The predictors of COVID-19 mortality among health systems parameters: an ecological study across 203 countries.

BACKGROUND: Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design. METHODOLOGY: Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately. RESULTS: Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability. CONCLUSION: To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.

Human Resources for Health in India: Need to go Beyond Numbers.

India's commitment to achieve the goal of Universal Health Coverage is evidenced by the launch of Ayushman Bharat and the transformation of Sub-Centres into Health and Wellness Centre to provide secondary and comprehensive primary healthcare to the vast majority of its population. Successful implementation of these initiatives requires adequate and skilled human resources for health and a conducive work environment. There exists a deficiency of doctors and paramedical professionals in different parts of the country. The vacancies in different categories of health functionaries have increased after 2005 despite the National Rural Health Mission/National Health Mission initiatives to strengthen the health system. The distribution of doctors and paraprofessionals in health is skewed, favoring urban areas. Properly oriented, trained, and skilled health workforce and informed public participation are critical to provide quality services for achieving national health goals. Therefore, it is necessary to establish public health cadre in all states of India and ensure appropriately skilled workforce to meet the functional requirements of health-care delivery system at different levels. This will also help to move forward on the way to reach the Sustainable Development Goals.

Addressing health inequity through strategic planning and management.

Substantial progress has been made to improve health in India in terms of availability, accessibility, cost-effectiveness, and quality. However, there are major health inequalities between and within the states. Strategic planning of health programs is required to address inequities in health. Need of the hour is to address this using a simplified strategic approach; who is left out, why are they left out, what causes are responsible for it and what are the determinants of inequality. The basic steps of strategic management, including strategic assessment, objectives, strategy formulation, and implementation, can be used to address the health equity. This article cites the examples of Serbia immunization programme, Government of India programme on Mission Indradhanush, and Thailand's universal health coverage to get better understanding to use strategic management to address health inequity. This approach is crucial in achieving sustainable development goals.

Overview of Zoonotic Diseases in Peri-Urban Areas and Introduction to the Special Issue.

Emerging zoonoses are the product of socio economic and anthropogenic environmental changes. As human societies continue to develop, pathogens from animal hosts have continued to spill over into our population However, Peri-urban ecosystems remain neglected in the country. With a subsequent increase in demand for food, there has been an expansion of formal and informal livestock-based food production sectors in these areas. The increasing close contact between animals and humans in both work and living environments creates hot spots in peri-urban areas, thereby increasing vulnerability to zoonotic disease transmission and other health hazards associated with food safety, water, and sanitation-related diseases. This paper explores the efforts made by different research bodies to reduce the prevalence of zoonotic diseases in peri-urban areas.

Changing Role of Nursing Cadre under Emerging Zoonotic Diseases.

With the launch of new Government of India's initiative Ayushman bharat that envisages conversion of all subcenters into health and wellness centers, the role of nursing professionals in primary health care will be undergoing paradigm shift. Nurses are approximately two-third of the population of health workforce in India. Nurses' scope of work has widened with additional roles and responsibilities due to shift in the pattern of burden of diseases. The emergence of zoonotic infectious diseases has further enlarged their responsibilities. The main areas, which need attention, are development of nursing workforce, selection and recruitment, placement as per specialization, and preservice and in-service training related to zoonotic surveillance. This article attempts to discuss the role of nurses under emerging zoonotic disease infections.

Community Acceptance of Available Milk and Assessment of Its Quality in Peri-Urban Area of Southwest Delhi.

BACKGROUND: Milk is considered to be a balanced food rich in fats, proteins, vitamins, and minerals, which is complete nutrition in a balanced proportion. However, most of milk sold in India does not match standards laid down by the Food Safety and Standards Authority of India. OBJECTIVE: The objective was to understand the perception of community regarding the acceptance of packaged and unpackaged milk, to assess the quality of milk with respect to adulterants, and to assess the difference in the quality of milk at a level of vendor/hawker and end user. MATERIALS AND METHODS: A cross-sectional study was conducted among 100 households in the peri-urban area of Kangan Heri, Delhi. A structured questionnaire and checklist were used for data collection. Purposive sampling was used. The analysis was done with the Statistical Package for the Social Sciences version 22. Descriptive statistics and cross tabulation were used. RESULTS: A total of 22.5% respondents preferred packaged milk over unpackaged milk. Only 8% of packaged milk samples contained no adulterant. Majority of the respondents were preferred unpacked milk for daily consumption. CONCLUSION: Community perceives good taste as traits of good quality milk followed by good smell, digestibility, and color and economical. The presence of neutralizer in packaged milk followed by detergent and urea. There was no difference in the presence of adulterants in packaged milk at the level of end user or vendor. There is a slight difference in the presence of adulterants in unpackaged milk at level of end user.

The Fate and Management of Sick and Dying Cattle - Consequences on Small-Scale Dairy Farmers of Peri-Urban Areas in India.

BACKGROUND: The livestock plays an important role in the economy of farmers. The mismanagement of sick and dying cattle leads to an increase in sanitation cost of municipalities, incidences of diseases by exposed carcasses, and hence more expenditure on avoidable health catastrophes. OBJECTIVE: The objective is to study the fate of sick and failing cattle and their detailed management regarding disposal of dead cattle. MATERIALS AND METHODS: The qualitative research approach was used. The dual strategies of purposive sampling and snowballing were employed to identify potential respondents. The study was conducted 15 in-depth interviews among smallholder dairy farmers, scientists, officials of National Dairy Research Institute (NDRI), municipality officials, and veterinarians in peri-urban areas of Karnal, Haryana, located in North India. Data were analyzed based on the contents of these audio-recorded interviews. The recordings have transcribed and translated. After translation completion, a content analysis was performed manually to identify emerging themes and interconnections. RESULTS: This article highlighted three core themes such as impact of low literacy and awareness levels, role of informal forms of disposal, and preference of informal channels over municipality. CONCLUSIONS: There is a gap in current practices and management of sick and dying cattle. Small-scale farmers prefer to dispose their cattle in an informal way. It needs to improve animal welfare by modeling guidelines for disposal of dead cattle and its consequences pertaining to zoonoses.

Is Small Scale Dairy Farming Dying Out? An In-depth Study.

BACKGROUND: Animal husbandry plays an important role in the Indian economy. Small scale milk producers contribute 62% of the total milk produced in the country. However, the lives and livelihoods of small dairy farmers are becoming vulnerable in India. OBJECTIVES: This article tried tried to explore the reasons of decrease in small scale dairy farms. Apart from that this article is also find out what were the challenges faced by small dairy farming families and its influence on animal health. METHODS: A qualitative exploratory study was carried out in the peri-urban area of Hodal, Haryana. Purposive and snowball sampling were employed. Twenty-six in-depth interviews were conducted with current small scale dairy farmers, ex small scale dairy farmers, households, and other stakeholders. Results are presented in the form of core and sub-themes evolved during this process. RESULTS: This study revealed that a small scale dairy farmer is present in peri-urban area, but there is a decrease in small scale dairy farming. The major reason is shrinking fringes, access to cattle provender, the tepid interest of future generation, increased cost of cattle, and cattle health. CONCLUSION: The study recommends that support (in the form of subsidy) should be provided to small scale dairy farmers for accessing land and provender. Awareness about the importance and scope of small scale dairy farming as a stable career opportunity should be spread among the young generation.