinoblastoma is a rare type of eye cancer of the retina that commonly occurs in early childhood and mostly affects the children before the age of 5. It occurs due to the mutations in the retinoblastoma gene (RB1) which inactivates both alleles of the RB1. RB1 was first identified as a tumor suppressor gene, which regulates cell cycle components and associated with retinoblastoma. Previously, genetic alteration was known as the major cause of its occurrence, but later, it is revealed that besides genetic changes, epigenetic changes also play a significant role in the disease. Initiation and progression of retinoblastoma could be due to independent or combined genetic and epigenetic events. Remarkable work has been done in understanding retinoblastoma pathogenesis in terms of genetic alterations, but not much in the context of epigenetic modification. Epigenetic modifications that silence tumor suppressor genes and activate oncogenes include DNA methylation, chromatin remodeling, histone modification and noncoding RNA-mediated gene silencing. Epigenetic changes can lead to altered gene function and transform normal cell into tumor cells. This review focuses on important epigenetic alteration which occurs in retinoblastoma and its current state of knowledge. The critical role of epigenetic regulation in retinoblastoma is now an emerging area, and better understanding of epigenetic changes in retinoblastoma will open the door for future therapy and diagnosis.

Genetic determinants of uveal melanoma.

Melanoma of the uveal tract is the most common primary intraocular tumor in adults. With advances in genetic research and the open source access of genetic databases, new insights are emerging into the molecular changes of this cancer. As with most other tumors, the driving force behind such research is the hope of finding and developing new modalities for therapeutic purposes, prognosticating disease and understanding risk factors for metastasis. With advances in proteomics, cytogenetics and gene profiling, the stage is set to unearth the underlying genetic basis which can in the future be a target of therapeutic modalities. This article describes the cytogenetic, molecular pathogenesis, and prognostic factors along with the most important findings and their attribution to current and future management of uveal melanoma.

Expression of P-glycoprotein in human retinoblastoma and its clinical significance.

Retinoblastoma is the most common malignant intraocular tumor of childhood. Drug resistance and relapses are major problems with chemotherapy, which is regarded as the mainstay of globe preserving treatment in retinoblastoma. P-glycoprotein (P-gp) expression has been reported to be associated with chemoresistance and poor prognosis in various malignancies. We analyzed P-gp expression in retinoblastoma specimens, enucleated either primarily or after neoadjuvant chemotherapy by immunohistochemistry and immunoblotting, and correlated with the histopathological findings. Variables were statistically analyzed by Fischer's exact and chi-square tests. Tumor tissues were collected from enucleated eyes of 24 children. Fifteen of these were primarily enucleated (group I), and nine (group II) had received chemotherapy prior to enucleation. P-gp was expressed in 4/15 (26.7 %) eyes in group I and in 5/9 (55.6 %) eyes in group II. P-gp was highly expressed in group II as compared to group I. There was no correlation between P-gp expression and tumor differentiation, invasion, or laterality. In conclusion, there was markedly high expression of P-gp in eyes with retinoblastoma enucleated after chemotherapy. This may possibly play a role in chemoresistance or it may be that chemotherapy might have induced high expression. These findings may have important implications for the treatment of retinoblastoma patients but need further prospective investigations in a larger patient population.

A novel duplication in the PAX6 gene in a North Indian family with aniridia.

Mutations in paired box gene 6 (PAX6) are the major cause of aniridia that may be associated with several other developmental anomalies of the eye, including microcornea in rare cases. Therefore, the purpose of this study was to identify the underlying genetic cause in a two-generation North Indian family diagnosed with aniridia. All the participants enrolled in the study, including the aniridia family and 20 healthy individuals (controls), underwent a comprehensive ophthalmic examination. Mutation screening was performed for the PAX6 gene by direct sequencing of the polymerase chain reaction products. A novel PAX6 duplication in exon 5 at position c.474dupC was identified in all three affected individuals from the family but not in the unaffected family members or unrelated controls. We reported a novel duplication in the PAX6 gene capable of causing the classic aniridia phenotype. This is the first report on the duplication in a North Indian family with autosomal dominant aniridia.

Harnessing the power of gold: advancements in anticancer gold complexes and their functionalized nanoparticles.

Cancer poses a formidable challenge, necessitating improved treatment strategies. Metal-based drugs and nanotechnology offer new hope in this battle. Versatile gold complexes and functionalized gold nanoparticles exhibit unique properties like biologically inert behaviour, outstanding light absorption, and heat-conversion abilities. These nanoparticles can be finely tuned for drug delivery, enabling precise and targeted cancer therapy. Their exceptional drug-loading capacity and low toxicity, stemming from excellent stability, biocompatibility, and customizable shapes, make them a promising option for enhancing cancer treatment outcomes and improving diagnostic imaging. Leveraging these attributes, researchers can design more effective and targeted cancer therapeutics. The potential of functionalized gold nanoparticles to advance cancer treatment and diagnostics holds a promising avenue for further exploration and development in the fight against cancer. This review article delves into the finely tuned attributes of functionalized gold nanoparticles, unveiling their potential for application in drug delivery for precise and targeted cancer therapy.

Role of genetic variants of deleted in colorectal carcinoma (DCC) polymorphisms and esophageal and gastric cancers risk in Kashmir Valley and meta-analysis.

Genetic alterations in the deleted in colorectal carcinoma (DCC) gene have been a priori reported to associate with metastasis in variety of human cancers. We investigated the association between potentially functional SNPs in DCC and susceptibility to esophageal (EC) and gastric (GC) cancers in Kashmir Valley. We genotyped two SNPs DCC rs714 (A>G) and DCC rs2229080 (C>G) of DCC in 135 EC patients, 108 GC patients, and 195 controls matched by age and sex in Kashmir Valley by polymerase chain reaction-RFLP method. Risk for developing EC and GC was estimated by binary logistic regression by using SPSS. We also performed a meta-analysis on DCC rs714 (A>G) and evaluated the association between the DCC rs714 (A>G) polymorphisms and cancer risk. A significant difference in DCC rs714 (A>G) genotype distribution between EC and GC cases and corresponding control groups was observed (odds ratio (OR) = 1.92; P = 0.03; P-trend = 0.04; false discovery rate (FDR) Pcorr = 0.03: OR = 2.15; P = 0.02; P-trend = 0.01; FDR Pcorr = 0.03). But no such association was observed in DCC rs2229080 (C>G). Further, DCC rs714 (A>G) AA genotype showed significantly increased risk for both gastric squamous cell carcinoma (OR = 5.63; P = 0.02; FDR Pcorr = 0.01) and gastric adenocarcinoma (OR = 2.15; P = 0.02; FDR Pcorr = 0.01). Smoking and salted tea are independently associated with both EC and GC, but gene-environment interaction did not further modulate the risk. Meta-analysis also suggested both independent and overall association of DCC rs714 (A>G) polymorphism with cancer (P = 0.000). In conclusion, genetic variations in DCC rs714 (A>G) modulate risk of EC and GC in high-risk Kashmir population.

Decomposing acute malnutrition by educational inequality of mother's among under five children in Jammu and Kashmir.

Health outcomes in the state of Jammu and Kashmir have shown improvement in recent decades. However, nutritional achievements, particularly among children under the age of five, have not seen similar progress. Various factors influence the nutritional status of this age group, with the socio-cultural and biological attributes of mothers being considered significant determinants. While some studies have examined these attributes, there is a scarcity of research exploring the causal link between socio-culturally determined factors, such as maternal education, and child nutritional achievements, especially in Indian states located in North India. This paper aims to address this gap by analysing the prevalence of acute malnutrition (stunting) among children under five in Jammu and Kashmir in relation to educational inequality among mothers. The latest round of the National Family Health Survey (NFHS-5) is used to assess the levels of stunting (low height for age) among children, considering the literacy status of mothers and other control variables. Bivariate and multivariable methods are employed to study the association and identify risk factors. Additionally, the Oaxaca decomposition method is used to analyse the educational gap in factors associated with child stunting. The results indicate a higher prevalence of stunting among children of uneducated mothers (29%) compared to those of educated mothers (25%). The findings demonstrate a lower risk of stunting among children whose mothers are literate (OR 0.89). The Oaxaca decomposition analysis reveals a statistically significant difference in stunting between children based on their mother's education. These results highlight the wide disparities in acute malnutrition among children due to variations in maternal education. It is therefore crucial for policymakers to prioritize efforts to reduce educational disparities in order to alleviate the nutritional burden faced by children.

Role of NQO1 609C>T and NQO2 -3423G>A gene polymorphisms in esophageal cancer risk in Kashmir valley and meta analysis.

Esophageal cancer (EC) is a complex multifactorial disorder, where environmental and genetic factors play major role. NADPH:quinone oxidoreductase 1 (NQO1) and NRH:quinone oxidoreductase 2 (NQO2) are phase II cytosolic enzymes that catalyze metabolism of quinones, important in the detoxification of environmental carcinogens. A case-control study was performed to investigated the associations of NQO1 609C>T and NQO2 -3423G>A polymorphisms with susceptibility to EC in a high-risk Kashmiri population of India in 135 EC patients and 195 unrelated healthy controls using PCR-RFLP. We also performed a meta analysis of nine published studies (1,224 cases and 1,740 controls) on NQO1 609C>T and evaluated the association between the NQO1 609C>T polymorphisms and esophageal cancer risk. A significant difference in NQO1 609C>T and NQO2 -3423G>A genotype distribution between EC cases and corresponding controls groups was observed (OR = 2.65; 95 % CI = 1.29-5.42 and OR = 1.88; 95 % CI = 1.02-3.49 respectively). Further, gene-gene interaction showed significantly increased risk for esophageal adenocarcinoma with variant genotypes of NQO1 609C>T and NQO2 -3423G>A polymorphisms and interaction with environmental risk factors revealed pronounced risk of EC with NQO1 609C>T TT genotype in high salted tea users of Kashmir valley (OR = 3.72, 95 % CI = 0.98-14.19). Meta analysis of NQO 609C>T polymorphism also suggested association of the polymorphism with EC in Asians as well as Europeans. In conclusion, NQO1 609C>T and NQO2 -3423G>A genetic variations modulate risk of EC in high-risk Kashmir population.

Fragility and challenges of health systems in pandemic: lessons from India's second wave of coronavirus disease 2019 (COVID-19).

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.