Evaluating the relative influence of climate and human activities on recent vegetation dynamics in West Bengal, India.

Assessing the relative importance of climate change and human activities is important in developing sustainable management policies for regional land use. In this study, multiple remote sensing datasets, i.e. CHIRPS (Climate Hazard Group InfraRed Precipitation with Station Data) precipitation, MODIS Land Surface Temperature (LST), Enhanced Vegetation Index (EVI), Potential Evapotranspiration (PET), Soil Moisture (SM), WorldPop, and nighttime light have been analyzed to investigate the effect that climate change (CC) and regional human activities (HA) have on vegetation dynamics in eastern India for the period 2000 to 2022. The relative influence of climate and anthropogenic factors is evaluated on the basis of non-parametric statistics i.e., Mann-Kendall and Sen's slope estimator. Significant spatial and elevation-dependent variations in precipitation and LST are evident. Areas at higher elevations exhibit increased mean annual temperatures (0.22 °C/year, p < 0.05) and reduced winter precipitation over the last two decades, while the northern and southwest parts of West Bengal witnessed increased mean annual precipitation (17.3 mm/year, p < 0.05) and a slight cooling trend. Temperature and precipitation trends are shown to collectively impact EVI distribution. While there is a negative spatial correlation between LST and EVI, the relationship between precipitation and EVI is positive and stronger (R2 = 0.83, p < 0.05). Associated hydroclimatic parameters are potent drivers of EVI, whereby PET in the southwestern regions leads to markedly lower SM. The relative importance of CC and HA on EVI also varies spatially. Near the major conurbation of Kolkata, and confirmed by nighttime light and population density data, changes in vegetation cover are very clearly dominated by HA (87%). In contrast, CC emerges as the dominant driver of EVI (70-85%) in the higher elevation northern regions of the state but also in the southeast. Our findings inform policy regarding the future sustainability of vulnerable socio-hydroclimatic systems across the entire state.

Air pollution status and attributable health effects across the state of West Bengal, India, during 2016-2021.

Air pollution is one of the most significant threats to human safety due to its detrimental health consequences worldwide. This study examines the air pollution levels in 22 districts of West Bengal from 2016 to 2021, using data from 81 stations operated by the West Bengal Pollution Control Board (WBPCB). The study assesses the short- and long-term impacts of particulate matter (PM) on human health. The highest annual variation of PM10 was noted in 2016 (106.99 ± 34.17 µg/m3), and the lowest was reported in 2020 (88.02 ± 13.61 µg/m3), whereas the highest annual variations of NO2 (µg/m3) were found in 2016 (35.17 ± 13.55 µg/m3), and lowest in 2019 (29.72 ± 13.08 µg/m3). Similarly, the SO2 level was lower (5.35 µg/m3) in 2017 and higher in 2020 (7.78 µg/m3). In the state, Bardhaman, Bankura, Kolkata, and Howrah recorded the highest PM10 concentrations. The monthly and seasonal variations of pollution showed higher in December, January, and February (winter season) and lowest observed in June, July, and August (rainy season). The southern part of West Bengal state has recorded higher pollution levels than the northern part. The short- and long-term health impact assessment due to particulate matter shows that the estimated number of attributable cases (ENACs) for incidence of chronic bronchitis in adults and prevalence of bronchitis in children were 305,234 and 14,652 respectively. The long-term impact of PM2.5 on human health ENACs for mortality due to chronic obstructive pulmonary disease for adults, acute lower respiratory infections in children aged 0-5, lung cancer, and stroke for adults were 21,303, 12,477, 25,064, 94,406, and 86,272 respectively. This outcome assists decision-makers and stakeholders in effectively addressing the air pollution and health risk concerns within the specified area.

Assessment of Co-Sensitization between Pollen and Food Allergen Sources among Bengali Population, West Bengal, India.

INTRODUCTION: Secondary food allergies due to cross-reactivity between pollen and food allergens are a significant health burden in India. Prevalence of cross-reactivity varies by region, and particularly in West Bengal, it remains unexplored. The present study investigated sensitivities of pollen-related food allergy (PFA) patients of West Bengal by empirically determining co-sensitization patterns. METHODS: The present study retrospectively analysed 1,310 pollen-allergic (PA) patients from the Allergy and Asthma Research Centre, West Bengal. A questionnaire survey was performed to record patients' demographic and clinical features and categorized into seasonal and perennial ones. All patients were subjected to the skin prick test and specific IgE for evaluation of sensitivity against 16 pollen and 16 food allergens. Co-relation and principal component analysis (PCA) was performed to determine co-sensitivity. RESULTS: Seasonal allergic patients were comparatively higher than perennial ones. PFA patients were mostly sensitive to eggplant (n = 387), while Azadirachta indica (n = 341) was predominant sensitizer among pollen allergen sources. Cynodon dactylon showed maximum significant positive correlation with banana, orange, peanut, pineapple, cucumber, eggplant, potato, tomato, and wheat. In the seasonal group, Cynodon dactylon-specific IgE in PFA patients (median = 4.60 kU/L) was significantly higher from that of PA ones (median = 3.44 kU/L). Among 32 allergens tested, 27 were placed in first two dimensions of the PCA biplot. CONCLUSION: The present study established that co-sensitivity between pollen and food allergen sources were predominant in allergic patients of West Bengal. The co-sensitization patterns among unrelated allergen sources may be due to possible expression of biologic cross-reactivity to similar allergens.

Genotyping and epidemiological distribution of diarrhea-causing isolates of Giardia duodenalis in southeastern part of West Bengal, India.

The prevalence and genetic diversity of the protozoan pathogen Giardia duodenalis have been extensively studied worldwide. There is currently a lack of data regarding the genetic variability of the organism in eastern India. Understanding the circulating genotypes and associated risk factors is crucial for effective planning and implementing control measures. Therefore, the objective of the study was to conduct an epidemiological study to determine the prevalence and identify the various genotypes present. This survey adds to our knowledge on the occurrence and distribution of Giardia genotypes in the studied region. The overall prevalence was found to be 6.8%. This parasitic infection was significantly associated with two age groups, i.e., >0-5 years and >5-12 years. Using a multilocus genotyping method, we genotyped 52 human Giardia isolates that were obtained from diarrheal patients. Two distinct assemblages were found in the population-30.8% belonged to assemblage A; 63.5% belonged to assemblage B, prevalent in the population; and 5.7% belonged to a combined assemblage A+B. Sub-assemblage AII was found in 17.3% of the cases, followed by sub-assemblage AI (13.5%). High levels of genetic diversity were found within the population of assemblage B undergoing balancing selection. Overall, the high prevalence of the parasite observed, particularly among children, raises a major concern and necessitates implementation of robust control measures. Furthermore, we report the presence of numerous unique genotypes, circulating in this limited geographical boundary, which can be useful dataset for future studies.

An analytical observational study on chronic kidney disease of unknown etiology at a rural tertiary care hospital in West Bengal.

Background: Chronic kidney disease of unknown etiology (CKDu) has been a growing concern in the Indian population causing significant morbidity and mortality in these recent years. Thus, it is vital to understand the probable risk factors associated with its manifestation. This study aims to assess the distribution of various etiologies among CKD patients, investigate all the probable risk factors associated with CKDu, and estimate the health-related quality of life (QoL) among all CKDu patients in the study area. Materials and Methods: It was an analytical, observational, cross-sectional study where one objective had a case-control study design. It was conducted at Bankura Sammilani Medical College in Bankura district, West Bengal, during July 2022-August 2022. A total of 198 patients have been studied through detailed interviews using a predesigned, pretested, semi-structured schedule. Potential risk factors and their strength of association were analyzed with the help of multivariate logistic regression. Results: It was found that the prevalence of CKDu was almost 71% in the study population, mostly affecting agricultural workers (67.17%), daily laborers (46.46%), and construction workers. Perceived heat stress, excessive daily dietary intake of salt, and drinking contaminated water are the factors that had shown the strongest association with the occurrence of CKDu in this population. The deterioration in QoL in CKDu pretty much mirrors that of CKD. Conclusion: CKDu is definitely an occupational disease, mostly affecting the wage workers and farmers spending long hours in unhealthy work environments. Environmental exposure to heavy metals must be checked and dietary modification must be done through counseling to regulate salt intake. CKDu, as a rising public health concern certainly needs special attention and immediate planning as it has a different etiopathology than CKD and the affected population, disease progression, and risk factors are markedly distinctive as well.

Comprehensive investigation of fever cases enrolled during 2019 dengue outbreaks from three hyperendemic regions of North 24 Parganas district of West Bengal, India.

For the past several decades, dengue fever has been emerging in epidemic proportions in several regions of the world. During August-September 2019, an increasing number of fever cases were being reported from some areas of North 24 Parganas district of West Bengal, India. Accordingly, outbreak investigation of fever cases from these affected areas of Bongoan, Barasat, and Habra was carried out. To characterize clinical and biochemical features of fever cases as well as to investigate the utility of CRP as a Dengue severity marker in resource-limited settings. We systematically enrolled 108 patients from the affected region of North 24 Parganas. Standard diagnostic assays along with routine serological and biochemical parameters were performed. Of the 108 patients, 77 (71%) were confirmed with Dengue infection followed by 22 (20%) DENV seronegative and 9 (8%) coinfected DENV cases. Among the 77 confirmed Dengue patients, 53 (69%) had primary infection while 24 (31%) had secondary infection. Among the DENV clinical symptoms, fever (r = 0.50; p = 0.004), headache (r = 0.40; p = 0.03) and abdominal pain (r = -0.40; p = 0.02) were found to bear significant correlation with DENV viral load. The predominant circulating serotype was found to be DENV2. CRP Dengue severity cut-off level of 10.15 mg/L (AUC: 0.85; 86% sensitivity, 77% specificity) was obtained. CRP had correlation with viral load (r = 0.4, p = 0.05) within febrile phase of infection. The performance of biomarkers can be influenced by local epidemiology, geography, and several patient factors, therefore, CRP Dengue severity cut-off value may be region-specific. This study for the first time attempts to estimate CRP Dengue severity cut-off value based on routine immunoturbidometric evaluation from Dengue Hyperendemic zones of North 24 Parganas, West Bengal, Eastern India.

Identifying risk factors in explaining women's anaemia in limited resource areas: evidence from West Bengal of India and Bangladesh.

BACKGROUND: Anaemia among women is a public health problem with associated adverse outcomes for mother and child. This study investigates the determinants of women's anaemia in two Bengals; West Bengal (a province of India) and Bangladesh. These two spaces are inhabitated by Bengali speaking population since historic past. The study argues that open defecation, contraceptive method use and food consumption patterns are playing crucial role in explaining anaemia. METHODS: Using non-pregnant women belonging to different religious groups, we analyzed a total of 21,032 women aged 15-49 from the nationally representative cross-sectional surveys, i.e., Bangladesh Demographic Health Survey (BDHS-VI, 2011) and National Family Health Survey (NFHS round 4, 2015-16). We performed spatial, bivariate and logistic regression analyses to unfold the important risk factors of anaemia in two Bengals. RESULTS: The prevalence of anaemia was 64% in West Bengal and 41% in Bangladesh. The significant risk factors explaining anaemia were use of sterilization, vegetarian diet and open defecation. Further, women who used groundwater (tube well or well) for drinking suffered more from anaemia. Also, younger women, poor, less educated and having more children were highly likely to be anaemic. The study also indicates that those who frequently consumed non-vegetarian items and fruits in West Bengal and experienced household food security in Bangladesh were less prone to be anaemic. Hindus of West Bengal, followed by Muslims of that state and then Hindus of Bangladesh were at the higher risk of anaemia compared to Muslims of Bangladesh, indicating the stronger role of space over religion in addressing anaemia. Unlike West Bengal, Bangladesh observed distinct regional differences in women's anaemia. CONCLUSIONS: Propagating the choices of contraception mainly Pill/ injection/IUDs and making the availability of iron rich food along with a favourable community environment in terms of safe drinking water and improved sanitation besides better education and economic condition can help to tackle anaemia in limited-resource areas.

Anthropogenic arsenic menace in contaminated water near thermal power plants and coal mining areas of India.

Coal mining and coal combustion in thermal power plants (TPPs) are the major anthropogenic sources of arsenic (As) contamination in many different industrial regions. In this study of industrial regions of West Bengal and Singrauli, it is observed that there is an anthropogenic contribution to the contamination from As-bearing coal. Up to 14.53 mg/kg of As is obtained in coal of West Bengal which also has very high average Fe concentration (16,095 mg/kg) along with high concentration of Cu, Mn and Hg. Similar observations are also found in Singrauli Industrial Region where 3.14 mg/kg of As with very high concentration of Fe 43,867 mg/kg along with high Cu, Mn and Hg concentration is found in coal samples. This low-grade bituminous coal contains arsenopyrite as observed by SEM-EDX. Arsenopyrite is converted to arsenolite upon combustion in these TPPs as observed in XRD. The fly ash has average As concentration of 1.53 mg/kg for West Bengal and 2.38 mg/kg for Singrauli Industrial Region and high concentration of toxic elements. The soil near these TPPs and mining areas is enriched in As, Fe, Hg, Cu and Mn. Not only As but high concentrations of Fe, Hg, Mn are also observed from analysis of water which relates to the anthropogenic inputs. The dissolution of arsenolite in reducing environments caused by periodic flooding releases As into water. Hence, the As contamination in the study area also has anthropogenic origin from coal consumption in TPPs.

Evaluation of the rashtriya bal swasthya karyakram (RBSK): A national children healthcare program in a health district of West Bengal, India.

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) was launched in 2013 to screen and manage birth defects, deficiencies, diseases, and developmental delays including disabilities in Indian children, with the help of designated mobile health teams and grassroot workers across the country. Objectives: Performance of the RBSK program in three selected blocks of a health district of a large Indian state (West Bengal) was assessed. Methods: The performance assessment was based on input, process, and output performances, using checklists based on RBSK operational guidelines. Results: While some essential evaluation tools were available in required numbers at the block level, many were unavailable. There were deficiencies in the number of health staff appointed. Although most screening camps were conducted as per microplan, some were not. Anthropometric measurements were not done in some camps; Information, Education, and Communication (IEC) materials were not used adequately. Issues with fund management were also noted. The intervention rate at higher centers (District Early Intervention Centre) was low with regard to the children referred for management. Involvement of grassroot workers such as ASHA was also found to be lacking. Conclusion: Frequent orientation training of medical officers and staff is needed along with the efforts to strengthen the referral system and the patient tracking system. Sensitizing the children and their guardians regarding the importance of the relevant health issues is also needed with the help of the proper implementation of IEC services.

Arsenic level in bladder tumor of patients from an exposed population: association with progression and prognosis.

Aims: To elucidate the impact of arsenic on progression and prognosis of bladder cancer. Patients & methods: Total arsenic in 145 tumors (80 non-muscle-invasive [NMIBC] and 65 muscle-invasive bladder cancer [MIBC]) was measured and associated with Ki67 expression, tumor-clinicopathological parameters and patient outcome. Results: Tumor arsenic concentration was higher in exposed than unexposed patients (256 µg/kg vs 77 µg/kg; p < 0.0001) and positively correlated (r = 0.65; p < 0.0001) with arsenic content of patient's drinking water. Arsenic concentration showed significant association with Ki67-overexpression (p = 0.001) and advanced tumor stages (NMIBC vs MIBC; p = 0.0009). In NMIBC, high tumor arsenic (>100 µg/kg) and Ki67 overexpression was established as predictors for recurrence (hazard ratio [HR]: 4.68; p = 0.005 and HR: 3.91; p = 0.018) and progression (HR: 6.04; p = 0.023 and HR: 6.87; p = 0.013). In MIBC, association of high arsenic remained significant with increased risk of recurrence (HR: 4.58; p = 0.04). Conclusion: In NMIBC, high arsenic and Ki67 overexpression and in MIBC, only high arsenic showed prognostic importance in predicting poor patient outcome.

Lay abstract Research work suggests arsenic as risk factor for bladder cancer. In developing countries such as India, arsenic contamination of underground drinking water is a major health problem. The present study aimed to evaluate impact of arsenic on parameters of bladder cancer aggressiveness and clinical outcome of patients from West Bengal, India. Our data showed accumulation of arsenic in bladder tumor of patients exposed mainly through contaminated drinking water. Arsenic content in tumor favored aggressive phenotypes in bladder cancer (higher cell proliferation and advanced tumor stages) and was found to be a potential predictor for cases of death and disease recurrence in patients after receiving primary treatment measures. Therefore, arsenic content in bladder tumor may be used to improve existing protocols for better prediction of patient outcomes in populations with a similar type of exposure.

Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal - Current status & the way forward.

India is perilously poised on the threshold of an explosion of infectious diseases, some of which have witnessed re-emergence while others await apposite opportunity to do so. The State of West Bengal is uniquely positioned with its innate geographical vulnerabilities that favour outbreaks of a host of infectious diseases. The northern districts of this State are well known endemic areas for many outbreak prone communicable diseases like malaria, Japanese encephalitis, scrub typhus, dengue and kala-azar. An outbreak of Nipah virus in the recent past is a pointer towards the emerging and re-emerging threat in these regions and warrants urgent prioritization for surveillance and monitoring of these diseases. Identification of risk factors, challenges in delivery of primary healthcare, implementation of intervention strategies along with strengthening of healthcare setup are also the need of the hour. Multisectoral initiatives with emphasis on understanding the complex and rapidly evolving human-animal-vector dynamics as envisaged under the 'One Health' concept are indubitably important pillars in the effective management of these emerging public health challenges.

Assessment of effectiveness of Japanese encephalitis vaccination in West Bengal, India using sample positivity rate as an alternate measure.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE), is a vaccine preventable mosquito borne arboviral disease. The State Health Department of West Bengal, India started a vaccination programme using live attenuated, single dose JE vaccine (SA-14-14-2) in children aged 1-below15 years since 2006 in five districts. The objectives were to compare Sample Positivity Rates (SPR) of Acute Encephalitis Syndrome (AES) cases for JE between vaccinated & unvaccinated districts and observe trend of SPR & Cumulative Incidence in vaccinated districts for three years. METHODS: The study was based on the analysis of surveillance data from all tested AES cases including confirmed JE (IgM ELISA) from all JE testing facilities existent in the state during the study period (2011-13). Calculation of Cumulative Incidence, Odds Ratio (OR) with 95% CI, Preventive Fraction and Chi Square for trend (for SPR) was done. Trend of incidence was assessed by linear regression. RESULTS: In three years, 5 vaccinated districts contributed 945 AES and 88 JE cases (SPR - 9.3%) compared to 1807 and 254 (SPR - 14.1%) JE cases in 14 unvaccinated districts. Effectiveness of vaccination was evident by gradual decline of Odds Ratio in favour of vaccinated districts. Vaccination effectiveness of 68% overall and 80% [OR = 0.20 (0.10 - 0.41)] in below 15 years were observed. Trend of SPR was found significantly declining in most of the vaccinated districts. INTERPRETATION & CONCLUSION: Significant reduction in sample positivity rate over three years in most of the vaccinated districts indicated that the vaccination programme had been gradually effective.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal.

BACKGROUND: Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. OBJECTIVES: : This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants. METHODS: : A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. RESULTS: : All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. CONCLUSION: Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Rural-urban differentials in fertility levels and fertility preferences in West Bengal, India: a district-level analysis.

Fertility in West Bengal is one of the lowest in India, and this relies heavily on the use of traditional methods of contraception. Social scientists and demographers have pointed to the historical role of the diffusion process of adhering to a small family size. The Total Fertility Rate (TFR) in Kolkata district, the state capital, is the lowest in the country, and has been a centre of low fertility historically. However, stark differences in rural-urban fertility rates have existed over the last few decades in West Bengal, but these have now started to narrow. This study aimed to capture the macro-level rural-urban differences in fertility levels and preferences in the West Bengal, and understand how socioeconomic factors affect these. Data were drawn from the Census of India (2011) and NFHS-4 (2015-16). Using census data and the Reverse-Surviving Method, the TFR of West Bengal was estimated to be 1.9, varying between 2.1 and 1.7 in rural and urban areas. The rural-urban gap in the district-level fertility rates was prominent, specifically in districts with higher levels of fertility. Kolkata, Hugli and North Twenty-Four Parganas had the lowest-low fertility (TFR = <1.5). Fewer than half of women with only one living child wanted further children, and this was somewhat higher in rural areas. Around 40% of women had achieved their desired number of children. However, a substantial proportion (43.1%) had a lower number of children than desired, varying between 45.9% and 41.7% in urban and rural areas, respectively. Contraception use, female education and age at marriage, along with the other socioeconomic factors, had a greater influence on rural fertility rates than on urban counterparts in the districts of West Bengal. Further research should be directed at understanding the contemporary fertility decline as well as the gap between ideal and desired number of children, specifically in those districts with very low fertility rates.

Natural shocks and marriage markets: Fluctuations in mehr and dowry in Muslim marriages.

We examine how mehr, a conditional payment from husbands to wives in the event of divorce, and dowry, a transfer from the bride's family to the groom at the time of marriage, have fluctuated in Bangladesh due to natural shocks. We develop a model of the marriage market in which dowry acts as a groom price, whereas mehr serves to deter inefficient divorces. Our comparative statics results show that mehr and dowry are both increasing (decreasing) in shocks that raise (lower) income. We then exploit several natural experiments in Bangladesh including the Green Revolution in the 1960s, war of independence in 1971, and famine of 1974 to explain fluctuations in the value of mehr and dowry observed in Muslim marriages. Using two household survey datasets, we find partial support for our theoretical predictions. To rule out alternative explanations, particularly the effect of legal changes, we use household survey data from the Indian state of West Bengal that experienced a similar increase in agricultural productivity but none of the legal changes affecting Bangladesh. These results demonstrate that natural shocks may affect social institutions.

Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India.

To assess the impact of lockdown amidst COVID-19 on undergraduate and postgraduate learners of various colleges and universities of West Bengal. An online survey was conducted from 1 May to 8 May 2020 to collect the information. A structural questionnaire link using 'Google form' was sent to students' through WhatsApp and E-mail. A total of 232 students provided complete information regarding the survey. The simple percentage distribution was used to assess the learning status of the study participants. During the lockdown period, around 70% of learners were involved in e-learning. Most of the learners were used android mobile for attending e-learning. Students have been facing various problems related to depression anxiety, poor internet connectivity, and unfavorable study environment at home. Students from remote areas and marginalized sections mainly face enormous challenges for the study during this pandemic. This study suggests targeted interventions to create a positive space for study among students from the vulnerable section of society. Strategies are urgently needed to build a resilient education system in the state that will ensure to develop the skill for employability and the productivity of the young minds.

HIV Risk profile and its socio-demographic correlates among long-distance truckers in West Bengal, India: Evidence from national HIV sentinel surveillance 2017.

BACKGROUND: Long-distance truckers (LDTs) belong to a special sentinel group with potentially high risk of acquisition of HIV owing to their high mobility, sociodemographic vulnerability, and high-risk behaviors. OBJECTIVE: The objective is to estimate the prevalence of HIV and identifies its sociodemographic correlates among a representative population of LDTs in West Bengal, India. METHODS: Between May and July 2017, HIV Sentinel Surveillance (HSS) was conducted in West Bengal by the National AIDS Control Organization. A total of 749 LDTs were recruited for the study, were interviewed, and tested for HIV. Descriptive and logistic regression analysis of socio-demographics, sexual risk behavior, and HIV serostatus were performed using SAS 9.3.2. RESULTS: The prevalence of HIV among LDT was 1.2% (95% confidence interval [CI] = 0.4-2.0). Mean age was 32.8 years (standard deviation 8.5), 77.1% were currently married, 89.9% were literate, 85.7% visited HSS site for collecting condoms or seeking medical care and treatment, 53.1% were rural residents, 86.7% had sex at least once with a female partner other than wife in the past 6 months, 2.7% had sex with a male partner and 1.7% injected drugs for recreational purpose. Higher age (odds ratio [OR] = 1.1 [95% CI = 1.0-1.1]), literate (OR = 0.3 [95% CI = 0.1-0.9]), visiting HSS sites for collecting condoms or seeking medical care and treatment (adjusted OR [AOR] = 0.2 [95% CI = 0.1-0.6]), rural residence (OR = 0.2 [95% CI = 0.1-0.3]) and duration of stay in home (AOR = 1.3 [95% CI = 1.1-1.5]) were found to be significant predictors of having sex with a female partner other than wife. CONCLUSION: High HIV burden calls for urgency in the implementation of targeted intervention to minimize HIV risk among LDTs in West Bengal to fight against HIV/AIDS.

Policy intervention for access to medicine: Does it work similarly for poor and non-poor?

Many federal states in India have recently taken steps to improve distribution and affordability of medicines across public hospitals for reducing high out-of-pocket (OOP) expenditure. West Bengal has introduced a Public-Private Partnership (PPP) scheme, Fair Price Medicine Shops (FPMS) within government hospitals in 2012, which offers high discounts on maximum retail price of the drugs. This model introduces the state as a facilitator, rather than provider or financer, of health care. This paper attempts to measure its impact on OOP expenditure (OOPE) of patients using propensity-score-matching technique on the data collected from primary survey among patients. The study finds that although for non-poor patients, the average OOPE has reduced significantly, the impact has been counter-productive for the poor patients, hinting that PPP intervention seems to work only for relatively better-off people, as the best alternative for the poorest remains to be free provision of drugs from the government. The difference in outcome lay in the fact that the nature of control groups differed between poor and non-poor patients. Those poor patients who did not visit FPMS received most of the medicines free (hence OOPE nearly zero), while for the non-poor patients not visiting FPMS bought the drugs from outside retail shops.

Interrelationship between iodine nutritional status of lactating mothers and their absolutely breast-fed infants in coastal districts of Gangetic West Bengal in India.

Iodine nutritional status of 128 lactating mothers and their breast-fed infants (1-3 months) from iodine-replete villages during post-salt iodization period was evaluated. Mothers' urine, blood, and breast milk (BM) and infants' urine and blood were collected and analyzed for iodine and serum FT4 and TSH estimation. Mothers' and infants' age, parity, occupation, education, and household income were recorded. Median urinary iodine concentration (UIC) of infants was 250 µg/L, indicating their iodine intake was more than adequate. Mothers' median UIC was 185 µg/L, indicating adequate iodine nutrition; however, 13.28% had mild to severe deficiency. Median breast milk iodine concentration (BMIC) was 230 µg/L, which was more than their median UIC 185 µg/L. In iodine-deficient mothers, positive correlation was found between mothers' and infants' serum FT4 and TSH levels, and negative correlation was found between mothers' and infants' serum FT4 and TSH levels in excessive iodine nutrition group. CONCLUSION: Iodine intake of breast-fed infants was at the limit of above requirement, and they are possibly at the risk of excess iodine intake. In iodine deficient and excessive iodine intake mothers, their infants' serum FT4 and TSH are independent on their iodine nutritional status but dependent on thyroid hormone profile of their mothers but differently. What is Known: • A median urinary iodine of 100 µg/L is used to define adequate iodine intake of lactating mothers and children < 2 years. However, adequate iodine intake in terms of urinary iodine of infants of age 1-3 months is not known. What is New: • Iodine intake of absolutely breast-fed infants (1-3 months) was more than adequate, though their mother's intake was adequate as breast milk contains more iodine than urine. The infants of iodine deficient and excessive iodine intake mothers, infants' hormonal profile is independent of their iodine nutritional status but dependent on their mothers thyroid hormone profile.

Challenges of Rasthryia Swasthya Bima Yojana (RSBY) in West Bengal, India: An exploratory study.

This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in-depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.