Assessment of natural radioactivity level before and after a mud-volcano eruption: A study from Piparo mud-volcano, Trinidad and Tobago.

The present study was conducted in the Piparo mud-volcano, which is situated in the central part of the island of Trinidad, is geologically connected with the Central Fault Range Zone (CFRZ). This fault zone is a neotectonic (active) strike-slip fault system and an extension of the Andes Mountain chain. This study was aimed at detecting the possible gamma radiation level in Piparo MV after its eruption in September 2019 and finding the change in the ambient radiation level after that eruption. To achieve this aim, gamma radiation data were collected for 6 months (three times at 3 months interval) after this eruption. As a pilot study, gamma radiation measurements were measured with the help of a portable Geiger Muller counter from 32 locations. Radiation levels were nearly 2 times higher than the average background levels in the country indicating Piparo mud-volcano could have controlled the elevated radiation levels in the area. Good correlations were also found between elevated radiation in the northern and western sides of the main crater and presence of auxiliary craters in the same sides. Previous studies reported that the northern side of the crater was more active, and the present study also supported their observation. Good correlation (with coefficient >0.9) indicates that these radioactivity values might be syngenetic. Continuous release and slow reduction of radiation levels (only 13% over 6 months) may indicate a continuous activity in Piparo mud-volcano and may support CRFZ as a creep fault.

Pro-poor policies and improvements in maternal health outcomes in India.

BACKGROUND: Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997-2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India. METHODS: This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015-16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India. RESULTS: On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors. CONCLUSIONS: The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India's impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play?

PURPOSE AND SETTING OF RESEARCH: Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. METHODS: This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. PRINCIPAL FINDINGS: Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. CONCLUSIONS: This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.

Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low- and middle-income countries.

OBJECTIVE: While childhood immunisation coverage levels have increased since the 70s, inequities in coverage between and within countries have been widely reported. Unvaccinated children remain undetected by routine monitoring systems and strikingly unreported. The objective of this study was to provide evidence on the magnitude of the problem and to describe predictors associated with non-vaccination. METHODS: Two hundred and forty-one nationally representative household surveys in 96 countries were analysed. Proportions and changes in time of 'unvaccinated' (children having not received a single dose of vaccine), 'partially vaccinated' and 'fully vaccinated' children were estimated. Predictors of non-vaccination were explored. RESULTS: The percentage of unvaccinated children was 9.9% across all surveys. 66 countries had more than one survey: 38 showed statistically significant reductions in the proportion of unvaccinated children between the first and last survey, 10 countries showed increases and the rest showed no significant changes. However, while 18 of the 38 countries also improved in terms of partially and fully vaccinated, in the other 20 the proportion of fully vaccinated decreased. The predictors more strongly associated with being unvaccinated were education of the caregiver, education of caregiver's partner, caregiver's tetanus toxoid (TT) status, wealth index and type of family member participation in decision-making when the child is ill. Multivariable logistic regression identified the TT status of the caregiver as the strongest predictors of unvaccinated children. Country-specific summaries were produced and sent to countries. CONCLUSION: The number of unvaccinated children is not negligible and their proportion and the predictors of non-vaccination have to be drawn from specific surveys. Specific vaccine indicators cannot properly describe the performance of immunisation programmes in certain situations. National immunisation programmes and national and international immunisation stakeholders should also consider monitoring the proportion of unvaccinated children (i.e. those who have received no vaccines at all) and draw specific plans on the determinants of non-vaccination.

A cost-effective method for detoxification of sludge containing lead.

The industrial wastewater treatment plant discussed in this paper generates sludge containing heavy metals, including lead. Occasionally, the concentration of lead in the Toxic Characteristics Leaching Procedure (TCLP) extract from the sludge exceeded the U.S. Environmental Protection Agency (EPA) regulatory limit of 5 mg/l and resulted in the solid waste exhibiting the characteristic of toxicity. The technical and economic feasibility of a process for conditioning the lead-containing sludge was investigated. The results revealed that the lead-laden sludge could be made non-hazardous by chemical conditioning. The lead reduction efficiency of triple super phosphate (TSP) is higher than that of either calcium carbonate or magnesium hydroxide. The laboratory and pilot-scale tests indicated that the conditioning system consistently reduced the lead in the TCLP extract below the regulatory limit of 5 mg/l. The economic feasibility evaluation demonstrated that more than 450,000 US dollars could be saved annually by conditioning the sludge with TSP and disposing it as a non-hazardous material in a landfill. The results obtained from the laboratory as well as from the pilot-scale operation are described and discussed in this paper.

Risk assessment of cardiovascular diseases among bank employees--a biochemical approach.

In different epidemiological studies, an association between sedentary life style and incidence of cardiovascular diseases has been demonstrated. This study was carried out among 50 sedentary bank employees working at different nationalized banks within Calcutta City, India and 50 individuals with non-sedentary jobs matched for age group and sex for the control group. Body mass index (BMI), blood pressure (BP), plasma level of glucose, total cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglycerides (Tgs) were found to be significantly higher whereas high density lipoprotein (HDL) and reduced glutathione were found to be significantly lower among the bank employees as compared with the control subjects. Further, significant alteration in the activity of different enzymes (e.g., glutathione reductase, glutathione S-transferase, glucose 6 phosphate dehydrogenase, catalase and superoxide dismutase) involved in glutathione-mediated antioxidant scavenging systems and increases in lipid peroxidation were also observed in the bank employees. From the study, it appears that the relative risk for cardiovascular disease is increased among bank employees due to the sedentary nature of their jobs.

Polio eradication in the World Health Organization South-East Asia Region by the year 2000: midway assessment of progress and future challenges.

In the South-East Asia Region (SEAR) of WHO, paralytic poliomyelitis has decreased from 25,711 cases in 1988 to 3304 cases in 1995, representing an 87% reduction. By 1995, in 6 of 10 member countries--India, Bangladesh, Myanmar, Nepal, Indonesia, and Democratic People's Republic of Korea--polio remained endemic. Two countries, Sri Lanka and Thailand, appear close to polio eradication, and 2, Bhutan and Maldives, reported no cases during 1989-1995. Although reported rates of acute flaccid paralysis and the percentage of cases virologically investigated are low in some countries, no isolates of wild poliovirus type 2 have been reported outside India since 1993. By the end of 1996, all 8 countries in which polio is endemic will have conducted national immunization days for polio eradication. The major challenge for polio eradication in SEAR will be strengthening surveillance, because national immunization days alone cannot eradicate polio.