24-Sep-2018: Nutrition norms issued to tackle severe acute malnutrition
India’s top nutrition panel has recommended that severely malnourished children must be fed freshly cooked food prepared from locally available cereals, pulses and vegetables, and distributed by anganwadi centres, as part of the country’s first-ever guidelines for nutritional management of children suffering from severe acute malnutrition (SAM).
The National Technical Board on Nutrition (NTBN) has approved guidelines proposed by the Ministry for severe acute malnutrition. The measures are part of the community-based health management of children suffering from SAM. The government had, till now, only put in place guidelines for the hospitalisation of severely wasted children who develop medical complications. Those norms were made public in 2011.
The norms were okayed by a scientific sub-committee under the NTBN, according to the minutes of the meeting issued last week.
The guidelines outline the role of anganwadi workers and auxillary nurse midwives (ANMs) in identifying severely wasted children, segregating those with edema or medical complications and sending them to the nearest health facility or nutrition rehabilitation centres.
The remaining children are enrolled into “community based management”, which includes provision of nutrition, continuous monitoring of growth, administration of antibiotics and micro-nutrients as well as counselling sessions and imparting of nutrition and health education.
According to the recommendations, anganwadi workers have to provide modified morning snacks, hot cooked meals and take home ration for SAM children.
The morning snacks and hot-cooked meals, which are served at anganwadis to children between the age of three to six years, should be “prepared freshly and served at the centralised kitchen/ anganwadi centres. Locally available cereals, pulses, green leafy vegetables and tubers, vitamin C rich fruits, as well as fresh milk and 3-4 eggs every week” have also been prescribed. It is also suggested that local self-help groups, mothers or village committees be engaged for the preparation of these meals.
Similarly, the take home ration, which is given to children between the ages of six months and three years, has to be prepared from “locally available and culturally appropriate food ingredients”. Use of extra oil/ ghee in these food items is also suggested in order to ensure these are “energy dense”.
The emphasis on freshly prepared food as well as locally procured ingredients clears the air on differences within the government on what form of food should be given at anganwadis, with Women and Child Development Minister Maneka Gandhi having backed “energy dense nutrient packets”.
Importantly, the government has also revised the method to be used to measure wasting and advised calculating weight based on the height of children instead of the mid-upper arm circumference.
According to the National Family Health Survey-4, 7.5%, or 8 million, of children aged under five years have severe wasting.
21-May-2018: Nepal: first country in South-East Asia validated for eliminating trachoma
The World Health Organization (WHO) has validated Nepal for having eliminated trachoma as a public health problem – a milestone, as the country becomes the first in WHO’s South-East Asia Region to defeat the world’s leading infectious cause of blindness.
Nepal’s achievement is commendable and results from strong political commitment, intense community engagement and impressive leadership demonstrated by civil society.
Trachoma was the second leading cause of preventable blindness in Nepal in the 1980s. In 2002, the Government of Nepal stepped up efforts to eliminate the disease with the establishment of a national trachoma programme. From 2002 to 2005, following the implementation of sustained control activities, the prevalence of active (inflammatory) trachoma fell by 40%.
The Government of Nepal, through the Ministry of Water Supply and Sanitation, provided incentives to local communities and districts to build and maintain latrines – measures that were crucial to improving sanitation and reducing disease-carrying flies.
To increase awareness, the national trachoma programme collaborated with the Ministry of Education to include a module on trachoma in the school curriculum.
Approximately 30 000 operations were provided to manage trichiasis, and almost 15 million doses of azithromycin were distributed. Between 2002 and 2014, eye hospitals and dozens of eye centres and clinics with trained staff were established across Nepal.
Azithromycin is donated by the pharmaceutical company Pfizer through the International Trachoma Initiative and was delivered in Nepal by NNJS with support from the United States Agency for International Development-funded ENVISION project, implemented by RTI International.
A series of surveys conducted progressively from 2005 to 2015 showed that active trachoma in children had been brought below the elimination prevalence threshold. Low prevalence was maintained after mass antibiotic treatment was discontinued.
Several criteria are used to assess a country’s claim for having eliminated trachoma as a public health problem. These include:
- less than 5% of children aged 1–9 years have signs of active trachoma (trachomatous inflammation–follicular), which can be treated with antibiotics, in each previously-endemic district;
- less than 0.2% of people aged 15 years and older have trachomatous trichiasis, which requires eyelid surgery, in each previously-endemic district; and
- a health system which can identify and manage new cases of trachomatous trichiasis.
Trachoma, an eye disease caused by infection with the bacterium Chlamydia trachomatis, is spread through contact with infective eye or nose discharges. Infection is particularly common in young children.
Ocular or nasal discharge can be transmitted directly from person to person, or be mediated by flies which have been in contact with the eyes and noses of infected people. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.
Trachoma puts more than 190 million people at risk of blindness in 41 countries. It is responsible for the blindness or visual impairment of around 1.9 million people worldwide.
16-Jan-2018: DBS Linked to Symptomatic Improvement in Tourette Syndrome
Deep brain stimulation (DBS) has been found to be associated with a symptomatic improvement in patients with Tourette syndrome. A study found that 1 year after the implantation of a DBS device, the average tic severity for patients improved by 45%.
With DBS, brain surgeons run thin electric leads to specific regions of the basal ganglia, a cluster of nerves in the brain related to motor control and behaviour. Doctors then apply electricity to the brain circuits they’ve most closely linked to Tourette, to try to control the patient’s tics. However, the procedure still needs more work. More than a third of patients experienced adverse events, most often slurred speech or a pins-and-needles sensation.
The adverse events at 1 year were consistent with previous Tourette DBS studies and were mostly reversible with programming. Longitudinal follow-up of safety and adverse events will be an important endpoint for this registry and database. It is clear that future technological innovations will be needed to improve the risk-benefit ratio of the procedure.
DBS, while a promising therapy for Tourette, still leaves some “critical questions” unanswered, including information on how to determine the appropriate candidates for the therapy. The results thus far, however, suggest it is a worthy treatment option to explore.
There are many neuropsychiatric disorders being studied in animal and early human experiments and it is likely we will see the indications for DBS expand. Additionally, DBS in the future will likely be personalized to individual symptoms that are impacting the quality of life.
What is Tourette syndrome?
Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.
The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst tic symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.