social sector services- health, education and HR; poverty and hunger

Question 1

Atal Community Innovation Centre

Answer 1

1. by AIM
2. aims at spurring community Innovation in underserved and unserved areas of the country through solution driven design thinking to serve the society
3. ACIC will be established either in PPP mode or with support of PSUs and other agencies.
4. maximum grant-in-aid support frm AIM will be up to 2.5 crores subject to following compliance to ACIC guidelines and contributing matching frm the host institutions and their funding partner(s)
5. serve as the bridge between the knowledge base existing in communities and the advanced technical ecosystem prevalent in the market base and the needs of society

Question 2

National Digital Health Blueprint?

Answer 2

1. lays out the ‘building blocks’ for the implementation of the National Health Stack (NHS), which aims to deploy AI in leveraging health records. In doing so, it lays down the following objectives:
   
   1. To establish national and regional registries to create single source of truth in respect of Clinical Establishments, Healthcare Professionals, Health Workers and Pharmacies.
   2. Creating a system of Personal Health Records accessible to the citizens and to the service providers based on citizen-consent.
   3. Promoting the adoption of open standards by all the actors in the National Digital Health Ecosystem.
   4. Promoting Health Data Analytics and Medical Research.
2. In line with ‘data as a public good’, the blueprint proposes the linking of multiple databases to generate greater and granular data that can be leveraged by the public as well as private sector – including insurance companies, hospitals, apps and researchers.
3. blueprint proposes a National Digital Health Mission “as a purely government organisation with complete functional autonomy on the lines of existing National Information Utilities like UIDAI and GSTN

Question 3

Availability of Doctors in INdia?

Answer 3

1. India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000
2. India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000
3. India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000

Question 4

Rotavirus?

Answer 4

1. Rotavirus is a leading cause of severe diarrhoea and death among children less than five years of age.
2. It is responsible for around 10% of total child mortality every year.
3. some rotavirus infections cause few or no symptoms, especially in adults.
4. Rotavirus is transmitted by the faecal-oral route, via contact with contaminated hands, surfaces and objects, and possibly by the respiratory route. Viral diarrhea is highly contagious.
5. Rotavirus diarrhoea presents in similar manner like any other diarrhoea but can mainly be prevented through rotavirus vaccination. Other diarrhoea can be prevented through general measures like good hygiene, frequent hand washing, safe water and safe food consumption, exclusive breastfeeding and vitamin A supplementation.

Question 5

National Youth Awards?

Answer 5

1. for excellent work and contribution in different fields of development and social service such as health, promotion of human rights, active citizenship, community service etc.
2. conferred on individuals (aged between 15-29 years) and organizations
3. given by the Ministry of Youth Affairs and Sports, Department of Youth Affairs.

Question 6

TEQIP?

Answer 6

1. Technical Education Quality Improvement Programme launched in 2002 by MHRD with assistance of WB
2. programme aimed to overhaul the quality of technical education in the Low Income States and Special Category States (SCS) in India
3. ended in March 2021, leaving more than 1,200 assistant professors out of a job and some rural colleges bereft of half their faculty.
4. GoI is planning to replace TEQIP with a similar project called MERITE

Measures included:

• Institution based: accreditation of the courses through NBA, governance reforms, improving the processes, digital initiatives, securing autonomy for the colleges.
• Student based: improving the quality of teaching, teacher training, equipping the class rooms, industry interaction, compulsory internships for students, training the students in industry-relevant skills, preparing them for the GATE exam

Question 7

National Essential Diagnostics List (NEDL)?

Answer 7

1. India’s First NEDL compiled by ICMR
2. With this, India has become the first country to compile such a list that would provide guidance to the government for deciding the kind of diagnostic tests that different healthcare facilities in villages and remote areas require.
3. The list is meant for facilities from village till the district level. NEDL builds upon the Free Diagnostics Service Initiative and other diagnostics initiatives of the Health Ministry to provide an expanded basket of tests at different levels of the public health system.
4. implementation of NEDL would enable improved health care services delivery through evidence-based care, improved patient outcomes and reduction in out-of-pocket expenditure; effective utilisation of public health facilities. It would help in effective assessment of disease burden, disease trends, surveillance, and outbreak identification; and address antimicrobial resistance crisis too.
5. In India, diagnostics (medical devices and in vitro diagnostics) follow a regulatory framework based on the drug regulations under the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules 1945.

Question 8

notifiable disease?

Answer 8

1. A notifiable disease is any disease that is required by law to be reported to government authorities.
2. WHO’s International Health Regulations, 1969 require disease reporting to the WHO in order to help with its global surveillance and advisory role.
3. The onus of notifying any disease and the implementation lies with the state government.
4. Any failure to report a notifiable disease is a criminal offence and the state government can take necessary actions against defaulters.
5. The Centre has notified several diseases such as cholera, diphtheria, encephalitis, leprosy, meningitis, pertussis (whooping cough), plague, tuberculosis, AIDS, hepatitis, measles, yellow fever, malaria dengue, etc.

Question 9

MDR-TB?

Answer 9

1. People with TB who do not respond to at least isoniazid and rifampicin, which are first-line TB drugs are said to have MDR-TB.
2. As per WHO’s Global Tuberculosis Report 2018, an estimated 4.5 lakh people across the world have MDR-TB
3. India has 24% of MDR-TB cases in the world

Question 10

XDR-TB?

Answer 10

1. People who are resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin, or capreomycin) are said to have XDR-TB.
2. As per WHO’s Global Tuberculosis Report 2018, nearly 37,500 people have XDR-TB.
3. By the end of 2017, XDR-TB had been reported from 127 countries, including India.

Question 11

National Sports Awards?

Answer 11

1. Rajiv Gandhi Khel Ratna Award is given for the spectacular and most outstanding performance in the field of sports by a sportsperson over a period of four year.
2. Arjuna Award is given for consistency outstanding performance for four years.
3. Dronacharya Award for coaches for producing medal winners at prestigious International sports events.
4. Dhyan Chand Award for life time contribution to sports development.
5. Rashtriya Khel Protsahan Puruskaris given to the corporate entities (both in private and public sector) and individuals who have played a visible role in the area of sports promotion and development.
6. MAKA Trophy:Overall top performing university in inter-university tournaments is given Maulana Abul Kalam Azad (MAKA) Trophy.

Question 12

Pretomanid?

Answer 12

1. USFDA has approved a new drug Pretomanid for treating drug-resistant tuberculosis- MDR-TB and XDR-TB
2. Pretomanid is only the third new anti-TB drug approved for use by FDA in more than 40 years.
3. duration of treatment for drug-resistant TB can be drastically cut from 18-24 months to just six-nine months when pretomanid drug is used along with two already approved drugs — bedaquiline and linezolid.
4. The all-oral, three-drug regimen can also vastly improve the treatment success rate

Question 13

What does the ‘efficacy’ of a vaccine mean?

Answer 13

Efficacy looks at the ability of the vaccine to protect the inoculated population using various parameters — ranging from the ability of the shot to prevent mild to severe symptoms from showing even if you have been infected, to preventing you from getting infected with the disease altogether.

In the case of Covid-19 vaccines, pharma companies have primarily focussed on bringing down the number of symptomatic cases — even if you’re infected with SARS-CoV-2, you may not present with the symptoms and fall as sick as you would have without the vaccine.

Question 14

What is Malana Cream??

Answer 14

• It is the charas or hash or hashish which comes from the Malana Valley in Kullu district of Himachal Pradesh.
• Charas, called bhang in Himachal, is the resin obtained from a species or strain of the cannabis plant, which grows naturally in the valley and is also cultivated illegally.
• A high proportion of THC (tetrahydrocannabinol, the primary psychoactive constituent) in the plant extract is required for recreational drug use and Malana Cream is believed to be particularly rich in THC, making it more potent. Resin extracted from the plant, generally by rubbing using hands, is also concentrated further to obtain the more potent hash oil.
• With greater road connectivity, Malana and its neighbouring Parvati Valley became notorious for ‘drug tourism’
• the plant grows naturally in the area, so it cannot be eliminated altogether.

Question 15

legality of cannabis cultivation is INdia?

Answer 15

• In 1985, India banned the cultivation of cannabis plant under the Narcotic Drugs and Psychotropic Substances (NDPS) Act.
• But this Act allows state governments to allow controlled and regulated cultivation of hemp for obtaining its fibre and seed for industrial or horticultural purposes. In 2018, Uttarakhand became the first state in the country to do so, allowing the cultivation of only those strains of cannabis plant which have a low concentration of THC. similar policy in UP, MP, Manipur and most recently in HP
• Currently, charas, ganja, or any mixture or drink prepared from the two products are banned in India under the NDPS Act, regardless of hemp cultivation.
• illegality of cannabis has made it a contentious issue in Himachal, since it has a certain cultural acceptance in the state.

Question 16

vaccine wastage?

Answer 16

• Different stages where wastage occurs:
  
  • Cold chain points.
  • District vaccine stores.
  • Vaccination session site
• how wastage happes:
  
  • in unopened vials
    
    • expired
    • exposed to heat
    • frozen
    • breakage
    • theft
  • in opened vials
    
    • discarding leftover doses
    • vials submerged in water
    • contamination
    • poor vaccine administration
• At the end of March 2021, vaccine wastage % was 6%, against centre’s guidelines of limiting it to 1%. some states lke Telangana had vaccine waste at 17.6%

Question 17

NISHTHA?

Answer 17

National Initiative for School Heads and Teachers Holistic Advancement

1. by MHRD
2. world’s largest teachers’ training programme of its kind in the world. Aims to build capacities of around 42 L participants covering all teachers and Heads of Schools at the elementary level in all Government schools etc.
3. launched to improve Learning Outcomes at the Elementary level.
4. basic objective of this massive training programme is to motivate and equip teachers to encourage and foster critical thinking in students.
5. nitiative is first of its kind wherein standardized training modules are developed at national level for all States and UTs. However, States and UTs can contextualize the training modules and use their own material and resource persons also

Question 18

Janaushadhi Sugam?

Answer 18

1. A mobile app launched by Min of Chemicals and Fertilisers
2. aims to enable people to search Janaushadhi generic medicines and the stores at the tip of their fingers.
3. It will also help analyse product comparison of Generic vs Branded medicine in form of MRP & overall Savings.

Question 19

implementing agency of Pradhan Mantri Bhartiya Janaushadhi Pariyojana?

Answer 19

Pharmaceuticals & Medical Devices Bureau of India (PMBI) formely known as Bureau of Pharma PSUs of India (BPPI)

Question 20

National Digital Library of India?

Answer 20

1. by MHRD
2. project under the aegis of National Mission on Education through Information and Communication Technology (NMEICT).
3. under the aegis of National Mission on Education through Information and Communication Technology (NMEICT).
4. objective of NDL is to make digital educational resources available to all citizens of the country to empower, inspire and encourage learning.
5. NDL is the Single Window Platform that collects and collates metadata from premier learning institutions in India and abroad, as well as other relevant sources.

Question 21

NMEICT?

Answer 21

1. National Mission on Education through Information and Communication Technology (ICT) has been envisaged as a Centrally Sponsored Scheme to leverage the potential of ICT, in teaching and learning process for the benefit of all the learners in Higher Education Institutions in any time anywhere mode.
2. Mission has two major components – providing connectivity, along with provision for access devices, to institutions and learners; and content generation.
3. Mission aims to extend computer infrastructure and connectivity to over 25000 colleges and 2000 polytechnics in the country including each of the departments of 419 universities/deemed universities and institutions of national importance as a part of its motto to provide connectivity up to last mile.

Question 22

Fit India Movement ?

Answer 22

Prime Minister launches nation-wide Fit India Movement on the occasion of National Sports Day (29th Aug)

On this Day, President confers the National Sports Awards, National Adventure Awards, Arjuna Award, Khel Ratna, Dronacharya Award and Dhyanchand Award to recognise the exceptional achievements of Indian sportspersons.

Question 23

T/F: ICMR has recommended ‘complete’ ban on Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes.

Answer 23

T

Question 24

Shagun?

Answer 24

1. one of world’s largest Integrated Online Junction for – School Education
2. by MHRD
3. It is an over-arching initiative to improve school education system by creating a junction for all online portals and websites relating to various activities of the Department of School Education and Literacy.
4. The word Shagun is coined from two different words- ‘Shala’ meaning Schools and ‘Gunvatta’ meaning Quality.

Question 25

food wastage in India: stats?

Answer 25

supply chain loss

1. As per FAO, Nearly 40 per cent of the food produced in India is wasted every year due to fragmented food systems and inefficient supply chains.
2. while the annual cost of food security is ~1.5Lcr, >90000cr worth of farm produce is waste annually
3. About 21 million tons of wheat is wasted in India
4. India ranks 94th among 107 countries in GHI 2020
5. 25% of fresh water used to produce food is ultimately wasted

HH loss

1. food waste generated in our homes is 50kgper person per yr acc to Food waste index report 2021
   
   • This excess food waste usually ends up in landfills, creating potent greenhouse gases which have dire environmental implications.
2. 300 million barrels of oil are used to produce food that is ultimately wasted.

Question 26

Household food wastage in India: suggestions?

Answer 26

• organisations such as Coimbatore-based No Food Waste which aim to redistribute excess food to feed the needy and hungry. Adrish, India’s first chain of zero-waste concept stores, which is focused on getting people to shift from harmful, artificial consumption to an eco-friendly, zero-waste lifestyle.
• We must attempt to change our “food abundance” mindset to a “food scarcity” one
• Regional Indian recipes like surnoli, a Mangalorean dosa made with watermelon rind, or gobhi danthal sabzi made with cauliflower stalks and leaves in Punjab, are born out of the ideas of frugality and respect for our food. Bengalis adopt a root-to-shoot philosophy throughout their cuisine — thor ghonto is a curry comprising tender banana stems, while ucche pata bora are fritters made with bitter gourd leaves.

Question 27

National Mental Health Programme (NMHP): need?

Answer 27

Lancet Report- India

• 197.3 million people were reported to have mental disorders in 2017.
• 45.7 million people suffered depression in 2017.
• 44.9 million people suffered with anxiety in 2017.
• The contribution of mental disorders to the total Disability-Adjusted Life-Years (DALYs) in India increased from 2·5 percent in 1990 to 4·7 percent in 2017.

Acc to NCRB data

• India reported an average 381 deaths by suicide daily in 2019

Question 28

National Mental Health Programme (NMHP): about?

Answer 28

1. launched by GoI in 1982
2. 3 components
   
   1. treatment of mentally ill
   2. rehabilitation
   3. prevention and promotion of positive mental health
3. obj:
   
   1. ensure availability and accessibility of minimum mental health care for all, esp most vulnerable
   2. encourage application of mental health knowledge in general health care and in social development.
   3. promote community participation in the mental health services development
4. aims to integrate mental health with primary health care through the NMHP, providing treatment for mental disorders at tertiary care institutions and eradicating stigmatization
5. proposed allocation for NHMP in FY 21 — Rs 40 crore — is too small an amount to handle mental health impact and fallouts of the COVID-19 pandemic.

Question 29

legal obligations imposed on govt to ensure public and individual health, even at the cost of individual liberty in case of public health emergencies?

Answer 29

1. Art 21 interpreted under RC Cooper v UoI and Maneka Gandhi case
2. DPSP: Art 39(f) read along with Art 47
3. India is a prty to International Covenant on Economic, Social and Cultural Rights (ICESCR), Art 12 of which postulates that states are required to take all possible measures to progressively realise the enjoyment of “highest attainable standards of physical and mental health” of its citizens.
   
   • Art 253enables Parliament to implement and discharge its onerous international obligations created by various treaties, which have been duly ratified.
   • landmark judgment of Vishaka v. State Of Rajasthan (1997), where it was remarked that the state should adhere to the ratified international agreements and enforce them by enacting necessary legislations.
4. Delhi HC judgement that declared private vehicle as public space with regards to mask wearing mandate in Delhi in wake of Corona, for the larger cause of public health.
5. Preamble: preservation of “public health”, ensures the “fraternity assuring the dignity of an individual”, leading subsequently to the achievement of “unity and integrity of a nation”

Question 30

Anti-microbial resistance and environmental pollution/degradation?

Answer 30

Acc to WHO, AMR is one of the top ten threats to global health. number of deaths linked to AMR will increase to 10 million per year by 2050.

focus on environmental contamination by antibiotics has been limited.

1. main cause of antibiotics in the environment is the effluent discharge of APIs frm mfg units, tat contains high concentrations of antibiotic residues that can lead to hotspots of resistant bacteria further contributing to AMR
   
   • study conducted by IIT Madras in and around Chennai indicated a high concentration of antimicrobial agents in the rivers and lakes in the vicinity of pharmaceutical plants and outlets of wastewater treatment plants.
2. Currently, there are no global standards for antibiotic discharge limits in the environment from pharmaceutical industries. India is the only country to have issued the Draft Environment Protection Amendment Rules in January 2020 to limit the amount of antibiotic residue permitted in wastewater released by drug factories. If notified, it will shift the paradigm from a focus on the quality of medicine to the impact, manufacturing has on workers and the environment.
3. none of the world’s 17 biggest antibiotic producers publishes particulars of the levels of antibiotic residue discharged in wastewater, as per the 2020 AMR Benchmark report by the Access to Medicines Foundation

Question 31

Drug resistant typhoid strain?

Answer 31

• significance
  
  • 11 mn infections
  • more than 100000 deaths per yr
  • South Asia accounts for > 70% of global disease burden
• since 2000, MDR S Typhi has declined steadily in BN and INdia and remained low i Nepal and increased slightly in Pakistan
• however, these MDR are now being replaced by strains resistant to other antibiotics as well
• MoHFW is considering introducing new typhoid conjugate vaccines into national immunisation programme

Question 32

Malnutrition in INdia: stats?

Answer 32

1. NFHS-4
   
   1. >1/3rd under 5 Children suffer from stunting and wasting
   2. 14% of India’s pop doesn’t get enough calories
   3. 35% children stunted, 17.3% are wasted
   4. 40% of children betn 1 and 4 yrs are anemic
   5. >50% oregnant and non-pregant women were anemic
   6. under-5 Mortality rate is 3.7%
   7. 21 per cent of children under-5 suffered from Moderate Acute Malnourishment (MAM) and 7.5 per cent suffered from Severe AM
2. Acc to Global Nutrition Report 2020, India will miss targets, for all the four nutritional indicators for which there is data available, i.e. stunting, anaemia, childhood overweight and exclusive breastfeeding.
3. rural vs urban: stunting prevalence being 10.1% higher in rural vs urban areas
4. INdian slipped from 94th to 102nd rank in GHI 2021, lower thna neighbours like PK and BN
5. Malnutrition affects cognitive ability, workforce days and health, impacting as much as 16% of GDP (World Food Programme and World Bank
6. According to a study by Lancet, 68 per cent of the under-5 deaths in India can be attributed to malnutrition.
7. India is home to nearly half of the world’s “wasted or acute malnourished” children of the world
8. Despite various targeted outreach and service delivery programmes, 16 out of the 22 states and UTs have still shown an increase in SAM, as per NFHS-5 conducted in 2019-20.
9. According to a study published in journal Global Health Science 2020, the challenges induced by COVID-19 are expected to push another four million children into acute malnutrition.

Question 33

Role of community in battling malnutrition?

Answer 33

1. Acute malnutrition is a complex socio-cultural problem that lies at the interplay of inequitable access to nutritious foods and health services, sub-optimal infant, and young child-feeding practices incl breastfeeding, low maternal education, poor sanitation and hygiene.
2. 70-80% of malnutritioned children face no medical complications or hospitalizations and thus Community Management of Acute Malnutrition (CMAM) can be feasible in these cases
3. CMAM is recommended by both WHO and UNICEF and has shown positive results across many countries and some of the states and district in India
4. case study: in 2007, the MH govt went on to implement CMAM at four different levels in the Nandurbar district.
   
   • first step involved community level screening, identification, and active case finding of SAM children by Anganwadi/ASHA workers.
   • second step initiated treatment of SAM children without any complications at community level through Village Child Development Centre (VCDC) by using different centrally and locally produced therapeutic food. These are energy dense formulations fortified with critical macro and micro nutrients
   • third step included treatment of children with complications at the NRCs (Nutrition Rehabilitation Centres).
   • fourth step involved following-up of children discharged from the CMAM programme to avoid a relapse, along with promotion of good IYCF practices, child stimulation for development, hygiene
   • As a result, the district witnessed a decline in SAM children — from 15.1 per cent in 2015-16 (NFHS-4) to 13.5 per cent in 2019-20 (NFHS-5).

Question 34

idea of ‘exchange entitlement decline’ for explanation of starvation?

Answer 34

1. proposed by Amartya Sen
2. idea of ‘exchange entitlement decline’ is characterised by an adverse shift in the exchange value of endowments for food. It essentially means the occupation a section of people are engaged in is not remunerative enough to buy adequate food.
3. Though Sen postulated this theory to describe reasons for famines, we may look at it to understand the hunger situation in our country.
4. Sen talked about four categories of entitlement: ‘Production-based entitlement’ (growing food); ‘trade-based entitlement’ (buying food); ‘own-labour entitlement’ (working for food); and ‘inheritance and transfer entitlement’ (being given food by others).
5. He postulated that individuals face starvation if their full entitlement set does not provide them with adequate food for subsistence. The idea that starvation is a result of decline in entitlements, is contrary to the Malthusian idea that identifies ‘more people less food’ as the reason for starvation.

Applying this idea to India’s hunger and malnutrition problem, one can figure out four-pronged reasons

• Though we have surplus food, most small and marginal farming households do not produce enough food grains for their year-round consumption.
• Second, relative income of one section of people has been on the decline.
• Third, the kind of work a section of people have been doing are less remunerative or there is less opportunity to get remunerative works.
• Fourth, the PDS of the state is not functioning well or is not accessible to everyone.

Question 35

“A single price for OVID vaccine will be most advisable to ensure efficient vaccination”: arguments?

Answer 35

In actuality, the latest govt policy requires vaccine manufacturers to supply 50% of their prodn to the Centre at controlled prices, while allowing them to sell the remaining half in the open market (incl SGs) at pre-announced “self-set” prices.

1. this policy susceptible to market failure. vaccines have a significant positive externality as well. It not only protects the vaccinated but also other people. Since every individual ignores the full set of benefits/costs from consuming goods with +ive/-ive externalities, the market isn’t always the most efficient mechanism for allocation of such goods. It leads to “under-provision” or “over provision”. That is a key reason why governments treat goods having large positive externalities as “public goods” and provide these while factoring in the full costs and benefits to society.
2. no limit per se on retail prices
3. can lead to diversion of supplies from controlled low price govt centres to open mkt
4. This could lead to a whole range of prices and vaccine inequality
5. Vaccine inequality: we may well have scarcity in the “mass” segment co-existing with a glut in the “elite” segment.
6. Apart from the ethical aspects, it is also inefficient. The ones who are most prone to suffering from and spreading COVID will be the ones who will be facing vaccine shortage the most i.e. small traders, vendors etc. And the people who will get the earliest ones will be the one who can afford working from home.

A better alternative can be a single price throughout the country and govt paying for the poor sections as in case of fertiliser subsidy

Question 36

Neglected tropical diseases?

Answer 36

• They are infections that are most common among marginalised communities in the developing regions of Africa, Asia and the Americas.
• Caused by a variety of pathogens such as viruses, bacteria, protozoa and parasitic worms.
• They generally receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
• Some examples include snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease.

NTDs affect more than a billion people globally. They are preventable and treatable. However, these diseases — and their intricate interrelationships with poverty and ecological systems — continue to cause devastating health, social and economic consequences.

Policies on neglected diseases research in India:

The National Health Policy (2017) sets an ambition to stimulate innovation to meet health needs and ensure that new drugs are affordable for those who need them most, but it does not specifically tackle neglected diseases.

The National Policy on Treatment of Rare Diseases (2018) includes infectious tropical diseases and identifies a need to support research on treatments for rare diseases. It has not yet prioritised diseases and areas for research funding or how innovation would be supported.

Question 37

major neglected tropical diseases?

Answer 37

1. Dengue
2. Rabies
3. Trachoma
4. Yaws
5. Leprosy
6. Chagas disease
7. sleeping sickness
8. Leischmaniases
9. guinea worm disease
10. schistosomiasis

Question 38

H10N3?

Answer 38

• It is a type of bird flu, common in wild aquatic birds and can infect domestic poultry and other bird and animal species
• China has reported the world’s first human infection of the H10N3 bird flu strain.
• Infected birds shed avian flu in their saliva, mucus, and poop, and humans can get infected when enough of the virus gets in the eyes, nose, or mouth, or is inhaled from infected droplets or dust.
• H10N3 is a low pathogenic or relatively less severe strain of the virus in poultry and the risk of it spreading on a large scale is very low.

Question 39

influenza virus classification?

Answer 39

Influenza viruses can also be classified into 4 subtypes

• influenza A: can be found in many species, including humans, birds, and pigs. Due to the breadth of potential hosts and its ability to genetically change over a short amount of time, influenza A viruses are very diverse.
  
  • further classified into subtypes based on two surface proteins, Hemagglutinin (HA) and Neuraminidase (NA). For example, a virus that has an HA 7 protein and NA 9 protein is designated as subtype H7N9.
• Influenza B is typically only found in humans.
• Influenza C mainly occurs in humans, but has been known to also occur in dogs and pigs.
• Influenza D is found mainly in cattle. According to the CDC, it’s not known to infect or cause illness in humans.

Question 40

emergence of China as ground zero for new and mysterious diseases?

Answer 40

SARS outbreak in 2003 was linked to the animal market in China and the H7N9, which spread in China in 2013, was linked to a market of live birds.

last human epidemic of bird flu in China occurred in late 2016 to 2017, with the H7N9 virus.

factors responsible

• China sees a lot of unsafe animal-human interaction, which is behind the spread of most of these zoonotic viruses, which transmit from animals to humans.
• unlike India, the animal markets (wet markets) have live animals, which are kept in closed space and culled for fresh meat.
• These places are frequented by a lot of people and are a hotbed of infections; so if one human gets infected, it will only spread
• High population density and developed transport links aid rapid spread of viruses.

Question 41

Bird flu in humans?

Answer 41

• can be transmitted directly to humans
• first known cases in humans were reported in 1997, when an outbreak of avian influenza A virus subtype H5N1 in poultry in Hong Kong.
• Small outbreaks of bird flu caused by other subtypes of the virus have also occurred. eg. H7N7 in Netherlands in 2003
• subtypes of bird flu viruses:
  
  • mild
  • highly virulent and contagious: called ‘fowl plague’
• With few exceptions (e.g., H5N1, H7N9), most H5, H7, and H9 subtypes are low pathogenecity
• Although isolated instances of person-to-person transmission appear to have occurred since 1997, sustained transmission has not been observed. However, through a rapid evolutionary process called antigenic shift, two viral subtypes—e.g., one a bird flu virus such as H5N1 and the other a human influenza virus—can combine parts of their genetic makeup to produce a previously unknown viral subtype.

Question 42

T/F:

1. India was declared free from H5N1 avian influenza.
2. WHO is the agency responsible for declaring countries free from avian influenza
3. status will only last until the next outbreak occurs
4. Spanish flu of 1918 was caused by H1N2 subtype of influenza A virus

Answer 42

1. T; multiple times eg. in 2017, 2019
2. F; OIE-World Organisation for Animal Health
3. T
4. F; H1N1

Question 43

T/F: not all subtypes of influenza A viruses can infect birds.

Answer 43

T

all except H17N10 and H18N11 which have only been found in bats

Question 44

Plasmodium Vivax is related to?

Answer 44

Malraria

Question 45

T/F: India has highest incidence of Plasmodium Vivax malaria

Answer 45

T (47%)

Question 46

Malaria drop in India in last one yr?

Answer 46

2.6 mn fewer cases in 2018, sharpest absolute decline in world

Question 47

Malaria cases have declined in all other major regions except?

Answer 47

Westen pacific

Question 48

Seven states accounting for 90% of malaria cases in india?

Answer 48

UP, JH, CHH, WB, GJ, Odisha and MP

Question 49

price cap on non-scheduled drugs: present system?

Answer 49

-> Currently, NPPA fixes prices of scheduled drugs (medicines under price control) -> The prices of non-scheduled drugs can be raised by up to 10% a year. -> For nonscheduled drugs, the industry norm has been to give 10% margin to stockists and 20% to retailers. -> However, there have been allegations that actual margins are far higher.

Question 50

Government’s proposal wrt price cap on non-scheduled drugs? Benefits?

Answer 50

cap trade margins for all medicines outside price control at 30% (10%+ 20%) 1) Although some say that there is already this cap, By making trade margins explicit, there will be less scope for exploitation by large institutions 2) expected to reduce the prices of nearly 80% of formulations. Non-scheduled drugs, or formulations outside price control, account for Rs 10,000 crore of sales in the Rs 1-lakh-crore Indian drug market. There are currently 10600 non scheduled drugs

Question 51

trade margin of pharma drugs: what is it?

Answer 51

difference between the price at which manufacturers/importers sell to stockists and the price charged to consumers.

Question 52

T/F: Drugs priced less than Rs 5 per unit are exempted from trade margin caps.

Answer 52

F

Question 53

% of India’s total healthcare spending goes towards medicines?

Answer 53

70%

Question 54

Causes of antibiotic resistance?

Answer 54

1. over-prescribing
2. Patients not finishing their treatment course
3. over-use of antibiotics in livestock and fish farming
4. poor infection control in hospitals and clinics
5. lack of hygiene and poor sanitation
6. lack of new antibiotics being develped.

Question 55

Over-Prescription in India: stats?

Answer 55

Public Health Foundation of India (PHFI) on antibiotic prescription rates-

1. India one of top users of antibiotics in world
2. private sector clocked high levels of antibiotic prescription rates (412 per 1,000 persons per year).
3. highest rate was seen among children aged 0–4 years (636 per 1,000 persons) and the lowest in the age group 10–19 years (280 per 1,000 persons)
4. Per-capita antibiotic consumption in the retail sector has increased by around 22% in five years from 2012 to 2016

Question 56

Intro/conclusion for ‘ Antibiotic resistance’?

Answer 56

1. discovery of antibiotics less than a century ago was a turning point in public health
2. Although antibiotic resistance develops naturally with normal bacterial mutation, humans are speeding it up by using antibiotics improperly.
3. According to a research, now, 2 million people a year in the US develop antibiotic-resistant infections, and 23,000 of them die of those infections.
4. Medical experts are afraid that we’re one step away from deadly, untreatable infections, since the mcr-1 E.coli is resistant to that last-resort antibiotic Colistin.
5. Already, infections like tuberculosis, gonorrhea, and pneumonia are becoming harder to treat with typical antibiotics.
6. A comprehensive estimate of the global impact of antimicrobial resistance (AMR), covering 204 countries and territories and published in The Lancet, has found that 1.27 million people died in 2019 as a direct result of AMR, which is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
7. Resistance to two classes of antibiotics often considered the first line of defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than 70% of deaths caused by AMR.

Question 57

Antimicrobial reisstance: facts and figures?

Answer 57

Global Research on Antimicrobial Resistance (GRAM) report, published in Lancet

● 1.27 million people died in 2019 as a direct result of AMR.
● AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
● Besides, another 49.5 lakh deaths were indirectly caused by AMR

● Of the 23 pathogens studied, drug resistance in six (E coli, S aureus, K pneumoniae, S pneumoniae, A baumannii, and P aeruginosa) led directly to 9.29 lakh deaths and was associated with 3.57 million.
● One pathogen-drug combination – methicillin-resistant S aureus, or MRSA – directly caused more than 1 lakh deaths.
● Resistance to two classes of antibiotics often considered the first line of defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than 70% of deaths caused by AMR.

Question 58

Antimicrobial resistance: initiatives by GoI?

Answer 58

• Currently, there are no global standards for antibiotic discharge limits in the environment from pharmaceutical industries. India is the only country to have issued the Draft Environment Protection Amendment Rules in January 2020 to limit the amount of antibiotic residue permitted in wastewater released by drug factories. If notified, it will shift the paradigm from a focus on the quality of medicine to the impact, manufacturing has on workers and the environment.
• National Action Plan on Antimicrobial Resistance 2017-21:
  
  • obj
    
    • improve awareness and understanding
    • strengthen surveillance
    • reduce incidence of infection through effective prevention
    • optimize usage of antimicrobial agents in health, animals and food
    • promote investments for AMR activities, Rsearch and innovations
    • focusing on One Health approach
  • In the line with NAP-AMR three states have launched their state action plan
    • Kerala has launched KARSAP
    • Madhya Pradesh has launched MP-SAPCAR
    • Delhi has launched SAPCARD
• AMR Surveillance Network: ICMR has established AMR surveillance and research network (AMRSN) in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
• National programme on AMR containment was launched during 12th FYP in 2012-17. Under this programme, AMR Surveillance Network has been strengthened by establishing labs in State Medical College.
• ICMR has initiated antibiotic stewardship program (AMSP) on a pilot project basis in 20 tertiary care hospitals across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
• On the recommendations of ICMR, DCGI has banned 40 fixed dose combinations (FDCs) which were found inappropriate.
• ICMR has developed evidence based treatment guidelines for treatment of ten syndromes of infections. It aims to rationalize the usage of antibiotics on Essential Medicines Formulary (EMF) and to establish consistency in the treatment of various infectious conditions.

Question 59

Antimicrobial resistance: initiatives by international orgs?

Answer 59

• Global leaders, including India, adopted a political declaration in 2016 at 71st UNGA which calls for a collaborative,global response to the threat of AMR
• In 2019 a new indicator was added to the SDG framework specifically addressing resistance (Indicator 3.d.2: Reduce the percentage of bloodstream infections due to selected antimicrobial resistant organisms)
• Global Antimicrobial Resistance Surveillance System (GLASS) was set up under WHO

Question 60

Banning e-cigarettes?

Answer 60

1. Bill passed in Parliament 2. production, manufacture, import, export, transport, sale, distribution, storage, and advertisement of e-cigarettes and similar devices as cognizable offences. 3. These include all forms of Electronic Nicotine Delivery Systems, Heat Not Burn Products, e-Hookah and the like devices. 4. WHO has also urged member countries to take appropriate steps

Question 61

ROTAVAC5D: what is it?

Answer 61

1. New rotavirus vaccine launched 2. by BharatBiotech

Question 62

Rotavirus: 1)significance? 2) feature 3) difference frm normal diarrhoea?

Answer 62

1.1) leading cause of severe diarrhoea and death among children less than five years of age. 1.2) responsible for around 10% of total child mortality every year. 2.1) It is a genus of double-stranded RNA virus in the Reoviridae family 2.2) transmitted by the faecal-oral route, via contact with contaminated hands, surfaces and objects, and possibly by the respiratory route. Viral diarrhea is highly contagious. 3) Other diarrhoea can be prevented through general measures like good hygiene bt rotavirus needs vaccine

Question 63

‘Eat right movement’ campaign: 1. by? 2. aim? 3. about?

Answer 63

1. by FSSAI 2. aims to cut down salt/sugar and oil consumption by 30% in three years 3.1) regulatory measures under three major pillars: Eat Safe, Eat Health and Eat Sustainably 3.2) FSSAI has prescribed a limit for Total Polar Compounds (TPC) at 25% in cooking oil to avoid the harmful effects of reused cooking oil

Question 64

Online sale of medicines: 1. legal standing? 2. what all has happened on it?

Answer 64

1. Ministry of Health, Central Drugs Standard Control Organisation and an expert committee appointed by the drug consultative committee have already concluded that the online sale of medicines is in contravention of the provisions of Drugs and Cosmetics Act, 1940 and the other allied laws. 2. Delhi HC in December 2018 had ordered the ban on sale of illegal or unlicensed online sale of medicines till the government drafts rules to regulate e-pharmacies. E-pharmacies told the Court that they do not require a license for online sale of drugs and prescription medicines as they do not sell them, instead they are only delivering the medications akin to food-delivery app Swiggy. Ministry of health and family welfare, in September 2018, issued a draft notification on the sale of drugs by E-Pharmacies

Question 65

Highlights of draft notification on sale of drugs by e-commerce companies?

Answer 65

1. All the e-pharmacies have to be registered compulsorily with the CDSO 2. Psychotropic substances, habit-forming medicines like cough syrup and sleeping pills, schedule x drugs will not be sold online. 3. Apart from registration, the e pharmacies have to obtain a license from the State government to sell the medicines online. 4. e-pharmacy registration holder will have to comply with provisions of Information Technology Act, 2000 5. The details of patient shall be kept confidential and shall not be disclosed to any person other than the central government or the state government concerned, as the case may be. 6. The supply of any drug shall be made against a cash or credit memo generated through the e-pharmacy portal and such memos shall be maintained by the e-pharmacy registration holder as record. 7. Both state and central drug authorities will be monitoring the data of sales and transactions of e pharmacies. Any violation of rules the registration of e-pharmacies will be suspended, and it can be cancelled too. 8. The premises from which e-pharmacy is operated regular inspections will be conducted every two years by the central licencing authority.

Question 66

T/F: india has the highest burden of all malaria cases.

Answer 66

F Nigeria (24%)

Question 67

What is Kawasaki disease?

Answer 67

• It affects children, typically <5yrs.
• Its symptoms include red eyes, rashes, and a swollen tongue with reddened lips — often termed strawberry tongue — and an inflamed blood vessel system all over the body.
• There is constant high fever for at least five days.
• The disease also affects coronary functions in the heart.
• What causes Kawasaki disease is not yet known. “What we do know is that it is an immunological reaction to an infection or a virus. A child’s immunity system responds to a particular infection and develops these symptoms
• in rare cases that children with Covid-19 have shown symptoms similar to those of Kawasaki disease, 2-3 weeks after getting infected with coronavirus. In Covid-19 cases, even adolescents are presenting these symptoms.

Question 68

INdian Education Resilience amid COVID?

Answer 68

1. government has initiated the YUKTI web portal, the Aarogya Setu app has been made available for free and the National Foundational Literacy and Numeracy Mission aims to boost literacy.
2. National Curriculum and Pedagogical Framework and the Bharat Padhe online campaign are bringing knowledge to the grass roots.
3. Prime Minister’s e-Vidya scheme synergises and strengthens several distance-education projects — digital, online, and mass media.
   
   1. Benefitting 25-crore school children, it focuses on developing permanent assets for quality education for generations to come.
   2. A dedicated channel for every class will ensure easy, customised lessons and study material.
   3. Importantly, it focuses on equity in education.
   4. This endeavour also individualises the teaching-learning experience to a considerable extent.
   5. For the differently-abled, this scheme provides bespoke materials under the Digitally Accessible Information System (DAISY). Webinars, podcasts, and online classes enrich the learning experience.
4. government has tried to address the equally important issue of psychological health with Manodarpan, a programme that covers both parents and students at a time when unprecedented challenges and stress have raised mental health issues.
5. Private Endeavours like University Social Responsibility (USR), under which free online open educational resources in English, Sanskrit, Hindi, Arabic, Chinese, French, German, Italian, Japanese, Korean, Persian, Russian
6. EnglishPro, a free mobile app, is ready for launch to help those around the SSC/Class X level in improving their English pronunciation in the Bharatiya way

Question 69

TULIP programme?

Answer 69

1. TULIP – Urban Learning Internship Program for providing opportunities to fresh Graduates in all ULBs & Smart Cities
2. pursuant to the Budget 2020-21 announcement under the theme ‘Aspirational India’.
3. It would help enhance the value-to-market of India’s graduates and help create a potential talent pool in diverse fields like urban planning, transport engineering, environment, municipal finance etc.
4. It will lead to infusion of fresh ideas and energy with engagement of youth in co-creation of solutions for solving India’s urban challenges.
5. This launch is also an important stepping stone for fulfilment of MHRD and AICTE’s goal of 1 crore successful internships by the year 2025.

Question 70

SWADES initiative?

Answer 70

1. part of the Vande Bharat Mission, fr the Indian citizens returning frm abroad, especially in the wake of COVID
2. It is a joint initiative of the Ministry of Skill Development & Entrepreneurship, the Ministry of Civil Aviation and the Ministry of External Affairs.
3. The National Skill Development Corporation (NSDC)is supporting the implementation of the project.
4. It aims to create a database of qualified citizens based on their skill sets and experience to tap into and fulfil demand of Indian and foreign companies.
5. The collected information will be shared with the companies for suitable placement opportunities in the country.
6. The returning citizens are required to fill up an online SWADES Skills Card.
7. The card will facilitate a strategic framework to provide the returning citizens with suitable employment opportunities through discussions with key stakeholders including state governments, industry associations and employers.

Question 71

Ebola?

Answer 71

1. Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
2. origins:
   
   • named after river in Congo, where it was first recognised in 1976
   • cases found in Sudan, DRC, Republic of Congo, Gabon and Liberia, Guinea, Sierra Leone, Nigeria, Mali etc. secondary infections also in USA, Spain
3. Transmission: The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission, via
   
   • direct contact with blood and secretions of infected persons
   • contact with contaminated objects like needles
   • eating contaminated meat
4. The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
5. Prevention: Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on case management, surveillance and contact tracing, a good laboratory service and social mobilisation.
6. Treatment: Early supportive care with rehydration, symptomatic treatment improves survival. There is yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
7. Vaccine: rVSV-ZEBOV vaccine is being used in the ongoing 2018-2019 Ebola outbreak in DRC.

Question 72

Why Indian institutions do not fare well in International rankings like QS World university rankings? vs NIRF?

Answer 72

In international rankings, Indian institutions struggle on the “internationalisation” parameter in global rankings. It is due to the high weightage given to the perception which is a subjective parameter.

Whereas, in NIRF, 90% of the parameters are completely objective and fact-based, while only 10% is based on the subjective parameter of perception by academic peers and employers.

Question 73

Case study of successful vaccination communication from remote region in MH: Melghat?

Answer 73

Vaccination in Melghat, nestled within a forest, a core tiger reserve and home to the Korku tribals, offers rich insights into behaviour, culture and the relationship between them

• A mode of communication that belonged to the people: shooting episodes of a serial we called Corona haarativa, Melghat jitauva (Corona will lose, Melghat will win), which was broadcast on YouTube. The tribal residents of Melghat acted in the serial, it was in their language, it had them asking questions and answering those questions.
• tailored vaccination camps around their work schedules. Villagers cannot sit at home all day long as most of them work for MGNREGA or in their fields.
• moved vaccination centres to open spaces in villages. That way, people could see others taking the vaccine.
• clapped for the first set of vaccinations and made sure the camp felt like a festival in the village, sometimes using music or our videos.
• set up intermittent goals. Which village can get itself 100 per cent vaccinated first? Reaward and challenge system. challenge to the sarpanches: Getting their gram panchayat bodies 100 per cent vaccinated because people would listen only to leadership that practises what it preaches.
• Post vaccination enquiry some days to see if they are doing good. People need belief that they are being cared for

Question 74

The 6 important Guiding principles learnt frm the success of Swachh Bharat Mission, that can be applied to any large Transformation Scheme?

Answer 74

A-> Align: A goal congruence has to be achieved across the administrative system; continuous engagement with states, 700 DMs (engaged by team SBM-Grameen), 2.5L panchayats; employ workshops and whatsapp grps for officials. PM-CM-DM model in cohesion

B->Believe: A mix of Younger people with less baggage and unique ideas and experienced but driven bureaucrats

C-> Communicate: SBM basically a behaviour change program;Swachgrahis for door-to-door;engaging media and star power to make it glamorous; Keep the buzz alive throughout its life-cycle; recent study by Dalberg found that each rural Indian was reached by SBM messaging abt 3000 times over past 5 yrs.

D-> Democratise: Make everyone a stake holder; communities planned activities and monitoring of progress; Corp, NGOs and civil society too

E-> Evaluate: third party monitoring of progress and evaluation; felicitation of pockets of excellence achieved and their models replicated

F-> Follow Through: NO ‘missionaccomplished’, need to sustain the efforts to not relapse; post delivery follow thorugh to ensure that change becomes norm

Question 75

Swachh Survekshan league?

Answer 75

conducted in three quarters (April-June, July-September and October-December) with the objective of sustaining the on-ground performance of cities along with monitoring of when it comes to cleanliness.

Swachh Survekshan 2020 is the 5th edition of the annual urban cleanliness survey conducted by the Ministry. first conducted in 2016, which covered 73 cities. The second and third round of the survey in 2017 and 2018 widened the coverage

Findings:

• Cleanest city: Indore for the fourth time in a row.
• Worst: Kolkata
• In cities with pop>10L, Bhopal and rajkot stood second in first and second quarters respectively.
• Among cantonment boards, Tamil Nadu’s St.Thomas Mount Cantt and Delhi Cantt stood 1st in the first and second quarters respectively.

Question 76

Concept of social mobility? significance?

Answer 76

• concept of social mobility is much broader than just looking at income inequality. It encompasses several concerns such as:
  
  • Intragenerational mobility: The ability for an individual to move between socio-economic classes within their own lifetime.
  • Intergenerational mobility: The ability for a family group to move up or down the socio-economic ladder across the span of one or more generations.
  • Absolute income mobility: The ability for an individual to earn, in real terms, as much as or more than their parents at the same age.
  • Absolute educational mobility: The ability for an individual to attain higher education levels than their parents.
  • Relative income mobility: How much of an individual’s income is determined by their parents’ income.
  • Relative educational mobility: How much of an individual’s educational attainment is determined by their parents’ educational attainment.
• ‘sticky floors’ and ‘sticky ceilings’ in high income countries i.e. stagnation at both the bottom and the top end of the income distribution
• For instance, in Denmark or Finland (which rank highest in social mobility index), if Person A’s parent earns 100% more than Person Z, it is estimated that the impact on Person A’s future income is around 15%, but in the US the impact is far more – about 50%– and in China, the impact is even more – roughly 60%.
• Social mobility levels helps in understanding both the speed(how long it takes for individuals at the bottom of the scale to catch up with those at the top) and the intensity ( how many steps it takes for an individual to move up the ladder in a given period). eg. it would take a whopping 7 generations for someone born in a low-income family in India or China to approach mean income level; in Denmark, it would only take 2 generations.
• Research also shows that countries with high levels of relative social mobility—such as Finland, Norway or Denmark— exhibit lower levels of income inequality.

Question 77

ASER2018: highlights?

Answer 77

• Indian students, especially those in elementary school (Classes I-VIII), are not learning enough. To cite a metric, only half (50.3%) of all students in Class V can read texts meant for Class II students.
• There seems to have been some improvement in learning levels, especially among students of Class III and Class V, in 2018 compared with those of the previous five years. However, the improvement is not visible at a higher level, for example among students of Class VIII.
• deficit is across government and private schools. Traditionally, students in private schools have fared better than their government school counterparts, but that’s a relative situation. For example, while 40% of Class VIII students in government schools can do simple division, the figure is 54.2% in private schools.
• gradual improvement in some segments and in some states. The reading ability among Class V students in Kerala jumped 10 percentage points in 2018 from that in 2016. In Himachal Pradesh, the growth is nearly 8 percentage points and in Chhattisgarh and Odisha it is around 7 percentage points between 2016 and 2018
• less than a percentage point growth since 2014(30.8%) among students in the 6-14 age group who were in private schools
• Access to elementary (classes I-VIII) schooling is almost universal and the number of children out of schools is below 4%, but there is a quality deficit
• Last year, the World Bank said Indians born today are likely to be just 44% productive as workers, way below their Asian peers.

Question 78

ASER2019:highlights?

Answer 78

• latest edition focuses on early years, defined globally as age 0-8, is known to be the most important stage of cognitive, motor, social and emotional development in the human life cycle.
• Only 16% of children in Class 1 in 26 surveyed rural districts can read text at the prescribed level, while almost 40% cannot even recognise letters.
• Only 41% of these children could recognise two digit numbers.
• Many Indian parents choose government schools for girls in the age group of 4 to 8 years while they favour private schools for boys.
• At least 25% of school children in the four-eight age group do not have age-appropriate cognitive and numeracy skills, making for a massive learning deficit at a very early stage.
• More than 90% of children in the 4-8 age group are enrolled in some type of educational institution. This proportion increases with age, from 91.3% of all 4-year-olds to 99.5% of all 8-year-olds
• Children from less advantaged homes are disproportionately affected. Although almost half of all 4-year-olds and more than a quarter of all 5-year-olds are enrolled in anganwadis, these children have far lower levels of cognitive skill and foundational ability than their counterparts in private LKG/UKG classes.
• Overall, 41.7% of children in class I are of the RTE-mandated age.
• Children’s skills and abilities improve in each subsequent class. As per the report, “children’s ability to read standard I level text improves from 16.2% of children in standard I to 50.8% children in standard III. This means that half of all children in standard III are already at least two years behind where the curriculum expects them to be
• Among the pre-primary section, children with mothers who completed eight or fewer years of schooling are more likely to be attending anganwadis or government pre-primary classes. Whereas their peers whose mothers studied beyond the elementary stage are more likely to be enrolled in private LKG/UKG classes.

Question 79

ASER2019: measures suggested?

Answer 79

• Focus on cognitive skills rather than subject learning in the early years can make a big difference to basic literacy and numeracy abilities.
• Children’s performance on tasks requiring cognitive skills is strongly related to their ability to do early language and numeracy tasks.
• focussing on play-based activities that build memory, reasoning and problem-solving abilities is more productive than an early focus on content knowledge.
• Global research shows that 90% of brain growth occurs by age 5
• entire age band from 4 to 8 needs to be seen as a continuum, and curriculum progression across grades and schooling stages designed accordingly
• Expand and strengthen the existing network of anganwadi centres.

Question 80

ASER Rport: general features? parameters of assessment in 2019 report?

Answer 80

• an annual survey that aims to provide reliable estimates of children’s enrolment and basic learning levels
• conducted every year since 2005 in all rural districts of India.
• largest citizen-led survey in India.
• only annual source of information on children’s learning outcomes available in India today.
• Unlike most other large-scale learning assessments, ASER is a household-based rather than school-based survey. This design enables all children to be included – those who have never been to school or have dropped out, as well as those who are in government schools, private schools, religious schools or anywhere else.
• Covers >25 districts and >1500 villages and > 35000 children
• All tasks done one-on-one with children in their homes.

1. Cognitive: eg. sort by color? spatial awareness? order by size
2. early language: eg. describe picture
3. early numeracy: eg. counting objects
4. social and emotional: eg. identify emotions and regulate them

Question 81

‘Rare diseases’?

Answer 81

1. A rare disease, also referred to as an orphan disease, is any disease that affects a small percentage of the population.
2. no universally accepted definition of rare diseases. In the US, for instance, a rare disease is defined as a condition that affects fewer than 200,000 people.The same definition is used by the National Organisation for Rare Disorders (NORD).
3. Most rare diseases are genetic
4. Rare diseases are characterised by a wide diversity of symptoms and signs that vary not only from disease to disease but also from patient to patient suffering from the same disease.
5. Rare diseases pose a significant challenge to health care systems because
   
   1. the difficulty in collecting epidemiological data,
   2. which in turn impedes the process of arriving at a disease burden,
   3. calculating cost estimations and
   4. making correct and timely diagnoses
   5. Many cases of rare diseases may be serious, chronic and life-threatening
   6. As per the 2017 report, over 50 per cent of new cases are reported in children and these diseases are responsible for 35 per cent of deaths in those below the age of one
   7. pharma companies are less inclined to invest in R&D fr a rare disease

Question 82

The most common rare diseases recorded in India are ?

Answer 82

Haemophilia,

Thalassemia,

sickle-cell anaemia and

primary immuno deficiency in children,

auto-immune diseases,

Lysosomal storage disorders such as Pompe disease, Hirschsprung disease, Gaucher’s disease, Cystic Fibrosis, Hemangiomas and

certain forms of muscular dystrophies

Question 83

National policy fr treatment of rare diseases?

Answer 83

1. covers 450 rare diseases
2. by MOHFW; policy was created on the direction of the Delhi High Court to the Ministry, in response to writ petitions for free treatment of such diseases, due to their “prohibitively” high cost of treatment.
3. Centre first prepared such a policy in 2017 and appointed a committee in 2018 to review it.
4. policy intends to kickstart a registry of rare diseases, which will be maintained by the ICMR
5. According to the policy, rare diseases include genetic diseases, rare cancers, infectious tropical diseases, and degenerative diseases.
6. Under the policy, there are three categories of rare diseases —
   
   • requiring one-time curative treatment: like osteopetrosis and immune deficiency disorders,
   • diseases that require long-term treatment but where the cost is low, and
   • those needing long-term treatments with high cost.
7. As per the policy, the assistance of Rs 15 lakh will be provided to patients suffering from rare diseases that require a one-time curative treatment under the Rashtriya Arogya Nidhi scheme.
8. The treatment will be limited to the beneficiaries of Pradhan Mantri Jan Arogya Yojana.

Question 84

yada Yada virus?

Answer 84

1. recently detected in australian mosquitoes
2. It belonged to a group that includes other alphaviruses such as chikungunya virus and the astern equine encephalitis.
3. poses no threat to human beings, because it is a part of a group of viruses that only infect mosquitoes.
4. Other viruses in the same group include the Tai forest alphavirus and the Agua Salud alphavirus.

Question 85

India’s Pulse POlio Program?

Answer 85

25 yrs this yr

India launched the Pulse Polio immunisation programme in 1995, after a resolution for a global initiative of polio eradication was adopted by World Health assembly in 1988

Coverage: Children in the age group of 0-5 years are administered polio drops during national and sub-national immunisation rounds (in high-risk areas) every year.

Question 86

Labour productivity growth needed?

Answer 86

• >5.2% growth in LP in FY19
• > To attain 8% GDP growth rate, LP has to increase by 6.3%.
• > Sectors that led in growth in LP: mfg, electricity, gas, water supply, transport, storage and communication
• > sectors that lagged: Constr, agri and mining.

Question 87

Vaccine derived polio?

Answer 87

1. In the last one year or so, polio has made a comeback in countries such as the Philippines, Malaysia, Ghana, Myanmar, China, Cameroon, Indonesia and Iran. All these countries had wiped the virus out at various times during the last couple of decades.
2. vaccine-derived poliovirus is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus.
3. A circulating vaccine-derived poliovirus (cVDPV) occur when routine or supplementary immunization activities (SIAs) are poorly conducted and a population is left susceptible to poliovirus, whether from vaccine-derived or wild poliovirus. Hence, the problem is not with the vaccine itself, but low vaccination coverage. If a population is fully immunized, they will be protected against both vaccine-derived and wild polioviruses.
4. A Lancet 2017 study shows that vaccine associated polio is becoming more relevant as compared to wild polio virus cases.

Question 88

India and Polio?

Answer 88

1. In January 2014, India was declared polio-free after three years on zero cases. The last case due to wild poliovirus in the country was detected on January 13, 2011.
2. To prevent the virus from coming to India, the government has since March 2014 made the Oral Polio Vaccination (OPV) mandatory for those travelling between India and polio-affected countries, such as Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon.
3. In 2018, there was a brief scare when some vials of the polio vaccine were found contaminated with the polio 2 virus that had been eradicated from the country in 1999. However, WHO quickly issued a statement saying that all vaccines used in the government programme in India were safe.
4. The current OPV we are using in India is a bivalent one i.e. it contains both Type-1 and type-3 strains. Till 2014, we were using trivalent vaccines with Type-2 strain also included but it was removed in 2014.
5. Some years ago, India introduced the injectable polio vaccine in the Universal Immunisation Programme. This was to reduce chances of vaccine-derived polio infection, which continues to happen in the country.
6. The govt is nw focussing on IPV and nw its necessary to get both IPV as well as OPV to get complete immunization frm Polio.

Question 89

IPV (inactivated Polio vaccine) vs OPV (Oral Polio vaccine)?

Answer 89

1. IPV contains killed formolised virus while OPV contains live attenuated virus
2. IPV is given as intramuscular/Subcutaneous (IM/SC) injections while OPV is given orally
3. IPV offers only individual protection while OPV provides individual as well as community protection i.e. along with the child who is vaccinated, people around him will also be protected. Thus OPV is more effective in fighting epidemics
4. IPV is more expensive compared to OPV though OPV requires stringent conditions during storage and transportation.
5. IPV provides only humoral immunity i.e. antibodies are limited to the fluids like blood of the child; OPV provides both humoral as well as local immunity (intestinal, gut). IPV doesn’t prevent reinfection by Wild polio viruses while OPV prevents intestinal reinfections.
6. In rare cases of OPV, child can contract vaccine related polio, but no such risk exists fr IPV. In India, almost 200 cases each yr were detected of vaccine related polio frm 1999 to 2001. Thus, OPV is now slowly replaced by IPV.

Question 90

public health emergency of international concern?

Answer 90

As per WHO, it is “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “to potentially require a coordinated international response.”

Previous emergencies have included Ebola, Zika and H1N1.

The responsibility of declaring an event as an emergency lies with the Director-General of the WHO and requires the convening of a committee of members.

Question 91

National Commission fr Indian systen of Medicine Bill, 2019 (NCIM)?

Answer 91

Objective of establishing NCIM: to promote equity by ensuring adequate supply of quality medical professionals and enforce high ethical standards in all aspects of medical services in Indian System of Medicine.

Composition of proposed NCIM:

• will consist of 29 members, appointed by CG
• A Search Committee will recommend names to the CG for the post of Chairperson, part time members, and presidents of the four autonomous boards set up under the NCISM.
• These posts will have a maximum term of four years
• Search Committee will consist of five members including the Cabinet Secretary and three experts nominated by the CG (of which 2 shud hv experience in any two fields of Indian Medicine)

Question 92

Neglected Diseases?

Answer 92

January 30, 2020 is the first-ever World Neglected Tropical Diseases Day(World NTD Day)

India doesn’t have a comprehensive policy fr research and innovation, diagnostics or vaccine development in neglected tropical disease

Why are some tropical diseases called “neglected”?

The people who are most affected by these diseases are often the poorest populations, living in remote, rural areas, urban slums or conflict zones. Neglected tropical diseases persist under conditions of poverty and are concentrated almost exclusively in impoverished populations in the developing world.

More than 70% of countries and territories that report the presence of neglected tropical diseases are low-income or lower middle-income economies.

Many neglected tropical diseases can be prevented, eliminated or even eradicated with improved access to existing safe and cost-effective tools. Control relies on simple interventions that can be carried out by non-specialists — for example schoolteachers, village heads and local volunteers — in community-based preventive action.

Question 93

Proliferation of low qlty technical education institutions: stats?

Answer 93

At its peak in 2014-15, AICTE-approved institutes had almost 35 lakh seats

Since 2015-16, at least 50 colleges have closed each year

Not a single industry body, be it CII, FICCI or ASSOCHAM has managed to effectively inform the education planners on the growth in different employment sectors. In the absence of any credible information on demand side numbers, investments made by institutions will only be based on perception. Yesterday, it was IT and its applications that propelled a growth in IT and Computer Science courses. Today, it is automation. Be it RPA, AI, ML, blockchain, hard robotics or IOT, the thrust is on complete automation. What happens when these areas get saturated? Several jobs have already disappeared with the base of the pyramid having shrunk considerably.

Question 94

Poverty reduction since independence: stats?

Answer 94

1. From more than 70 per cent poor in 1947, the head-count ratio (HCR) of poverty in India dropped to 21.9 per cent in 2011, as per the erstwhile Planning Commission’s estimates based on the Tendulkar poverty line.
2. The drop in HCR during 2004-11 was almost three times faster than during 1993 to 2004, and much faster than during the socialist era of 1947-91.
3. C. Rangrajan committee, in 2011, established a ne povetry benchmark and estimated India’s HCR poverty at 29.5%. after 2011, we have no official estimates of poverty.
4. WB estimated India’s HCR to be between 8.1 and 11.3 per cent in 2017, as per the international definition of per capita income of $1.9 per day (at 2011 PPP).
5. Using the same definition, the World Poverty Clock estimates India’s poverty at just 6 per cent in 2021.

Question 95

Pre-Pandemic poverty stats:

1. median HH income in India?
2. bottom 25% of HHs lived on an income of ?

Answer 95

1. Rs. 15000 per month i.e. a family of four at the median income level lived on just Rs 125 per day per person for all their expenditure on food, clothing, housing, healthcare, festivals and more. Half of India lives with less than that.
2. <8500 per month or <70Rs. per day per person

Question 96

All India Survey of Higher Education (AISHE) report: about?

Answer 96

1. annual web-based survey conducted since 2010-11
2. by MHRD
3. under the central sector scheme Higher Education Statistics and Public Information System (HESPIS).
4. Survey is based on voluntary uploading of data by institutions of Higher Education and covers all higher education institutions in the country, which are categorised into 3 broad categories:

o Universities

o Colleges/Institutions

o Stand-alone Institutions (not affiliated with Universities and are not empowered to provide degree, therefore run Diploma Level Programmes.)

Question 97

All India Survey of Higher Education (AISHE) report 2019-20?

Answer 97

1. Enrolment in Higher Education: Gross Enrolment Ratio (GER) in higher education in India has risen marginally from 26.3% in 2018-19 to 27.1% in 2019-20
2. Gender Parity: The GER for women in 2019-20 is 27.3% as compared to 26.9% for men. Thus Gender Parity Index in HE in 2019-20 is 1.01 against 1.00 in 2018-19.
3. Pupil Teacher Ratio (PTR): in Higher Education is 26 and there are large variations among the States. For instance, PTR is more than 50 in Bihar and Jharkhand and among top 6 States in terms of Enrolment, Karnataka and Tamil Nadu have the best PTR of 18 each.
4. Nearly 85% of the students (2.85 crore) were enrolled in the six major disciplines such as Humanities, Science, Commerce, Engineering & Technology, Medical Science and IT & Computer.
5. The total number of foreign students enrolled in higher education is 47,427. Highest share of foreign students come from the neighbouring countries of which Nepal is 26.88% of the total, followed by, Afghanistan (9.8%), Bangladesh (4.38%), Sudan (4.02%), Bhutan (3.82%) and Nigeria (3.4%).

Question 98

HIgher Education in India: Challenges?

Answer 98

1. Low students enrolment: more than 88% in US, 54% in China and 51% in Brazil. Low GER creates bottleneck in achieving massification of higher education in India
2. Social Inequity: Though Gender inequality has come down, the social inequality between various social grps persevere. GER for HE among SCs, STs, OBCs and Muslims are at 16%, 5%, 37% and 5% respectively.
3. Shortage of resources: Bulk of the enrolment in HE is handled by state universities and their affiliated colleges which receive very small amounts of grants in comparison to central uni. Nearly, 65% of the UGC budget is utilised by the central universities.
4. Poor Employability: India Skills Report 2021 finds that employability across disciplines is at 45%. The skill gap and unemployment rate for graduates point to two problems in the HE- Woeful lack of quality in many colleges in India and the disconnect between education in colleges and the skills required in a workplace.
5. Quality of institutions: A large number of colleges and universities in India are unable to meet the minimum requirements laid down by the UGC and while UGC publishes an annual list of ‘fake universities’ and ‘fake colleges’ that operate without recognition it does not have the power to directly act against such HEIs.
   
   • Only 14% of all HEIs in India have valid NAAC accreditation
   • only three universities from India rank in the top-200 positions in the latest QS World University Rankings 2022
6. Faculty shortages along with the inability of the state educational system to attract and retain well-qualified teachers. Further, there is no mechanism for ensuring the accountability and performance of professors in universities and colleges unlike foreign universities where the performance of college faculty is evaluated by their peers and students.
7. Suboptimal research ecosystem: India’s gross expenditure on R&D is 0.65 per cent of its GDP, significantly lower than the 1.5-3 per cent of GDP spent by the top 10 economies. As a result, just 2.5% HEIs run PhD programmes and students enrolled in Ph.D. is only about 0.5% of the total student enrolment.
   
   • Additionally, despite an increase in publications, low citation impact implies that the quality of Indian research papers is not at par with that of other countries. The relative impact of citations for India is half (0.51) of that of the world average (1.0)
8. Governance and Accountability: State-level authorities and affiliating universities are the primary regulators of higher education. This has led to higher education system marked by over-centralization, bureaucratic structures and lack of accountability, transparency, and professionalism.
9. COVID implications: Covid-19 has created several negative impacts on higher education such as passive learning, unprepared teachers for virtual class, altering structure of student enrolment, increased unemployment due to delays in exam and getting degree certificates.
   
   • It also highlighted the challenge of prevailing digital divide
   • The health crisis combined with a recession increases the probability of families deciding to forego higher education entirely or defer enrolment.

Question 99

Jan Shikshan sansthan: about?

Answer 99

It is an initiative for skill development in rural areas.

Jan Shikshan Sansthan (formerly known as Shramik Vidyapeeth) are established for providing vocational skills to non-literate, neo-literates as well as school dropouts by identifying skills that have a market in the region of their establishment.

It has been implemented through a network of NGOs in the country since March 1967.

Obj:

1. improve the occupational skills and technical knowledge of non-literates, neo-literates and other school dropouts
2. To create a pool of master trainers working across the department/agencies of skill development through training/orientation programmes.
3. widen the range of knowledge and understanding of social, economic and political systems and create awareness about the environment.
4. promote national values and to align with national programmes
5. promte self-employment and facilitate financial support including loans for the target groups through linkage with credit

Question 100

Food fortification: intro?

Answer 100

FSSAI, defines fortification as “deliberately increasing the content of essential micronutrients in a food so as to improve the nutritional quality of food and to provide public health benefit with minimal risk to health

Question 101

Fortification of Rice: recent context and main points?

Answer 101

1. PM, in his 2021 independence day speech, announced that by 2024, fortified rice will be given under PDS and Mid day meals
2. need
3. India had three possible pathways to use fortified rice to fight malnutrition
4. India has already a good established ecosystem in this regard.
5. way forward:
   
   • the success of the scaling up, however, is predicated on designing better quality programmes, data alliances, continuous monitoring and evaluation, robust quality control and assurance and gender integration
   • government can also rope in the private sector to create a market segment for premium-quality biofortified foods to cater to high-end consumers. For instance, trusts run by the TATA group are supporting different states to initiate fortification of milk with Vitamin A and D. Other private dairies should also be encouraged to scale up milk fortification
   • a national awareness drive on the lines of the “Salt Iodisation Programme” launched by the government in 1962 to replace ordinary salt with iodised salt, can play an important role at the individual and community levels to achieve the desired goals of poshan for all.
   • equally important is grandma’s recipe of diversified diets — we should always keep that in mind.

Question 102

Fortification of Rice:need?

Answer 102

• NFHS 2015-16: >50% women anaemic; every third child stunted; every fifth child is wasted; over 70% of pop consumes less than 50% of recommended dietary allowance
• India is ranked 94th (out of 107) in GHI- lower than not only similar cohort countries like Mexico, China, Brazil bt also than other countries of South Asia like Nepal, SL and BN
• WHO declares it a severe health problem if 40 per cent of the population has anaemia, a stage India is facing in her face as NFHS-5 (2019-20) shows that actual anaemia among non-pregnant women and children has increased in 16 and 18 states/UTs respectively.
• consequential impacts on under-5 mortalities (malnutrition causes 60% of U-5 MR) and lost productivity in workig age (stunted children earn comparatively 20% lessas adults than healthy adults)
• FSSAI’s Food Fortification Resource Centre (FFRC) has reported that over 70% of India’s population consumes less than half the daily recommended dietary allowance of micronutrients.
• economic burden: ~10 billion annually in terms of lost productivity, illness, and death.
• 65 per cent of the population consuming rice at the rate of 6.8 kg per capita per month and an abundance of supply at around 350 lakh MT through social safety net programmes in India, covering 81 crore people in PDS, 8.5 crore in ICDS and 10.4 crore beneficiaries in MDM, rice inarguably is the most effective vehicle for supplying micronutrients to the vulnerable population.
• Long-standing empirical evidence with many countries employing it successfully. WHO’s meta-analysis of 16 countries on rice fortification shows that fortified rice reduces the risk of iron deficiency by 35%. Successful pilot programmes have been conducted by states like GJ, KN, UP, odisha, MH etc. offer evidence of a reduction in anaemia by 10 per cent in the districts of Gadchiroli (Maharashtra) and Narmada (Gujarat).

Question 103

Fortification of Rice: Three possible pathways? nutrients in the Fortified rice under the announced scheme of the ministry?

Answer 103

Three possible pathways:

• bio-fortification: efficacy of bio-fortification, though a potentially promising long-term strategy, is yet to be ascertained
• micronutrient rich (vitamin B1, B6, Thiamin) unpolished rice: has a low shelf life (3-6 months), is susceptible to insects and microbial infestation and has low micronutrient absorption due to high dietary fibres
• fortified rice: found to be the best and most cost-effective option to enhance the nutrient value for improving nutritional outcomes in a short period by requiring minimal behavioural change for its acceptance.

According to the Food Ministry, fortification of rice is a cost-effective and complementary strategy to increase vitamin and mineral content in diets.
● According to FSSAI norms, 1 kg fortified rice will contain iron (28 mg-42.5 mg), folic acid (75-125 microgram) and Vitamin B-12 (0.75-1.25 microgram).
● In addition, rice may also be fortified with micronutrients, singly or in combination, with zinc (10 mg-15 mg), Vitamin A (500-750 microgram RE), Vitamin B1 (1 mg-1.5 mg), Vitamin B2 (1.25 mg-1.75 mg), Vitamin B3 (12.5 mg-20 mg) and Vitamin B6 (1.5 mg-2.5 mg) per kg.

Question 104

Fortification of Rice: India already has the ecosystem ?

Answer 104

1. FSSAI has laready notified its stds in 2016
2. Centrally Sponsored Pilot Scheme on Rice Fortification through PDS- an idea that germinated at NITI Aayog, has been rolled out in 6 states- AndhraP, GJ, MH, TN, CHH and UP and is expected to be started in JH, MP, Odisha, Telangana and UK soon
3. In total, 1.73 LMT of fortified rice is being supplied through the pilot scheme
4. FCI is already procuring 6.60 LMT out of 31 LMT of fortified rice for distribution in the ICDS/MDM
5. 2,600 rice millers across 14 states have installed blending equipment with a capacity to blend 14 LMT of fortified rice.
6. 34 manufacturers of Fortified Rice Kernels (FRK), are operating in the market with an annual production of 60,000 MT, which is enough to meet the requirements of the pilot scheme, ICDS and MDM combined. This policy announcement by the PM will induce a further ramping up of FRK production and milling capacity within a short time due to definitive demand.
7. With this existing ecosystem, pan India expansion of rice fortification (at 73 p/kg) can be covered in two years at a minimal cost of about Rs 2,600 crore amounting to only 1.1 per cent of the total food subsidy bill but the GDP will gain by a massive Rs 49,800 crore, according to FSSAI.

Question 105

Limitations of Rice Fortification as a tool to fight anaemia pandemic in India?

Answer 105

1. Anaemia prevalence in India is itself inflated
   
   1. WHO haemoglobin cut-offs are used to diagnose anaemia in India. There is a growing global consensus that these may be too high, and a recent Lancet paper suggested a lower haemoglobin cut-off level to diagnose anaemia in Indian children. Using this will actually reduce the anaemia burden by two-thirds.
   2. Hg levels are checked in India by capillary blood samples, which are less reliable than venous blood samples. global studies, including from India, have shown that using capillary blood inflates the anaemia burden substantially (by ~50% in India, as per some studies)
2. Iron deficiency not responsible for anaemia burden in India
   
   1. recently, a MoHFW national survey (Comprehensive National Nutrition Survey) of Indian children showed that iron deficiency was related to less than half the anaemia cases.
   2. Many other nutrients and adequate protein intake as well as env factors are also important, for which a good diverse diet is required.
   3. older iron requirements (as per National Institute of Nutrition [NIN] 2010), were much too high. The latest corrected iron requirements (NIN 2020) are 30-40 per cent lower, with the so-called iron “gap” also being much lower. The iron density of the Indian vegetarian diet, about 9 mg/1000 kCal, can thus meet most requirements
3. Food fortification easy way out: considered attractive as it requires no behavioural modification by the beneficiary. It also plays into our fascination for applying technology to create a “future food utopia”, But if the iron present in Indian foods is not well-absorbed, then fortification would be like flogging a dead horse.
4. threat of too much iron intake:
   
   1. the recent rice fortification mission is over and above salt fortification that exists in some states, wheat flour fortification and Anaemia Mukt Bharat programme of pharmaceutical iron supplementation
   2. Ingesting fortified salt (two teaspoons, 10 g/day) or rice (quarter kilo/day) will deliver an additional 10 mg iron/day each to the diet. Compare this to the iron requirement of a woman (15 mg/day) and a man (11 mg/day). Actually, one could exceed this requirement by a lot, without even counting the supplemental iron tablet (60 or 100 mg/week for women). When the iron intake exceeds 40 mg/day, the risk of toxicity goes up. The unabsorbed iron that remains in the gut can wreak havoc among the beneficial bacteria in the large intestine. Iron causes oxidative stress, and more seriously, is implicated in diabetes and cancer risk.
5. this mandatory fortification will cost the public exchequer Rs 2,600 crore annually, with poor likelihood of benefit and posing significant risks
6. complexity of making matching kernels for each rice cultivar that is distributed in the food safety net programmes in various states. If it does not match, the instinct of a home cook will be to pick out and discard the odd grains, thereby defeating the purpose. it might even reduce the demand for the naturally-occurring diverse varieties in India.

Question 106

T/F:

1. ICAR has developed biofortified staples for three crops only- wheat, rice and maize.
2. These biofortified crops have 4 to 5 times higher levels of protein, vitamins, minerals and amino acids compared to the traditional varieties.
3. These varieties are not considered genetically modified

Answer 106

1. F; As per the ICAR website, they had developed 21 varieties of biofortified staples including wheat, rice, maize, millets, mustard, groundnut by 2019-20.
2. F; 1.5 to 3X
3. T; they have been developed through conventional crop breeding techniques

Question 107

What is Biofortification? How is it different from fortification?

Answer 107

It is the process of increasing nutritional value of food crops by increasing the density of vitamins and minerals in a crop through either conventional plant breeding; agronomic practices or biotechnology.

• Examples of these vitamins and minerals that can be increased through biofortification include provitamin A Carotenoids, zinc and iron.

How are crops fortified?

1. Conventional crop breeding techniques are used to identify varieties with particularly high concentration of desired nutrients.
2. These are cross-bred with varieties with other desirable traits from the target areas (such a virus resistance, drought tolerance, high yielding, taste) to develop biofortified varieties that have high levels of micronutrients (for example, vitamin A, iron or zinc), in addition to other traits desired by farmers and consumers.

What is Agronomic biofortification?

It entails application of minerals such as zinc or iron as foliar or soil applications, drawing on plant management, soil factors, and plant characteristics to get enhanced content of key micronutrients into the edible portion of the plant.

How does Biofortification differ from food fortification?

• Biofortification has the increased nutritional micronutrient content embedded in the crop being grown.
• Food fortification increases the nutritional value of foods by adding trace amounts of micronutrients to foods during processing.

Question 108

Samagra Shiksha 2.0 scheme?

Answer 108

CCEA has approved the school education programme Samagra Shiksha Scheme 2.0 till the 2025-26 FY

It has been upgraded to align it with the SDG for Education and the new NEP launched in 2020

Features:

1. DBT: all child-centric interventions will be provided directly to the students through DBT mode on an IT-based platform over a period of time. This DBT would include RTE entitlements such as textbooks, uniforms and transport allowance.
2. on NEP recommendations:
   
   1. encouraging Indian languages: a new component for appointment of language teachers, which includes salaries, and training costs as well as bilingual books and teaching learning material as recommended in NEP.
   2. pre-primary edu: will now include funding to support pre-primary sections at govt schools. Trainers for pre-primary teachers and anganwadi workers will be supported
   3. NIPUN Bharat: an annual provision of Rs. 500 per child for learning materials, Rs. 150 per teacher for manuals and resources and Rs. 10-20 lakh per district will be given for assessment for foundational literacy and numeracy. (refer FC# 115)
   4. digital initiatives: provision for ICT labs and smart classrooms, including support for digital boards, virtual classrooms and DTH channels, esp imp in wake of COVID
   5. for out of school children: includes a provision to support out of school children from age 16 to 19 with funding of Rs. 2000 per grade to complete their education via open schooling.
   6. greater focus on skills and vocational education both for in schools and school drop outs
3. Financial support for State Commission for Protection of Child Rights @ Rs 50 per elementary school in the state
4. Holistic Progress Card (HPC): Holistic, 360-degree, multi-dimensional reports showing progress/uniqueness of each learner. Support for activities of PARAKH, a national assessment centre (Performance, Assessments, Review and Analysis of Knowledge for Holistic Development)
5. Capacity building will now focus not just on in-service teacher training but also on building capacities of stakeholders — school management committee members, parents, PTA, etc.
6. Additional Sports grant of upto Rs. 25000 to schools in case at least 2 students of that school win a medal in Khelo India school games at the National level.
7. Provision for Bagless days, school complexes, internships with local artisans, curriculum and pedagogical reforms etc included.
8. Support for Social Audit covering 20% of schools per year so that all schools are covered in a period of Five years.
9. Gender related interventions: additional funds for extending Kasturba Gandhi Balika Vidyalayas to grade 12, and provisioning of sanitary pad vending machines and incinerators in all girls’ hostels. The self-defence training component is now extended from grades 6 to 12.
10. for the first time provides for block-level camps for identification and training of special educators and equipping Block Resource Centres and home-based schooling for severe and profound disabilities.

Question 109

Samagra Shiksha scheme?

Answer 109

• It was launched by the Ministry of Education in 2018.
• It is an integrated scheme for school education covering the entire gamut from pre-school to class XII.
• It aims to deliver inclusive, equitable, and affordable school education.
• It subsumes the three Schemes of Sarva Shiksha Abhiyan (SSA), Rashtriya Madhyamik Shiksha Abhiyan (RMSA) and Teacher Education (TE).
• The scheme covers 1.16 million schools, over 156 million students and 5.7 million Teachers of Govt. and Aided schools (from pre-primary to senior secondary level).
• It is being implemented as a centrally sponsored scheme. It involves a 60:40 split in funding between the Centre and most States.

Question 110

link between nutrition and sanitation?

Answer 110

1. Several other factors apart from inadequate dietary intake also affect nutritional outcomes, such as contaminated drinking water, poor sanitation, and unhygienic living conditions.
2. Acc to WHO, 50% of all mal- and under-nutrition can be traced to diarrhoea and intestinal worm infections, which are a direct result of poor water, sanitation and hygiene.
3. One of the first instances of the link between WASH ( (Water sanitation and Hygiene)) and nutrition appeared in the Convention on the Rights of the Child in 1989, which urges states to ensure “adequate nutritious foods and clean drinking water” to combat disease and malnutrition
4. In 2015, Jean H. Humphrey from the Johns Hopkins Bloomberg School of Public Health highlighted that poor hygiene and sanitation in developing countries leads to a sub-clinical condition called “environmental enteropathy” in children, which causes nutritional malabsorption and is the source of a variety of problems, including diarrhoea, retarded growth and stunting.
5. Childhood diarrhoea is a major public health problem in low- and middle-income countries, leading to high mortality in children under five. According to NFHS 4, approximately 9 per cent of children under five years of age in India experience diarrhoeal disease.
6. poor WASH facilities exacerbate the effects of malnutrition and vice versa as well i.e. existing micronutrient deficiencies exacerbate children’s vulnerability to WASH-related infections and diseases.
7. WHO has estimated that access to proper water, hygiene and sanitation can prevent the deaths of at least 8,60,000 children a year caused by undernutrition.

Question 111

economic fallout of the pandemic affected different communities in different ways?

Answer 111

• recent Periodic Labour Force Survey for 2019-20:
• self-employed had to bear the brunt of the onslaught of the pandemic. The percentage of people who did not work (reporting no work during the reference week) went up from 6.1 per cent in rural and 7.6 per cent in urban areas in the pre-pandemic quarter to 15.6 per cent and 29.9 per cent, respectively, in the pandemic quarter (April-June 2020).
• In rural areas, the percentage of persons with no work among the self-employed among the SC/ST population, Muslims and others (non-SC/ST and non-Muslim) increased from 6.9 per cent, 8.6 per cent and 5.5 per cent, respectively, to 15.1 per cent, 27.5 per cent and 13.7 per cent, respectively.
• A similar story emerges in urban areas, but the impact here is far more severe (due to higher compliance of lockdown restrictions) but not as differentiated across communities as in rural areas. People with no work formed 7.7 per cent, 11 per cent and 7.1 per cent of SC/STs, Muslims and others, respectively, and these went up to 39.2 per cent, 42.6 per cent and 39.3 per cent, respectively.
• unemployment rate also went up sharply for women from 6.3 per cent to 44 per cent over this period, the corresponding figures for men being 7.8 per cent and 39.0 per cent respectively.
• In rural areas, monthly earnings during the Covid quarter were 9 per cent less than the average for the year 2019-20. The deficit, however, is 21 per cent in urban areas. In urban areas, maximum loss suffered — 27 per cent — is by the SC/ST community.

Question 112

NFHS: about?

Answer 112

• conducted in a representative sample of households throughout India.
• by MoHFW
• International Institute for Population Sciences(IIPS) Mumbai, as the nodal agency for providing coordination and technical guidance
• The survey provides state and national information for India on:
  • Fertility
  • Infant and child mortality
  • The practice of family planning
  • Maternal and child health
  • Reproductive health
  • Nutrition
  • Anaemia
  • Utilization and quality of health and family planning services.
• The funding for different rounds of NFHS has been provided by USAID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MoHFW
• NFHS-1: conducted in 1992-93.
• NFHS-2: conducted in 1998-99 in all 26 states of India.
  • The project was funded by the USAID, with additional support from UNICEF.
• NFHS-3: The NFHS-3 was carried out in 2005-2006.
  • NFHS-3 funding was provided by the USAID, the Department for International Development (UK), the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and the GoI.
• NFHS-4: The NFHS-4 in 2014-2015.
  • In addition to the 29 states, NFHS-4 included all six union territories for the first time and provided estimates of most indicators at the district level for all 640 districts in the country as per the 2011 census.
  • The survey covered a range of health-related issues, including fertility, infant and child mortality, maternal and child health, perinatal mortality, adolescent reproductive health, high-risk sexual behaviour, safe injections, tuberculosis, and malaria, non-communicable diseases, domestic violence, HIV knowledge, and attitudes toward people living with HIV.

Question 113

NFHS-5: about?

Answer 113

• The NFHS-5 has captured the data during 2019-20 and has been conducted in around 6.1 lakh households.
• Many indicators of NFHS-5 are similar to those of NFHS-4, carried out in 2015-16 to make possible comparisons over time.
• Phase 2 of the survey (covering remaining states) was delayed due to the Covid-19 pandemic and its results were released in September 2021.
• NFHS-5 includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.
• NFHS-5 includes new focal areas that will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention. The areas are:
  • Expanded domains of child immunization
  • Components of micro-nutrients to children
  • Menstrual hygiene
  • Frequency of alcohol and tobacco use
  • Additional components of non-communicable diseases (NCDs)
  • Expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above.
• In 2019, for the first time, the NFHS-5 sought details on the percentage of women and men who have ever used the Internet.

Question 114

NFHS-5: population?

Answer 114

1. use of family planning methods: All states (except Mizoram) have seen an increase in the use of family planning methods. Go and Bihar saw the highest increase
2. TFR:
   
   1. TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1.
   2. most states have seen a decrease in the total fertility rate (TFR). Bihar’s TFR has declined from 3.4 (in NFHS-4) to 3. All other medium and large states in the survey (i.e., population above 1 crore) have a TFR below the replacement level rate of 2.1.
   3. In rural areas, the TFR is still 2.1.
   4. In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.
   5. share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.
3. Sex ratio:
   
   1. For the first time in India, between 2019-21, there were 1,020 adult women per 1,000 men.
   2. This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.
   3. In the 2005-06 NFHS, the sex ratio was 1,000 or women and men were equal in number.
4. sex ratio at birth:
   
   1. Despite positive sex ratio overall, India still has a sex ratio at birth (SRB) more skewed towards boys than the natural SRB (which is 952 girls per 1000 boys).
   2. Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, Maharashtra are the major states with low SRB.
   3. In three states, the ratio is below 900 (Goa: 838, Himachal Pradesh: 875, and Telangana: 894).
   4. ratio has declined in seven states. The most notable decline was in Goa (from 966 to 838), and Kerala (from 1,047 to 951).
   5. Only Tripura has a sex ratio at birth above 1,000 (i.e., more females born than males).

Question 115

NFHS-5: Health and nutrition?

Answer 115

1. institutional births:
   
   1. In 7 states, more than 90% of the births in the last five years were institutional births.
   2. In Kerala, nearly 100% of the births were institutional births.
   3. Only 46% of the births in Nagaland were institutional births. Bihar <80%
2. OoP expenditure on deliveries: average out of pocket expenditure on a delivery in a public health facility increased in 8 of the 17 states.
3. IMR:
   
   1. marginally declined in nearly all states.
   2. Assam has seen one of the largest drops in IMR, from 48 deaths (per 1,000 live births) to 32 deaths.
   3. IMR remains high in Bihar (47 deaths per 1,000 live births).
4. nutritional status of children <5yrs of age
   
   1. Child Nutrition indicators show a slight improvement at all-India level as Stunting has declined from 38% to 36%, wasting from 21% to 19% and underweight from 36% to 32% at all India level.
   2. Stunting or chronic malnutrition has increased in 11 of the 17 states.
   3. Proportion of severely wasted children has increased in 13 of the 17 states.
   4. proportion of children who are underweight has increased in 11 of the 17 states.
   5. In Bihar and Gujarat, 40% or more of the children under the age of five years are underweight.
5. Obesity:
   
   • The share of overweight children has increased from 2.1% to 3.4%.
   • proportion of women and men, between the age of 15-49 years, who are overweight or obese have increased across nearly all states (except Gujarat and Maharashtra).
   • In Andhra Pradesh, Goa, Karnataka, Telangana, Kerala and Himachal Pradesh, nearly one-third of men and women (between 15-49 years of age) are overweight or obese.
6. Anaemia: The incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%) has worsened in all States of India (20%-40% incidence is considered moderate).
   1. Barring Kerala (at 39.4%), all States are in the “severe” category.
7. Immunization: Full immunization drive among children aged 12-23 months has recorded substantial improvement from 62% to 76% at all-India level.
   • 11 out of 14 States/UTs have more than three-fourth of children aged 12-23 months with fully immunization and it is highest (90%) for Odisha.
8. Institutional Births: Institutional births have increased substantially from 79% to 89% at all-India Level.
   
   1. Institutional delivery is 100% in Puducherry and Tamil Nadu and more than 90% in 7 States/UTs out of 12 Phase II States/UTs.
   2. Along with an increase in institutional births, there has also been a substantial increase in C-section deliveries in many States/UTs especially inprivate health facilities.
9. Family Planning: Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% at all-India level and in almost all Phase-II States/UTswith an exception of Punjab.
   • Use of modern methods of contraceptives has also increased in almost all States/UTs.
   • Unmet needs of family Planning have witnessed a significant decline from13% to 9% at all-India level and in most of the Phase-II States/UTs.
   • The unmet need for spacing which remained a major issue in India in the past has come down to less than 10% in all the States except Jharkhand (12%), Arunachal Pradesh (13%) and Uttar Pradesh(13%).
10. Breastfeeding to Children’s: Exclusive breastfeeding to children under age 6 months has shown an improvement in all-India level from 55% in 2015-16 to 64% in 2019-21. All the phase-II States/UTs are also showing considerable progress.

Question 116

NFHS-5: access to infrastr?

Answer 116

1. access to electricity: proportion of HHs witha access to electricity has increased across all states
2. improved drinking water source: proportion of HHs with improved drinking water source has increased across all states
3. improved sanitation facility: increased across all states. 99% households in Kerala have an improved sanitation facility, while only 49% households have it in Bihar.
4. use of clean cooking fuel: increased across nearly all states. Telangana has seen a nearly 25%-point increase

The proportion of women who have a mobile phone has increased across all states. However, only about 50% women own and use a mobile phone in Andhra Pradesh, Bihar, Gujarat, and West Bengal.

Across all states, the proportion of men who have used the internet was higher than women, with the difference being higher than 25%-point in states such as Telangana, Gujarat, and Andhra Pradesh. In Andhra Pradesh, Bihar, and Tripura, less than 25% women have used internet.

Significant progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts from 53% to 79% at all-India level.More than 70% of women in every state and UTs in the second phase have operational bank accounts.

the proportion of women who own a house or land (including joint ownership) has declined in 9 of the 17 states. Tripura, Maharashtra and Assam have seen a large decline in women owning house/ land.

Question 117

NFHS-5: women specific?

Answer 117

• proportion of women (15-24 years) who are using hygienic methods of protection during their menstrual period has increased across almost all states. The largest increase was seen in Bihar and West Bengal (28%-point). However, it still remains low in Bihar (59%), Assam and Gujarat (66%).
• women having their own saving bank accounts (63.0 in 2014-15 to78.6% in 2019-20); women owning mobile phones that they themselves use (45.9 % to 54.0%); women married before 18 years of age (26.8 % to 23.3 %); women with 10 or more years of schooling (35.7% to 41.0%), and access to clean fuel for cooking (43.8 % to 68.6%).

Question 118

NFHS-5: gender based violence?

Answer 118

proportion of married women (between 18-49 years of age) who have ever faced spousal violence has increased in 5 states.

In Karnataka, it has doubled, from 21% to 44%.

More than a third of the married women face spousal violence in Karnataka (44%), Bihar (40%), Manipur (40%), and Telangana (37%).

Question 119

Ayushman Bharat Digital Mission: about and features?

Answer 119

• launched in Sep 2021
• It aims to provide digital health IDs for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required.
• pilot project of the Mission had been announced by the Prime Minister from the ramparts of the Red Fort on 15th August 2020. The project is being implemented in the pilot phase in six States & Union Territories.
• Features:
  
  • Health ID:
    
    • will be issued for every citizen that will also work as their health account.
    • This health account will contain details of every test, every disease, the doctors visited, the medicines taken and the diagnosis.
    • ID is free and voluntary
    • It will help in doing analysis of health data and lead to better planning, budgeting and implementation for health programs.
  • Healthcare Facilities (HFR) & Professionals’ Registry (HPR)
    
    • HPR will be a comprehensive repository of all healthcare professionals involved in delivering healthcare services across both modern and traditional systems of medicine.
    • HFR database will have records of all the country’s health facilities.
  • Ayushman Bharat Digital Mission Sandbox
    
    • ​Sandbox, created as a part of the mission, will act as a framework for technology and product testing that will help organisations, including private players intending to be a part of the national digital health ecosystem become a Health Information Provider or Health Information User or efficiently link with building blocks of Ayushman Bharat Digital Mission.
• National Halth Authority under MoHFW will be the implementing authority
• benefits:
  
  • EoDB for heathcare providers
  • enable access and exchange of health records of citizens with their consent. Data portability could expedite the treatment of the critically ill, especially those who suffer from more than one ailment.
  • creation of a health record system could improve public health monitoring and advance evidence-based policymaking.
  • smoothen the process of health insurance
  • The system also makes it easier to find doctors and specialists nearest to you. Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest. Also, labs and drug stores will be easily identified for better tests using the new platform.

Question 120

Ayushman Bharat Digital Mission : global experience?

Answer 120

globally a mixed experience

UK: UK’s National Health Service was one of the first to deploy a digital system to make patients’ records accessible to doctors across the country. The programme did not earn the trust of doctors and failed to adequately address issues related to data confidentiality. Aborted in 2011, the project is regarded as amongst the most expensive failures in IT history.

In the US and Australia, where digital healthcare has enjoyed a relatively better outing, the creation of a patient and physician-centric e-healthcare ecosystem remains a work in progress. The US medical system has witnessed regular debates on what must be jotted down in hospital records and prescriptions. The task of data entry — a lot of which might not always be relevant to clinical care — has added to the American doctor’s burden and is seen by experts as one of the major reasons for the high rate of physician burnout in the country.

Question 121

Ayushman Bharat Digital Mission: issues?

Answer 121

1. data safety
2. Evolving a language of communication in the digital health ecosphere could pose unforeseen problems in India given the country’s diversity and its chronic shortage of doctors, especially in public health centres
3. Poor internet speeds could make data entry an onerous proposition for the rural healthcare provider.

Question 122

NIPUN Bharat Mission?

Answer 122

NIPUN (National Initiative for Proficiency in Reading with Understanding and Numeracy) Bharat Scheme

• by Deptt of School Education and Literacy, MoEd
• It aims to cover the learning needs of children in the age group of 3 to 9 years.
• part of NEP 2020 and samagra Shiksha 2.0. A five-tier implementation mechanism will be set up at the National- State- District- Block- School level in all States and UTs, under the aegis of the centrally sponsored scheme of Samagra Shiksha.
• obj: To create an enabling environment to ensure universal acquisition of foundational literacy and numeracy, so that every child achieves the desired learning competencies in reading, writing and numeracy by the end of Grade 3, by 2026-27.
• A special package for foundational literacy and Numeracy (FLN) under NISHTHA (National Initiative for School Heads and Teachers Holistic Advancement) is being developed by NCERT. NISHTHA is a capacity building programme for “Improving Quality of School Education through Integrated Teacher Training”.
• features:
  
  • Activity based learning and a conducive learning environment
  • Innovative pedagogies such as toy-based and experiential learning will be used in classroom transactions thereby making learning a joyful and engaging activity.
  • Intensive capacity building of teachers will make them empowered and provide greater autonomy for choosing the pedagogy.
  • Holistic development of the child by focusing on different domains of development like physical and motor development, socio-emotional development, literacy and numeracy development, cognitive development, life skills etc. which are interrelated and interdependent, which will be reflected in a Holistic Progress Card.
  • Since almost every child attends early grades, therefore, focus at that stage will also benefit the socio-economic disadvantageous group thus ensuring access to equitable and inclusive quality education.

Question 123

Impact of Exemption under Article 15 (5) with regards to Article 21A of the Constitution of India on Education of Children in Minority Communities?

Answer 123

report by National Commission for Protection of Child Rights (NCPCR)

Minority schools are exempt from implementing The Right to Education policy and do not fall under the government’s Sarva Shiksha Abhiyan.

Clause 5 in Art 15 was inserted by 93rd CAA in 2006, it enabled the state to create special provisions, such as reservations for advancement of any backward classes of citizens like SCs/STs, in all aided or unaided educational institutes, except minority educational institutes.

in 2012, through an amendment, the institutions imparting religious education were exempted from following the RTE Act. upheld by SC in 2014 (Pramati judgement), owing to the exception provided in Art 15(5) wrt minority educational institutions

Findings of NCPCR:

1. there are schools, mostly Christian Missionary schools, which are admitting only a certain class of students and leaving underprivileged children out of the system, thus becoming what the Commission has called “cocoons populated by elites’’.
2. Some other minority schools, in particular madarasas, have become “ghettos of underprivileged students languishing in backwardness’’
3. students in madarasas which do not offer a secular course along with religious studies – such as the sciences – have fallen behind and feel a sense of alienation and “inferiority’’ when they leave school.
4. only 4.18% of total students received benefits such as freeships, free uniforms and books, scholarships, etc. from school. For ensuring free and compulsory quality education to children, the RTE Act, 2009 provides for norms pertaining to basic minimum infrastructure, number of teachers, books, uniform, Mid-day Meal etc, benefits that students in minority schools have not been receiving.
5. Commission has also found surges in the number of schools applying for minority status certificates after the 93rd amendment was brought in, with more than 85% schools of the total schools securing the certificate in the years 2005-2009 and later. Commission believes this took place as schools wanted to operate outside the legal mandate to reserve seats for backward classes.
6. Commission has said that state governments need to introduce strict guidelines on the minimum percentage of minority students that these schools need to admit. 74 per cent of students studying at Christian missionary schools are non-minority students. across minority communities – 62.50% of students in minority schools belong to non-minority communities.
7. only 8.76% of total students in minority schools belong to socially and economically disadvantaged backgrounds.
8. Minority schools are inexcess of the % of that particular religion eg. Christians comprise 11.54 percent of the minority population but run 71.96 percent schools, Muslims comprise 69.18 percent of the minority population but run 22.75 percent of schools

Question 124

Case study: Patiya village?

Answer 124

Patiya village in Dharni block of Amravati district, MH

part of Melghat region, a difficult to reach hilly, forest area inhabited by tribal communities

Apart from the anganwadis or rural child care centres that are present in every village under the Centre’s ICDS and provide nutrition supplements to children and monitor their growth, state has set up Nutrition Rehabilitation Centres (NRCs) and Village Council of Development Committees (VCDCs). NRCs ensure proper food to children with severe acute malnutrition, monitor their height and weight, and counsel caregivers on nutrition; vcdcs focus on rehabilitation by admitting such children to monitor food uptake

Patiya village is the only village within the 25 km radius of Dharni where malnutrition was prevalent. Factors:

• anganwadi records are not updated regularly and that the children are being deprived of any government intervention
• lack of awareness and education: Some 90 per cent of the population in Dharni is Korku tribe, a forestdwelling community that was resettled after the establishment of the Melghat Tiger Reserve in Amravati in 1973. People in Patiya still believe in age-old Korku and Gond practices like bhumka, which entail sacrificing parts of your body to get rid of diseases. Parents often ignore their children’s conditions and do not take them to the nutrition or rehabilitation centres
• Supply of nutrition by the anganwadis is also faulty. Though they measure height, weight and arm circumference of children, they only consider weight while deciding nutritional supplements
• efforts hit by COVID: the interventions of nrcs and vcds are restricted to sending food packets to the children at home, with no way to ensure proper consumption
• Immediate pregnancy after childbirth
• Another peculiar trend came to light while comparing the nutrition rates of Patiya with Karada village just 500 m away. Both villages governed by the same panchayat, Karada fares much better in health factors. One reason for this could be that Karada houses the panchayat, and is the base for local governance.

Question 125

POSHAN 2.0?

Answer 125

Government is merging the Supplementary Nutrition Programme and Poshan Abhiyan to launch Mission POSHAN 2.0.

to deal with additional complications caused by COVID

Under Poshan 2.0, several related schemes have been merged to tap the synergies, malnutrition hotspots are being identified and 112 aspiring districts will receive extra attention.

Under the current Poshan Maah, the drive to identify children suffering from severe acute malnutrition has been intensified and Anganwadi workers have been asked to refer those having medical complications to health institutions and NRCs.

For those facing severe acute malnutrition without medical complications, community management protocols should be strengthened, so that they do not go on to develop medical complications in times of the pandemic.

we must adapt our nutrition interventions to the possibility of such repeated pandemic shocks.

Question 126

For effective implementation of various schemes and programmes of the Ministry of Women and Child Development, all major schemes of the Ministry have been classified under?

Answer 126

1. Mission POSHAN 2.0
2. Mission Vatsalya
3. Mission Shakti

Question 127

POSHAN Abhiyaan: about?

Answer 127

Prime Minister’s Overarching Scheme for Holistic Nutrition

• aka National Nutrition Mission
• Launched in 2018
• multi-ministerial initiative, but implementing agency is MoWCD
• India’s flagship programme to improve nutritional outcomes for children, pregnant, women, and lactating mothers.
• aims to make India a malnutrition-free country by 2022.
• Under the POSHAN Abhiyaan, the 1st POSHAN Maah was celebrated in September 2018 with a special focus on Social Behavioural Change and Communication (SBCC).
  • Themes included eating healthy – food fortification, hygiene and sanitation, right age of marriage, antenatal care, optimal breastfeeding, anaemia, and education of girls.
• The mission also encompasses mapping of various other schemes, incl
  
  • Pradhan Mantri Matru Vandana Yojana (PMVVY)
  • Janani suraksha Yojana
  • Scheme for Adolescent Girls
  • Swachh Bharat Abhiyaan
  • PDS
  • NHM

through,

* ICT based real time monitoring system
* robust convergence b/n schemes
* incentivising states and UTs for meeting set targets
* optimising Anganwadis
* social audits

Question 128

POSHAN Abhiyaan Targets? Obj?

Answer 128

Obj: to align different ministries to work in tandem on the “window of opportunity” of the first 1,000 days in life (270 days of pregnancy and 730 days; 0-24 months)

1. ‘Mission 25 by 2020’: reduce stunting in children from 38.4 per cent to 25 per cent by 2022.
2. reducing stunting in children (0-6 yrs) by 6pp @2pp per annum by 2022
3. reducing underweight prevalence in children (0-6 yrs) by 6pp @2pp per annum by 2022
4. reducing anemia prevalence in children (6-59 months) by 9pp @3pp per annum by 2022
5. reducing anemia prevalence in women and adolescent girls (15-49 yrs) by 9pp @3pp per annum by 2022
6. reducing Low Birth weight by 6pp @2pp per annum by 2022

Question 129

Malnutrition in India: stats and facts?

Answer 129

• In 2008, when distinguished international economists including many Nobel laureates were asked by the Copenhagen Center to build consensus on the most important development agenda in which policymakers and philanthropists should invest, ‘battling malnutrition’ emerged as the top priority.
• About 68% of the deaths of children under the age of five in India can be attributed to child and maternal malnutrition, said Lancet in 2019.
• As per the Global Nutrition Report 2020, India is among 88 countries that are likely to miss global nutrition targets by 2025.
• Over half of our children under five years were found to be either stunted (too short for their age) or wasted (too thin for their age) or both, reckoned the Comprehensive National Nutrition Survey, released in 2019.
• FAO) estimates that 194.4 million people in India (about 14.5% of the total population) are undernourished.
• COVID impacts:
  
  • According to recent estimates, even in the best possible scenario and accounting for changes in the provision of essential health and nutrition services due to COVID-19, India could have around additional 60,000 child deaths (around 3,00,000 in the worst-case scenario) in the next six months.
  • Covid-related shocks could lead to an additional 9 million children under the age of five suffering from wasting globally, of which two-thirds will be in South Asia, predicted research in Nature.

Question 130

POSHAN Abhiyaan: COVID impact?

Answer 130

• even in the best possible scenario and accounting for changes in the provision of essential health and nutrition services due to COVID-19, India could have around additional 60,000 child deaths (around 3,00,000 in the worst-case scenario) in the next six months
• The momentum set by this entire nutrition movement was disturbed once Covid lockdowns led to the shutting of schools, Anganwadi centres, Nutritional Rehabilitation Centres;
• Further, frontline workers had to be engaged in Covid-related work that took precedence over their daily duties, which entailed identifying, referring and monitoring children suffering from severe acute malnutrition and moderate acute malnutrition among other nutrition-strengthening activities.
• States tried to cope to the best of their abilities by replacing hot-cooked meals with dry ration or cash transfers. But no guarantee on actual consumption by children

Question 131

POSHAN Abhiyaan: significance?

Answer 131

• movement built in its approach that, on top of direct interventions, nutrition can be improved in many ways, including:
• Better sanitation that addresses intestinal diseases and
• Allows people to absorb more nutrients;
• Increasing dietary diversity;
• Vaccinating children against diseases;
• Counselling more women to breastfeed babies for longer, which in turn improves immunity.
• by involving many ministries and departments outside the nodal ones, along with bringing on board other stakeholders including communities, Poshan Abhiyan helped to build a comprehensive nutrition response, never seen before in this country’s history.
• Given that the damage malnutrition does in the first 1,000 days of life is irreversible, it beamed intense focus on nutrition-related intervention to improve maternal and child health in that window since conception.
• mission also measured and monitored indicators real-time during the programme using technology, so that timely course corrections could be made in different contexts.
• galvanised it into a people’s movement, with the celebration of Poshan Maah in September and Poshan Pakhwara in March, along with several other activities.

Question 132

National Scheme for PM Poshan Shakti Nirman?

Answer 132

Mid Day meal scheme was renamed to this. Changes:

• Supplementary nutrition: The new scheme has a provision for supplementary nutrition for children in aspirational districts and those with high prevalence of anaemia.
• States to decide diet: It essentially does away with the restriction on the part of the Centre to provide funds only for wheat, rice, pulses and vegetables. Currently, if a state decides to add any component like milk or eggs to the menu, the Centre does not bear the additional cost. Now that restriction has been lifted.
• Nutri-gardens: They will be developed in schools to give children “firsthand experience with nature and gardening”.
• Women and FPOs: To promote vocals for local, women self-help groups and farmer producer organisations will be encouraged to provide a fillip to locally grown traditional food items.
• Social Audit: The scheme also plans “inspection” by students of colleges and universities for ground-level execution.
• Tithi-Bhojan: Communities would also be encouraged to provide the children food at festivals etc, while cooking festivals to encourage local cuisines are also envisaged.
• DBTs to school: In other procedural changes meant to promote transparency and reduce leakages, States will be asked to do direct benefit cash transfers of cooking costs to individual school accounts, and honorarium amounts to the bank accounts of cooks and helpers.
• Holistic nutrition: The rebranded scheme aims to focus on “holistic nutrition” goals. Use of locally grown traditional foods will be encouraged, along with school nutrition gardens.

Question 133

Mid Day meal scheme?

Answer 133

• The scheme guarantees one meal to all children in government and aided schools and madarsas supported under Samagra Shiksha.
• Students up to Class VIII are guaranteed one nutritional cooked meal at least 200 days in a year.
• The Scheme comes under the Ministry of HRD.
• It was launched in 1995 as the National Programme of Nutritional Support to Primary Education (NP – NSPE), a centrally sponsored scheme. In 2004, the scheme was relaunched as the Mid Day Meal Scheme.
• The Scheme is also covered by the National Food Security Act, 2013.

MDM rules 2015, provide that:

• The place of serving meals to the children shall be school only.
• If the Mid-Day Meal is not provided in school on any school day due to non-availability of food grains or any other reason, the State Government shall pay food security allowance by 15th of the succeeding month.
• The School Management Committee mandated under the Right to Free and Compulsory Education Act, 2009 shall also monitor implementation of the Mid-day meal Scheme.

Nutritional Norms

• In terms of calorie intake, as per the MDM guidelines, the children in primary schools must be provided with at least 450 calories with 12 grams of protein through MDM while the children in upper primary schools should get 700 calories with 20 grams of protein, as per MHRD.
• The food intake per meal by the children of primary classes, as provided by MHRD is 100 grams of food grains, 20 grams of pulses, 50 grams of vegetables and 5 grams of oils and fats. For the children of upper-primary schools, the mandated breakup is 150 grams of food grains, 30 grams of pulses, 75 grams of vegetables and 7.5 grams of oils and fats.

Flagging “critical” levels of malnutrition and anaemia among children, the Union Government has urged the states to explore the possibility of introducing millets in the mid-day meal scheme

Question 134

Meningitis Belt?

Answer 134

The African meningitis belt is a region in sub-Saharan Africa where the rate of incidence of meningitis is very high. It extends from Senegal to Ethiopia

Question 135

Mosquirix?

Answer 135

• The First Malaria Vaccine endorsed by WHO. It is the first and, to date only, vaccine shown to have the capability of significantly reducing malaria, and life-threatening severe malaria, in tests on young African children.
• The vaccine acts against falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa.
• It is also the first malaria vaccine to be introduced by three national ministries of health through their childhood immunization programmes — Ghana, Kenya, and Malawi.
• The latest vaccine is considered only the first step towards effective immunisation of the global population against malaria. This vaccine is able to prevent severe cases of malaria in only 30 percent of the cases

Reasons for failure to develop a malaria vaccine so far:

1. The complexity of the life-cycle of the malaria-causing parasite, a part of which is spent in the human host.
2. These parasites are also able to hide inside human cells to avoid being recognised by the immune system, creating further challenges.
3. Lack of funding and interest in developing a malaria vaccine.

Question 136

Malaria Burden across the world?

Answer 136

• Malaria is most endemic in Africa, with Nigeria, Congo, Tanzania, Mozambique, Niger and Burkina Faso together accounting for over half the yearly deaths.
• Even now, the disease kills over four lakh every year, according to WHO figures.
• Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274,000) of all malaria deaths worldwide.
• In 2019, India had an estimated 5.6 million cases of malaria compared to about 20 million cases in 2020.
• Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination.
• Over the last two decades, 11 countries have been certified by the WHO Director-General as malaria-free: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019), and El Salvador (2021).

Question 137

World Malaria Report 2020?

Answer 137

by WHO

• Global analysis:
  
  • Malaria cases globally numbered about 229 million, an annual estimate that has remained virtually unchanged over the last four years.
  • In 2019, it claimed about 4,09,000 lives
  • 11 highest-burden countries viz. Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and Tanzania, account for 70% of the global estimated case burden and 71% of global estimated deaths from malaria.
  • Countries in South-East Asia made particularly strong progress, with reductions in cases and deaths of 73% and 74%, respectively.
• India:
  
  • India is the only high endemic country which has reported a decline of 17.6% in 2019 as compared to 2018.
  • The Annual Parasite Incidence (API, the number of new infections per year per 1000 population) reduced by 18.4% in 2019 as compared to 2018. India has sustained API less than one since the year 2012.
  • India has also contributed to the largest drop in cases region-wide, from approximately 20 million to about 6 million.
  • India achieved a reduction of 83.34% in malaria morbidity and 92% in malaria mortality between the year 2000 and 2019, thereby achieving Goal 6 of the Millennium Development Goals.
  • States of Odisha, Chhattisgarh, Jharkhand, Meghalaya and Madhya Pradesh (high endemic states) disproportionately accounted for nearly 45.47% of malaria cases in 2019.

Question 138

Indian initiatives to combat Malaria?

Answer 138

• In India, malaria elimination efforts were initiated in 2015 and were intensified after the launch of the National Framework for Malaria Elimination (NFME) in 2016 by the MoHFW.
  • NFME is in line with WHO’s Global Technical Strategy for Malaria, 2016-2030, which guides the WHO Global Malaria Programme (GMP), responsible for coordinating WHO’s global efforts to control and eliminate malaria.
• The National Strategic Plan for Malaria Elimination(2017-22) was launched in July 2017 which laid down strategies for the following five years.
  • It gives year wise elimination targets in various parts of the country depending upon the endemicity of malaria.
• Implementation of High Burden to High Impact (HBHI) initiative was started in four states (West Bengal, Jharkhand, Chhattisgarh and Madhya Pradesh) in July 2019.
  • In 2018, the WHO and the RBM Partnership initiated the HBHI initiative in 11 high malaria burden countries, including India to end malaria.
  • It has continued to make impressive gains in India, with 18% reductions in cases and 20% reductions in death, over the last 2 years.
• Due to the efforts made by the Government of India in the provision of microscopes, rapid diagnostics Long Lasting Insecticidal Nets (LLINs) to high burden areas has led to a reduction in endemicity in these otherwise very high endemic states.
  • LLINs are nets treated in the factory with an insecticide incorporated into the net fabric which makes the insecticide last at least 20 washes in standard laboratory testing and three years of recommended use under field conditions.

Question 139

PM-Jan Arogya Yojana?

Answer 139

1. The world’s largest health insurance/ assurance scheme fully financed by the government.
2. It provides cover of 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.
3. Coverage: Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
4. Provides cashless access to health care services for the beneficiary at the point of service.
5. The National Health Authority (NHA) is the nodal agency responsible for the nationwide roll-out and implementation of the AB-PMJAY scheme.
6. This scheme is a Centrally sponsored scheme with some Central sector components.
7. Eligibility:
   
   1. No restrictions on family size, age or gender.
   2. All pre–existing conditions are covered from day one.
   3. Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
   4. Benefits of the scheme are portable across the country.
   5. Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
   6. Public hospitals are reimbursed for the healthcare servicesat par with the private hospitals.
8. Effectiveness:
   
   1. States that joined the PM-JAY, compared to those that did not, experienced greater penetration of health insurance, reduction in infant and child mortality rates, realised improved access and utilisation of family planning services and greater awareness of HIV/AIDS.
   2. Across all the States, the proportion of households with health insurance increased by 54% for States that implemented PM-JAY while falling by 10% in States that did not.
   3. Summary findings from the fifth edition of the National Family Health Survey, released recently showed a 12.3 percentage point increase over the previous edition of the survey in the coverage of health insurance to 41% of households surveyed, an indication of the impact of the scheme.

Question 140

PM-SEHAT scheme?

Answer 140

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) SEHAT Health Insurance scheme for the residents of Jammu and Kashmir

• The Scheme provides free of cost insurance cover. It provides financial cover upto Rs. 5 lakh per family on a floater basis to all residents of the UT of J&K.
  
  • Floater basis, means that it can be used by one or all members of the family. The whole family is insured under one plan.
• The scheme would work in convergence with Pradhan Mantri Jan Arogya Yojana (PMJAY).
• Full coverage to residents of J&K:
  • At present, about 6 lakh families of the UT are getting the benefit of the Ayushman Bharat Scheme. After the health plan, all 21 lakh families will get the same benefit.
• Portability of treatment: Treatment will not be limited to government and private hospitals in Jammu and Kashmir only. Rather, various hospitals are connected under this scheme in the country.

Question 141

PM-Bharatiya Jan Aushadhi Yojana (PM-BJP)?

Answer 141

It is a campaign launched by the Department of Pharmaceuticals of the Ministry of Chemicals and Fertilizers.

• It seeks to provide quality medicines at affordable prices to the masses through special kendra’s known as Pradhan Mantri Bhartiya Jan Aushadhi Kendra.
• Initially launched in 2008, the scheme was rechristened in 2015.
• The Pharmaceuticals & Medical Devices Bureau of India (PMBI) is implementing the scheme.
• obj:
  
  • ensure access to qlty medicines
  • Extend coverage of quality generic medicines so as to reduce the out of pocket expenditure on medicines
  • Create awareness about generic medicines through education and publicity
• Under the Scheme, medicines are procured from World Health Organization – Good Manufacturing Practices (WHO-GMP) certified suppliers for ensuring the quality of the products.
  
  • GMP, also referred to as ‘cGMP’ or ‘current Good Manufacturing Practice’ is the aspect of quality assurance that ensures that medicinal products are consistently produced and controlled to the quality standards appropriate to their intended use and as required by the product specification.
  • GMP also has legal components, covering responsibilities for distribution, contract manufacturing and testing, and responses to product defects and complaints.
• target to increase the number of PMBJKs to 10,000 by March 2024.

Question 142

‘One Health’ Consortium?

Answer 142

launched by DBT

• It envisages carrying out surveillance of important bacterial, viral and parasitic infections of zoonotic as well as transboundary pathogens in the country.
• The project also looks into use of existing diagnostic tests and development of additional methodologies for surveillance and understanding the spread of emerging diseases.

Composition:

The ‘One Health Consortium’ consists of 27 organisations led by DBT-National Institute of Animal Biotechnology, Hyderabad.

Question 143

One Health Concept?

Answer 143

• focuses on acknowledging the interconnectedness of animals, humans, and the environment. It involves a multi-disciplinary and cross-sectoral approach to address potential or existing risks that originate at the animal-human-ecosystems interface.
• One Health model facilitates interdisciplinary approach in disease control so as to control emerging and existing zoonotic threats.
• The father of modern pathology, Rudolf Virchow, emphasised in 1856 that there are essentially no dividing lines between animal and human medicine.
• The overarching purpose is to encourage collaborations in research and sharing of knowledge at multiple levels across various disciplines like human health, animal health, plants, soil, environmental and ecosystem health in ways that improve, protect and defend the health of all species.
• The Wildlife Conservation Society (WCS) introduced the term “One World-One Health” in 2007 along with 12 recommendations (the Manhattan Principles) that focused on establishing a more holistic approach to preventing epidemic disease and maintaining ecosystem integrity.
• Need:
  
  • Scientists have observed that there are more than 1.7 million viruses circulating in wildlife, and many of them are likely to be zoonotic.
  • Another category of diseases, “anthropozoonotic” infections, gets transferred from humans to animals.
  • in recent years such as the Nipah virus, Ebola, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and Avian Influenza

Question 144

India’s ‘One Health Vision’?

Answer 144

India’s ‘One Health’ vision derives its blueprint from the agreement between the tripartite-plus alliance of FAO, World Organisation for Animal Health (OIE), WHO and UNEP- a global initiative supported by the United Nations Children’s Fund (UNICEF) and the World Bank under the overarching goal of contributing to ‘One World, One Health’.

• In keeping with the long-term objectives, India established a National Standing Committee on Zoonoses as far back as the 1980s.
• This year, funds were sanctioned for setting up a ‘Centre for One Health’ at Nagpur.
• The Department of Animal Husbandry and Dairying (DAHD) has launched several schemes to mitigate the prevalence of animal diseases since 2015
• DBT’s One Health COnsortium

Question 145

India’s efforts to reduce TB incidence and deaths?

Answer 145

1. India is aggressively implementing its fully-funded National Strategic Plan to End TB.
2. In the last few years, 50 million people have been treated.
3. India seeks to achieve national scale-up of TB preventive treatment (TPT).
4. It also seeks to achieve the UN High-Level Meeting (UNHLM) targets of 40 million persons started on TB treatment and 30 million on TPT globally in the remaining 18 months.
5. Sub-national Certification of States and Districts instituted in 2020- The initiative marks districts/States-UTs on “Progress towards TB Free Status” under different categories measured with graded milestones of decline in TB incidence.

Question 146

BCG Vaccine?

Answer 146

100years has passed since the Bacillus Calmette–Guérin (BCG) vaccine was introduced to combat TB in 1921

• is a vaccine primarily used against TB.
• BCG was developed by modifying a strain of Mycobacterium bovis (that causes TB in cattle). It was first used in humans in 1921.
• Currently, BCG is the only licensed vaccine available for the prevention of TB.
• It is the world’s most widely used vaccine with about 120 million doses every year and has an excellent safety record.
• In India, BCG was first introduced in a limited scale in 1948 and became a part of the National TB Control Programme in 1962.
• In children, BCG provides strong protection against severe forms of TB. This protective effect is far more variable in adolescents and adults, ranging from 0–80%.
• BCG also protects against respiratory and bacterial infections of the newborns, and other mycobacterial diseases like leprosy and Buruli’s ulcer.
• It is also used as an immunotherapy agent in cancer of the urinary bladder and malignant melanoma.
• BCG works well in some geographic locations and not so well in others. Generally, the farther a country is from the equator, the higher is the efficacy.

Question 147

SDG on TB Reduction?

Answer 147

SDGs) include ending the TB epidemic by 2030 under Goal 3

Question 148

National TB elimination Program (NTEP)?

Answer 148

At the start of 2020 the central government of India renamed the RNTCP as NTEP

It is a Centrally sponsored scheme

The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

It provides technical and managerial leadership to anti-tuberculosis activities in the country.

program is managed through a four level hierarchy from the national level down to the sub-district (Tuberculosis Unit) level.
Central TB Division, MoHFW→ State TB Cell → District TB Office

Various Diagnostic services and Treatment services are provided

Question 149

Annual TB report: findings?

Answer 149

Eliminating TB by 2025: India is committed to eliminating tuberculosis from the country by 2025, five years ahead of the global target by WHO

• India is now home to about a quarter of the total global TB patients.
• State TB Index: On the basis of the score in State TB Index, Gujarat, Andhra Pradesh and Himachal Pradesh were the top three best-performing states for tuberculosis control under the category of states with 50 lakh population.
  • Tripura and Nagaland were best-performing in the category of states having less than 50 lakh population.
  • Dadra and Nagar Haveli, and Daman and Diu were selected as the best performing Union Territories.
• Rising Tobacco Consumption: It also revealed that Tobacco consumption is rising among Indian TB patients. 8% of TB cases can be attributable to tobacco usage.
• HIV Patients and TB:
  
  • India accounts for 9% of all HIV-associated TB deaths in the world, the second-highest number globally.
  • A total of 92,000 HIV-associated TB patients were recorded on an annual basis.
  • Awareness among TB patients about their HIV status has gone up to 81% from 67%.
• The report highlighted that the notification of TB is a major hurdle in surveillance of the disease in India. Nearly 0.54 million TB cases are still missing across India.
• Lower Reporting than WHO: According to the report, India notified the highest number of 24.04 lakh tuberculosis cases last year (2018) as against an estimated 26.9 lakh cases by WHO, indicating that around three lakh patients missed out from the national TB programme. It stated that 79,144 deaths due to tuberculosis were reported in 2019, which is much lower than the WHO estimate of 4.4 lakh fatalities.
• introduction of Nikshay, the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.
• Treatment Success Rate: It is around 70-73% in the last two years. From 2014-2016, it was between 76 and 77%.

Question 150

“India’s TB report must be seen in light of the country’s slide in Hunger Index”?

Answer 150

Over the last century or so, it has been established beyond doubt that TB is more of a social disease owing its roots to poverty, malnutrition and poor sanitary conditions.

despite a national notification system — of Nikshay — other factors like patient confidentiality issues, poor knowledge of notification system, etc, prevented notification of TB patients in a hospital setting. These factors are social and without intervening at that level, it is hard to believe that the notification of TB cases can reach a significant number vis-à-vis ending TB by 2025.

A hungry India cannot be free of TB. Dietary deprivation is a direct indicator of inequality. Unequal societies cannot be made free of disease and infirmity. In an important study on nutrition and TB published this month in the BMC Pulmonary Medicine journal from Ethiopia, the researchers clearly show that the proportion of malnutrition in TB patients was nearly 60 per cent. The authors conclude that even a very distal reason for malnutrition in the community became a proximal causefor TB.

An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in the response to TB.

Question 151

Ebola Outbreak in Democratic republic of Congo?

Answer 151

After the outbreak was declared in August 2018, the virus infected at least 3,470 people, killing 66% of them. That makes it the world’s second-largest outbreak of the haemorrhagic disease, after the 2014–16 West Africa epidemic, which killed more than 11,000 people.

It was one of the most complex health emergencies the world has ever seen, because it occurred in a region of the DRC plagued by 25 years of war and political instability.

But the epidemic was marked by successes in vaccination and treatment. This was the first Ebola outbreak in which a vaccine for the virus was widely deployed. It was given to more than 300,000 people who had been in close proximity to people with Ebola, and their contacts. More than 80% of people who were vaccinated didn’t end up with the disease

two antibody-based drugs, called mAB114 and REGN-EB3, reduced deaths dramatically among people who were hospitalized soon after being infected.

Role of local leadership: rate of new infections in the region slowed after governors and mayors of cities hit hard by Ebola began pushing to stamp out the virus, and once local health workers had been trained and equipped to care for people

Question 152

Sowa Rigpa?

Answer 152

• It is a traditional system of medicine practised in the Himalayan belt of India.
• It originated in Tibet and popularly practiced in countries namely, India, Nepal, Bhutan, Mongolia, and Russia.
• The majority of theory and practice of Sowa-Rigpa is similar to “Ayurveda”.
• Yuthog Yonten Gonpo from Tibet is believed to be the father of Sowa Rigpa.

The basic theory of Sowa-Rigpa may be adumbrated in terms of the following five points:

1. The body in disease as the locus of treatment.
2. Antidote, i.e., the treatment.
3. The method of treatment through antidote.
4. Medicine that cures the disease.
5. Materia Medica, Pharmacy & Pharmacology.

Question 153

WHO’s Emergency use list? Why WHO’s approval for Covaxin is necessary?

Answer 153

The WHO Emergency Use Listing Procedure (EUL) is a risk-based procedure for assessing and listing unlicensed vaccines, therapeutics and in vitro diagnostics with the ultimate aim of expediting the availability of these products to people affected by a public health emergency.

To be eligible, the following criteria must be met:

1. The disease for which the product is intended is serious or immediately life threatening, has the potential of causing an outbreak, epidemic or pandemic and it is reasonable to consider the product for an EUL assessment, e.g., there are no licensed products for the indication or for a critical subpopulation (e.g., children).
2. Existing products have not been successful in eradicating the disease or preventing outbreaks (in the case of vaccines and medicines).
3. The product is manufactured in compliance with current Good Manufacturing Practices (GMP) in the case of medicines and vaccines and under a functional Quality Management System (QMS) in the case of IVDs.
4. The applicant undertakes to complete the development of the product (validation and verification of the product in the case of IVDs) and apply for WHO prequalification once the product is licensed.

If Bharat Biotech’s Covaxin gets the approval, those inoculated with the vaccine can travel to countries that permit entry of fully vaccinated people. The company can also export it to countries that use vaccines approved by WHO.

Question 154

What is Emergency Use Authorization?

Answer 154

Vaccines and medicines, and even diagnostic tests and medical devices, require the approval of a regulatory authority before they can be administered. In India, the regulatory authority is the Central Drugs Standard Control Organisation (CDSCO).

For vaccines and medicines, approval is granted after an assessment of their safety and effectiveness, based on data from trials. This is a long process. The fastest approval for any vaccine until now — the mumps vaccine in the 1960s — took about four-and-a-half years after it was developed. In emergency situations, like the current one, regulatory authorities around the world have developed mechanisms to grant interim approvals if there is sufficient evidence to suggest a medical product is safe and effective. Final approval is granted only after completion of the trials and analysis of full data; until then, emergency use authorisation (EUA) allows the medicine or the vaccine to be used on the public.

In the US, the Food and Drug Administration (FDA) grants an EUA only after it has been determined that the “known and potential benefits outweigh the known and potential risks of the vaccine” (or medicine). This means that an EUA application can be considered only after sufficient efficacy data from phase 3 trials had been generated. An EUA cannot be granted solely on the basis of data from phase 1 or phase 2 trials, although these too need to show the product is safe.

EUA is a relatively recent phenomenon. the FDA granted its first EUA for the civilian population in 2009. the first EUA allowed the use of Tamiflu drug for infants and young children for the treatment of H1N1 infection. Since then, EUAs have been granted for several medicines, diagnostics, and equipment like ventilators or even PPEs, but never for a vaccine. An EUA can be granted only in a declared public health emergency; previous EUAs came during the spread of the Ebola virus, Zika virus and MERS coronavirus.

Remdesivir or faviparir, which received EUA for treatment of Covid-19, including in India, are existing drugs approved for other ailments. They could not be administered to Covid-19 patients without extensive trials, but because they showed promise in limited testing, in specified conditions, they were therefore “repurposed” for Covid-19 patients through EUAs.

Experts and activists say India’s drug regulations do not have provisions for an EUA, and the process for receiving one is not clearly defined or consistent. Despite this, CDSCO has been granting emergency or restricted emergency approvals to Covid-19 drugs during this pandemic — for remdesivir and favipiravir in June, and itolizumab in July.

Question 155

Improvement in India’s HDI indicators since ‘turn of century’?

Answer 155

1) per capita income has tripled 2) life expectancy at birth has increased by nearly 7 yrs 3) children are staying in school for at least 2 yrs longer

Question 156

Indian public uni has been a politicised space frm its very founding: some facts?

Answer 156

1) early 20th century, began to be recognised as a space for redressal of caste inequalities as in measures that were pioneered, for eg, by Mysore state in 1918. 2) frm 1920s, became imp site for nationalist and revolutionary agitation. 3) bengal in late 1960d and Sampoorna Kranti movements of Bihar in 70s took anti-govt mobilisations to new heights 4) anti-reservation stirs of 90s and 2006 5) frm historic strike in FTII in 2015 to protests in multiple institutions incl JNU, IITs etc against fee hike in 2019.

Question 157

main reasons women do not seek healthcare services according to NFHS-4?

Answer 157

1) unaffordable 2) not easily available 3) aren’t enough women healthcare providers.

Question 158

HDI: intro?

Answer 158

1. by UNDP 2. part of HDR, along with 2.1) Inequality-adjusted Human Development Index (IHDI) 2.2) Gender DI 2.3) GII 2.4) MPI 3. three basic dimensions of human development: A long and healthy life: avg life expectancy at birth Access to knowledge: expected years of schooling + mean yrs of schooling A decent standard of living: GNI per capita (PPP $)

Question 159

HDI 2019: global?

Answer 159

1. Norway, Switzerland, Ireland occupied the top three positions in that order. 2. Globally, there are 1.3 billion poor people. 3. Around 661 million of these poor people live in Asia and the Pacific. 4. South Asia constitutes 41% of the world’s poor. 5. As the number of people coming out of poverty is increasing, the world is veering towards another type of poverty: one based on technology, education and climate.

Question 160

HDI 2019: India?

Answer 160

1. India’s rank- 129. Last year’s rank- 130. 2. Despite lifting 271 million people out of poverty between 2005-15, India still remains home to 28% (364 million) of the world’s poor. 3. Between 1990 and 2018, India’s HDI value increased by 50 per cent (from 0.431 to 0.647), which places it above the average for countries in the medium human development group (0.634) and above the average for other South Asian countries (0.642). 4. This means that in the last three decades, life expectancy at birth in India increased by 11.6 years, whereas the average number of schooling years increased by 3.5 years. Per capita incomes increased 250 times. 5. India is only marginally better than the South Asian average on the Gender Development Index (0.829 vs 0.828), and ranks at a low 122 (of 162) countries on the 2018 Gender Inequality Index.

Question 161

HDI 2019: India’s neighbours?

Answer 161

Sri Lanka (71) and China (85), Bhutan (134), Bangladesh (135), Myanmar (145), Nepal (147), Pakistan (152) and Afghanistan (170).

Question 162

India skills report?

Answer 162

1. a joint initiative by PeopleStrong, a Global Talent Assessment Company, in collaboration with CII and partners like UNDP, AICTE and AIU Key findings: 1.About 46.21 per cent students were found employable in 2019, compared with 33 per cent in 2014, and 47.38 per cent in 2018. 2. Female employability witnessed an upward trend at 47 per cent this year from 38 per cent in 2017 and 46 per cent in 2018. 3. Most employable candidates as per the courses were MBA Students at 54 per cent as against 40 per cent in the last two years. 4. A decline in employability was seen in BTech, Engineering. MCA graduates, Technical & Computer-related courses. 5. Top three states in terms of employability: MH, TN and UP 6. WB and Haryana ergtd a dip in employability rankings

Question 163

Ayushman Bharat Health Infrastructure Mission (ABHIM)?

Answer 163

• launched in Oct 2021, it is one of the largest pan-India schemes for strengthening healthcare infrastructure
• Its objective is to fill gaps in public health infrastructure, especially in critical care facilities and primary care in both urban and rural areas.
• It will provide support to 17,788 rural Health and Wellness Centres in 10 ‘high focus’ states and establish 11,024 urban Health and Wellness Centres across the country.
• Through this, critical care services will be available in all the districts of the country with more than five lakh population through exclusive critical care hospital blocks, while the remaining districts will be covered through referral services.
• People will have access to a full range of diagnostic services in the public healthcare system through a network of laboratories across the country, and integrated public health labs will be set up in all the districts.
• Integrated public health labs will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country. The need for these labs will meet the need for robust surveillance system** and **diagnostic interface as evident during recent times
• ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
• The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
• An IT-enabled disease surveillance system will be established through a network of surveillance laboratories at block, district, regional and national levels.
• All the public health labs will be connected through the Integrated Health Information Portal, which will be expanded to all states and UTs.
• Under the scheme, a national institution for one health, four new national institutes for virology, a regional research platform for WHO South East Asia Region, nine biosafety level-III laboratories, and five new regional national centres for disease control will be set up.
• It will provide support for 17,788 rural health and wellness centres in 10 high-focus states. Further, 11,024 urban health and wellness centres will be established in all the States.

Question 164

ABHIM: significance?

Answer 164

1. India has long been in need of a ubiquitous healthcare system. A study (‘State of Democracy in South Asia (SDSA)–Round 3’) by Lokniti-CSDS in 2019 highlighted how access to public health care remained elusive to those living on the margins. A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
2. The study found that 70 per cent of the locations have public healthcare services. However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
3. Need for public health infrastr: Years before the ongoing pandemic drew attention to these issues, a study (‘State of Democracy in South Asia (SDSA)–Round 3’) by Lokniti-CSDS in 2019 found that people expect the government to take maximum responsibility for providing basic medical care.
4. Imp as part of India’s endeavour to keep ahead of the infectious organisms that bring our life to a halt

Question 165

Indian SARS-CoV-2 Consortium on Genomics (INSACOG)?

Answer 165

• The Indian SARS-CoV-2 Genomics Consortium (INSACOG) is jointly initiated by the Union Ministry of Health and Family Welfare, and Department of Biotechnology (DBT) with Council for Scientific & Industrial Research (CSIR) and Indian Council of Medical Research (ICMR).
• It is a consortium of 28 National Laboratories to monitor the genomic variations in the SARS-CoV-2.
• It carries out whole genome sequencing of SARS-CoV-2 virus across the nation, aiding in understanding the spread and evolution of the virus.
• INSACOG also aims to focus on sequencing of clinical samples to understand the disease dynamics and severity.

Question 166

Mission Indradhanush?

Answer 166

• launched by MoHFW in 2014, with the aim of expanding immunization coverage to all children (either unvaccinated, or are partially vaccinated) across India.
• provides life-saving vaccines to all children across the country free of cost to protect them against
  
  • Tuberculosis,
  • Diphtheria,
  • Pertussis (whooping cough),
  • Tetanus,
  • Polio,
  • Hepatitis B,
  • Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib),
  • Measles,
  • Rubella,
  • Japanese Encephalitis (JE) and
  • Rotavirus diarrhoea.
  • Rubella, JE and Rotavirus vaccine in select states and districts.
• Also the pregnant women are administered the tetanus vaccine, ORS packets and zinc tablets are distributed for use in the event of severe diarrhoea or dehydration and vitamin A doses are administered to boost child immunity.
• Mission Indradhanush aims to increase full immunization coverage in India to at least 90% children by December 2018.
• Phase I in 2015: in 201 high focus districts. During this phase, more than 75 lakh children were vaccinated of which 20 lakh children were fully vaccinated and more than 20 lakh pregnant women received tetanus toxoid vaccine.
• Phase II in 2015: covered 279 medium focussed and 73 high focussed districts: 73L children were vaccinated
• Earlier the increase in full immunization coverage was 1% per year which has increased to 6.7% per year through the first two phases of ‘Mission Indradhanush’.
• Phase III in 2016: Apart from the standard of children under 2, it also focussed on 5-year-olds and on increasing DPT booster coverage, and giving tetanus toxoid injections to pregnant women.
• Phase IV: launche din 2017, it covered NE states
• The four phases of Mission Indradhanush have reached to more than 2.53 crore children and 68 lakh pregnant women with life-saving vaccines.
• Intensified Mission Indradhanush (IMI) was launched in 2017 to reach each and every child under two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme. The target under IMI is to increase the full immunization coverage to 90% by December 2018.Under Intensified Mission Indradhanush, greater focus was given on urban areas which was one of the gaps of Mission Indradhanush.

Question 167

Intensified Mission Indradhanush 3.0 (IMI 3.0)? IMI 2.0?

Answer 167

launched in 2021

• The focus of IMI 3.0 will be on children and pregnant women who missed their vaccine doses during the COVID-19 pandemic.
• conducted in pre-identified 250 districts/urban areas across 29 States/UTs in the country.
• Beneficiaries from migration areas and hard to reach areas will be targeted as they may have missed their vaccine doses during the pandemic.

‘Intensified Mission Indradhanush 2.0‘was launched on October 31, 2019 to ensure that not a single child in the country misses out on vaccination.

• It had a special focus on improving coverage in areas with “low” immunisation.
• Through ‘IMI 2.0’, the health ministry aims to reach each and every child below the age of two years and all pregnant women still uncovered/partially covered in 271 districts of the country.

Question 168

Universal Immunization Programme (UIP)?

Answer 168

• Launched by the government in 1985, UIP prevents mortality and morbidity in children and pregnant women against 12 vaccine preventable diseases.
• Under UIP free of cost vaccination is provided against twelve vaccine preventable diseases i.e. Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea.
• The programme was the one of largest health programme in the world. Despite being operational for many years, UIP has been able to fully immunize only 65% children under 1 year of age.
• It was superseded by Mission INdradhanush in 2014

Question 169

Pneumococcal 13-valent Conjugate Vaccine (PCV)?

Answer 169

• The government has launched a nationwide expansion of Pneumococcal 13-valent Conjugate Vaccine (PCV), in Oct 2021, under the Universal Immunisation Programme (UIP) as a part of ‘Azadi ka Amrit Mahotsav’.
• It was for the first time in the country that PCV would be available for universal use.
• PCV13 protects against 13 types of bacteria that cause pneumococcal disease.
• Pneumonia caused by pneumococcus is the most common cause of severe pneumonia in children.
• Pneumonia was a leading cause of death among children under five, globally and in India. Around 16% of deaths in children occur due to pneumonia in India.

Also, Drug Controller General of India (DCGI) has approved the first fully indigenously developed conjugate vaccine for pneumonia- Pneumococcal Polysaccharide Conjugate Vaccine. developed by Serum Institute of INdia

Question 170

INdia’s monumental achievement in COVID vaccination: some stats and keywords?

Answer 170

India has completed vaccination of 100 crore doses on October 21, 2021, in just about nine months since starting vaccination.

“journey from anxiety to assurance”

“world’s largest vaccination drive”

“a truly bhagirath effort involving multiple sections of society.”

India unanimously trusted ‘Made in India’ vaccines. This is a significant paradigm shift.

India’s vaccine drive is an example of what India can achieve if the citizens and the Government come together with a common goal in the spirit of Jan Bhagidari.

“entire vaccination program of India has been Science born, Science driven and Science-based.”

All Ministries of the Government came together to facilitate the vaccine makers and remove any bottlenecks as a result of our ‘whole of Government’ approach.

In a country of the scale of India, it is not enough to just produce. Focus has to be on last mile delivery and seamless logistics.

robust tech platform in CoWIN. It ensured that the vaccine drive was equitable, scalable, trackable, and transparent. This ensured that there was no scope for favouritism or jumping the queue. It also ensured that a poor worker could take the first dose in his village and the second dose of the same vaccine in the city where he works, after the required time interval. In addition to a real-time dashboard to boost transparency, the QR-coded certificates ensured verifiability.

Question 171

Dengue?

Answer 171

• Dengue virus is transmitted through the bite of a female Aedes (Ae.) Egypti mosquito.
• Aedes is a day time feeder and can fly up to a limited distance of 400 meters.
• Does not spread from human to human
• Although it usually results in mild illness, severe dengue infections can sometimes prove fatal. No vaccine or cure
• World Health Organization (WHO) estimates suggest an annual incidence of 100-400 million dengue infections every year, with its global incidence growing dramatically “in recent decades”.

Question 172

POSHAN Tracker?

Answer 172

• The Poshan Tracker, known as the ICDS-CAS (Integrated Child Development Services-Common Application Software) in its earlier avatar, was set up with the aim of tracking and improving various services delivered at anganwadis and to ensure nutritional management of beneficiaries.
• This real-time monitoring system is one of the key pillars of Poshan Abhiyan or Nutrition Mission
• The Ministry of Women and Child Development has spent over ₹1,000 crore on its Poshan or Nutrition Tracker. But four years since its launch, the Government is yet to make the data public, citing privacy concerns

Question 173

HIV-AIDS in India: HIV and AIDS (Prevention and Control) Act?

Answer 173

enacted in 2017

• State and Central Government are responsible for the following measures:
  
  • Preventing the spread of HIV/AIDS
  • Providing ART (Anti-Retroviral Therapy) for infected patients
  • Providing awareness about HIV & AIDS
  • Conducting educational programmes about AIDS & HIV
  • Prohibiting discrimination of infected patients
  • Providing HIV treatment and counselling services under the state care facilities
  • protect the property of children affected by HIV or AIDS
• The Act lists various grounds on which discrimination against HIV positive persons and those living with them is prohibited.
  
  • These include the denial, termination, discontinuation or unfair treatment with regard to employment, education, health care, residing or renting property, standing for public or private
    office, and insurance.
  • The requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is prohibited
• It prohibits individuals from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.
• Informed consent- No HIV-affected person can be subject to medical treatment, medical interventions or research without informed consent. Further, no HIV positive woman, who is pregnant, can be subjected to sterilisation or abortion without her consent.
• Guidelines for testing centres- No HIV test shall be conducted or performed by any testing or diagnostic centre or pathology laboratory or blood bank, unless such centre or laboratory or blood bank follows the guidelines laid down for such test
• Disclosure of HIV status- No person is compelled to disclose his HIV status except by an order of the court. Every establishment is obligated to keep HIV-related information protected. Every HIV-positive person is compelled to take reasonable precautions to prevent the transmission of HIV to other persons.
• Confidentiality of data- Every establishment keeping the records of HIV-related information of protected persons shall adopt data protection measures in accordance with the guidelines to ensure that such information is protected from disclosure
• A person between the age of 12 to 18 years who is mature in managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age.
• Isolation of Person- It prohibits isolation of segregation of an HIV-positive person. Every HIV-positive person has the right to reside in a shared household and use facilities in a non-discriminatory manner.
• Ombudsmen- Every state has to appoint one or more Ombudsmen to inquire into violations of the provisions of the Act. Within 30 days of receiving a complaint, the Ombudsman is required to pass an order as he deems fit. Failing to comply with the orders of the Ombudsman attracts a penalty of up to Rs 10,000.

Question 174

HIV-AIDS in India: stats?

Answer 174

• India has the third largest HIV-infected population with an estimated 2 million people. The country aimed to decrease new infections by 75 per cent between 2010 and 2020 and eliminate AIDS by 2030.
• National AIDS Control Organisation (NACO) noted that the rate of decline in annual new HIV infections has been relatively slower in recent years.
• However, impact of the HIV/AIDS control programme has been significant, with more than an 80 per cent decline in estimated new infections from the epidemic’s peak in 1995
• Estimated AIDS-related deaths declined by 71 per cent since its peak in 2005.

Question 175

HIV-AIDS in India: other steps taken by GoI?

Answer 175

• NACP (National AIDS Control Programme): Central Sector Scheme - Launched in 1992, Targeted interventions for the most at risk populations, preventive interventions among the general population, and involvement of NGOs and other sectors and departments, such as education, transport and police was made under it. National AIDS Control Board (NACB) and an
  autonomous National AIDS Control Organization (NACO) was set up to implement the project.
  
  • NACP IV (2012-17) was extended to last till 2020. NACP IV had objectives of reducing new infections by 50% (from 2007 baseline) and provied comprehensive care and support to all persons living with HIV/AIDS
• National Strategic Plan 2017-24 with aim to eradicating HIV/AIDS by 2030 (SDG 3.3)
• Mission “SAMPARK”, to trace those who are Left to Follow Up and are to be brought under ART services
• For preventing HIV/AIDS transmission from mother to child
  
  • Prevention from Parent to Child Transmission (PPTCT) programme have been integrated with the RCH programme.
  • PALS (PPTCT ART Linkages Software) System has also been launched to maintain details of all HIV positive pregnant and breast-feeding women and their new-born babies.
• Government would be implementing the 90:90:90 strategy as adopted by UNAIDS. It is a new HIV treatment that has set targets of
  
  • 9% diagnosed
  • 90% on HIV treatment-sustained antiretroviral therapy
  • 90% viral suppression
• Immoral Trafficking Prevention Act, 1986: It provides for conducting compulsory medical examination for detection of HIV/AIDS among the victims of trafficking.
• Project Sunrise: It aims for prevention of AIDS specially among people injecting drugs in the 8North-Eastern states.
• India has extended support to the African countries in their fight against HIV-AID which reflects India’s global commitment

Question 176

HIV-AIDS in India: achievements of GoI?

Answer 176

target of ending the epidemics of AIDS by 2030 (SDG 3.3)

1. HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03. An estimated 2.14 million persons living with HIV and records 87,000 estimated new infections and 69,000 AIDS-related deaths annually.
2. India’s HIV epidemic is slowing down. Between 2010 and 2017 new infections declined by 27% and AIDS-related deaths more than halved, falling by 56%
3. In 2017, 79% of people living with HIV were aware of their status, of whom 71% were on ART
4. Although the prevalence of AIDS has reduced among children below 15 years to 3.3%, it remain high among women at about 39%.
5. There are wide state variation. Nine States have rates higher than the national prevalence figure.North Eastern States like Manipur, Nagaland and Mizoram account for highest adult (15-49 years) HIV prevalence in the country
6. India achieved MDG goal 6. Between 2010 and 2017, new HIV infections have decreased by 27% and AIDS-related deaths have decreased by 56%.

Question 177

HIV-AIDS in India: challenges?

Answer 177

1. Stigma
   
   1. esp in vulnerable social groups like sex workers, homosexuals and transgenders
   2. Acc to UNAIDS’s AIDS Data 2019, In 2016, a third of adults demonstrated a discriminatory attitude towards people living with HIV. This is a similar level recorded a decade earlier in 2006, suggesting current stigma-reduction activities are not working.
   3. Acc to a NACO 2015 report: A 2013 study of doctors, nurses and ward staff in government and non-government clinics in Mumbai and Bengaluru found discriminatory attitudes were common. This included a willingness to prohibit women living with HIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs ‘got what they deserved’ (50 to 83%)
2. Gender inequality: Women, particularly in rural areas, have little control over important aspects of their lives. Intimate-partner violence, including sexual violence, is relatively widespread. The power imbalance between men and women means women are often unable to negotiate condom use or protect themselves from risk of HIV infection in other ways.
3. India is also home to arguably the largest number children orphaned by AIDS. These children endure stigma and face an impenetrable barrier in many Indian societies. This situation encourages children and their guardians to hide HIV and discourages access to essential treatment services (if available)
4. drug injecting users are the dominant mode of transmission, esp in NE INdia
5. data issues: lack of integrated quality data systems, which limit availability and use, plus a lack of structure for case-based reporting, a lack of district HIV and key population size estimates

Question 178

“End of COVID may not be its eradication”?

Answer 178

In the past 130 years, respiratory pandemics have been followed by annual seasonal waves fuelled by viral endemicity, which generally lasts until the next pandemic.

The term “waves” to refer to patterns of disease spread during an outbreak was first used during the Russian Flu pandemic of 1889. It lasted three years, had multiple phases of spikes and valleys with the second phase being the most severe.

The Spanish Flu of 1918-20 had three distinct peaks. It began as a small wave in March 1918, which subsided during the summer. Following the initial peak in cases, a larger peak occurred in the fall of 1918. A third peak occurred during the winter and spring of 1919. This wave subsided in the summer of 1919, signalling the end of the pandemic. It is estimated that over 500 million people were infected and about 100 million died. Although the pandemic subsided, the viruses didn’t go away; a descendant of the Spanish Flu virus, the contemporary H1N1, is circulating even today.

A combination of herd immunity and the virus mutating to become less infectious and severe led to the eventual end of past pandemics. Usually, viruses don’t just go away. Following three pandemics since 1900, the influenza A strain mutated to become increasingly human-adapted and eventually displaced the dominant seasonally circulating influenza virus. Viruses descended from the 1918 virus have caused almost all instances of influenza A since, as well as all subsequent flu pandemics. Seasonal flu continues to result in the deaths of 6,50,000 people each year.

Multiple factors contribute to determine disease patterns:

1. some diseases are seasonal and the waves follow seasonal patterns eg. vector borne disease durinh monsoon in India
2. HUman behaviour and interactions: for eg school closings in summer and winter leads to reduced social contracts and erduction in influenza cases
3. level of immunity
4. eveloving epidemeology of the virus
5. SARS-CoV-2’s destiny will also be determined by whether or not it spreads to wild animals. Several illnesses that have been controlled continue to exist because animal reservoirs allow infections to spread back into humans. Yellow fever, Ebola, and the chikungunya virus are examples of these diseases. Many animals, including cats, rabbits and hamsters, are susceptible to SARS-CoV-2. Mink are particularly susceptible to Covid-19, and outbreaks have occurred on mink farms in Denmark and the Netherlands.

The epidemiological characteristics of a pandemic’s end are not universally defined. Prior respiratory pandemics illustrate that ends are usually ambiguous, and that pandemic closure is better viewed as the return of social life rather than the attainment of specific epidemiological goals.

Question 179

organ shortage problem in India?

Answer 179

• India has a dismal 0.65 per million population (PMP) Organ Donation Rate
• Roughly 5 lakh people die annually in India due to lack of an organ donor but with less than one per million people opting to donate, the organ donation rate in the country is one of the lowest in the world, according to estimates.
• In India, patients need 25,000-30,000 liver transplants annually. But only about 1,500 end up receiving them.
• Similarly, nearly 50,000 persons suffer from heart failures annually. Still, only about 10-15 heart transplants are performed every year.
• issues faced: Lack of training to doctors, misgivings among people and lack of trust in the system

Question 180

“NFHS data offers a reality check for claims of Swachh Bharat success”?

Answer 180

• recently conducted NFHS-5 (2019-20) gathered information from around 6.4 lakh households. This is much beyond what the NSSO or any other national survey usually covers.
• All villages, gram panchayats, districts, states and Union territories in India declared themselves “open-defecation free” (ODF) by October 2, 2019, by constructing over 100 million toilets in rural India. The government is now moving towards the next Phase II of SBMG to reinforce ODF behaviours and focus on providing interventions for the safe management of solid and liquid waste in villages.
• Reliability of sanitation data from NFHS data
  
  • NFHS collects sanitation data in great detail from surveyed households. These include the type of toilet facility used, its location, access, sharing, and drainage system.
  • Usually, in surveys, collection of visible and verifiable physical information has the advantage of fewer response errors, unlike quantitative information
  • any omission of homeless or marginalised homes can only lead to the presentation of an improved picture rather than a dismal one.
• So far, only a few detailed state reports are available from NFHS. However, we have fact sheets that give key indicators for all states and the all-India level. The percentage of the rural population with improved sanitation is poor for many states.
• The NSSO had conducted a survey during July-December 2018 covering drinking water, sanitation, hygiene, etc. It had reported 71.3 per cent of households having access to latrine — far lower than the NARSS 2018-19 (conducted by MoSPI) figure of 93.3 per cent. Though the NSSO findings did show a vast improvement in sanitation practices in rural areas, these findings were not accepted by officials

Question 181

Accreditation in India: policy change?

Answer 181

National Assessment and Accreditation Council (NAAC) has relaxed the eligibility criteria for accreditation of higher educational institutions.

The purpose of the change, according to the guidelines, is to “widen the horizon of accreditation”.

• Under the new manual, colleges and universities that have completed even one academic year will be eligible to apply for a newly created category of ‘Provisional Accreditation for Colleges’ or PAC.
• The PAC, which will not offer any grading, will be valid for two years, and institutions cannot get it more than two times.

Question 182

Accreditation in India: current status?

Answer 182

Accreditation is a quality check exercise.

• It checks whether an institution meets certain standards of quality set by the evaluator in terms of curriculum, faculty, infrastructure, research and financial well-being among others.
• Based on these parameters, the NAAC gives institutions grades ranging from A++ to C. If an institution is graded D, it means it is not accredited.

Benefits of accreditation:

• Apart from recognition, being accredited also helps institutions attract capital as funding agencies look for objective data for performance funding.
• It helps an institution know its strengths, weaknesses, and opportunities through an informed review process.
• Accreditation helps students going for higher education abroad as many global higher education authorities insist on recognition and accreditation of the institution where the student has studied.

Current rules:

• accreditation has been made mandatory through the University Grants Commission (Mandatory Assessment and Accreditation of higher Educational Institutions) Regulations 2012
• Under the rules before the new guidelines were issued, only higher education institutions that are at least six years old, or from where at least two batches of students have graduated, could apply for accreditation with NAAC.
• The accreditation is valid for five years. Aspiring institutes need to be recognised by the UGC and have regular students enrolled into their full-time teaching and research programmes.
• Distance education units and offshore campuses are not covered under the accreditation process.

As of Feb 2022, there were 392 universities and 8,483 colleges that were NAAC-accredited.

Question 183

Antimicrobial reisstance: facts and figures?

Answer 183

Global Research on Antimicrobial Resistance (GRAM) report, published in Lancet

● 1.27 million people died in 2019 as a direct result of AMR.
● AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
● Besides, another 49.5 lakh deaths were indirectly caused by AMR

Question 184

Antimicrobial reisstance: facts and figures?

Answer 184

Global Research on Antimicrobial Resistance (GRAM) report, published in Lancet

● 1.27 million people died in 2019 as a direct result of AMR.
● AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
● Besides, another 49.5 lakh deaths were indirectly caused by AMR

Question 185

Academic Bank of Credit

Answer 185

covered in NEP mindmap

Question 186

Some key health parameters in select states (sample survey 2018):

States IMR U5MR MMR TFR % of deliveries by untrained professionals

Answer 186

Bihar 32 37 149 3.2 19

UP 43 47 197 2.9 14

RJ 37 40 164 2.5 1.6

TN 15 17 63 1.6 0.2

Kerala 7 10 42 1.7 0.1

India 32 36 113 2.2 7.8

Question 187

Consider the following statements regarding State Nutrition Profiles (SNPs).

1. The State Nutrition Profiles are based on the analyses and use of data from National Family Health Survey (NFHS-5).
2. The State Nutrition Profiles help identify priority districts in the state with public health concern as per WHO guidelines.
3. It was launched by Ministry of Health and Family Welfare. Which of the above statements is/are correct?
   a) 1 only b) 1, 3 c) 1, 2 d) 1, 2, 3

Answer 187

C

NITI Aayog, in a joint effort with International Food Policy Research Institute (IFPRI), Indian Institute of Population Sciences (IIPS), UNICEF and Institute of Economic Growth (IEG) launched ‘The State Nutrition Profiles” for 19 States and Union Territories on 30th September, 2021.

The trend analysis of key indicators such as wasting, stunting, anemia, underweight and overweight and NCDs (Diabetes and High blood pressure) showcase the variability of performance across districts. The reports highlight the best and worst performing districts, highest burden districts and top coverage districts of the country. The SNPs are based on the headcount-based analyses and use of data from NFHS-5 to provide evidence that helps identify priority districts and number of districts in the state with public health concern as per WHO guidelines. Each SNP has incorporated key takeaways for children, women and men and identifies areas where the state has the potential to improve further.

Question 188

According to National Family Health Survey-5 (NFHS-5) data, which of the following indicators have seen improvement in 2019-20, compared to 2015-16 levels?
1. Children under five who are stunted
2. Children under five who are wasted
3. Children under five who are underweight
4. Children aged six months to 59 months who are anaemic
Select the correct answer code:
a) 1, 2, 4
b) 1, 2, 3
c) 2, 3, 4
d) 1, 2, 3, 4

Answer 188

B

Question 189

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

Children aged 6 months to 59 months who are anaemic.

Answer 189

69. 4 %(2005-06)
70. 6% (2015-16)
71. 1% (2019-20)

Question 190

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

Children under five who are stunted?

Answer 190

48 %(2005-06)

38. 4% (2015-16)
39. 5% (2019-20)

Question 191

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

children under 5 who are wasted?

Answer 191

19.8 %(2005-06)

21% (2015-16)

19.3% (2019-20)

Question 192

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

children under 5 who are severely wasted?

Answer 192

6. 4 %(2005-06)
7. 5% (2015-16)
8. 7% (2019-20)

Question 193

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

children under 5 who are underweight?

Answer 193

42. 5 %(2005-06)
43. 8% (2015-16)
44. 1% (2019-20)

Question 194

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

children aged 6-23 months receiving an adequate diet?

Answer 194

NA (2005-06)

9. 6% (2015-16)
10. 3% (2019-20)

Question 195

Acc to NFHS-5, 2005-06, 2015-16 and 2019-20 values for India for the indicator:

institutional births?

Answer 195

38. 7% (2005-06)
39. 9% (2015-16)
40. 6% (2019-20)

Question 196

Zika virus?

Answer 196

● The Zika virus is predominantly transmitted by infected mosquitoes from the Aedes genus, mainly Aedes aegypti. The Aedes mosquitoes also spread dengue, chikungunya and yellow fever.
● The virus was first identified in Uganda in 1947 in monkeys.
Transmission:
● Apart from the mosquitoes, an infected person can also spread the virus.

● Generally, the symptoms include fever, rash, conjunctivitis, muscle and joint pain, malaise, or headache. It lasts for about two to seven days. Most infected people do not develop any symptoms.
● Zika virus infection during pregnancy can cause infants to be born with microcephaly (smaller than normal head size) and other congenital malformations, known as congenital Zika syndrome.
● It has no treatment or vaccine. Instead, the focus is on relieving symptoms and includes rest, rehydration and acetaminophen for fever and pain.

Question 197

STARS Project?

Answer 197

STARS stands for Strengthening Teaching-Learning and Results for States Program (STARS).

STARS project would be implemented as a new Centrally Sponsored Scheme under the Department of School Education and Literacy, Ministry of Education.

It is a WB-aided project

It is a project to improve the quality and governance of school education in six Indian states.
● Six states are- Himachal Pradesh, Kerala, Madhya Pradesh, Maharashtra, Odisha, and Rajasthan.
● Some 250 million students (between the age of 6 and 17) in 1.5 million schools, and over 10 million teachers will benefit from the program.

Reform Initiatives:

1. Focusing more directly on the delivery of education services at the state, district and sub district levelsby providing customized local-level solutions towards school improvement
2. greater accountability and inclusion by producing better data to assess the quality of learning; giving special attention to students from vulnerable section.
3. Equipping teachers to manage this transformation by recognizing that teachers are central to achieving better learning outcomes
4. Investing more in developing India’s human capital needs by strengthening foundational learning for children in classes 1 to 3

Components:

1. Contingency Emergency Response Component (CERC): which would enable it to be more responsive to any natural, man-made and health disasters. It will help the government respond to situations leading to loss of learning such as school closures/infrastructure damage, inadequate facilities and use technology for facilitating remote learning etc
2. PARAKH:** (Performance Assessment, Review, and Analysis of Knowledge for Holistic Development) as a **National Assessment Centre. Included in NEP 2020, this autonomous institution under the Union Education Ministry will set norms for student assessment and evaluation for all school boards across the country, most of which currently follow norms set by State governments. It will also guide standardised testing to monitor learning outcomes at the State and national levels, according to the NEP.

Question 198

Virus Variants: Variant of Interest (VOI) and Variant of Concern (VOC)?

Answer 198

A SARS-CoV-2 VOI is a SARS-CoV-2 variant:

1. with genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; AND
2. that has been identified as causing significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence alongside increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health.

A SARS-CoV-2 VOC is a SARS-CoV-2 variant that meets the definition of a VOI and, through a comparative assessment, has been demonstrated to be associated with one or more of the following changes at a degree of global public health significance:

1. increase in transmissibility or detrimental change in COVID-19 epidemiology; OR
2. increase in virulence or change in clinical disease presentation; OR
3. decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics.

Question 199

T/F:

1. RTE does not include madrassas and other institutions imparting religious education
2. exclusion of these institutions was specifically inserted into the 2009 Act by an amendment of August 2012

Answer 199

1. T
2. T

Question 200

Lassa Fever?

Answer 200

The Lassa virus is named after a town in Nigeria where the first cases were discovered in 1969.
The disease is primarily found in countries in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria where it is endemic.
Spread:
● The fever is spread by rats.
● Person-to-person transmission is also possible.
Symptoms:
● Mild symptoms include slight fever, fatigue, weakness and headache and more serious symptoms include bleeding, difficulty breathing, vomiting, facial swelling, pain in the chest, back, and abdomen and shock.
● The most common complication associated with the fever is deafness.
● The death rate associated with this disease is low, at around one per cent. But the death rate is higher for certain individuals, such as pregnant women in their third trimester.

Question 201

Clustering of Colleges?

Answer 201

Context: The University Grants Commission (UGC) has finalized guidelines for transforming colleges and universities into multidisciplinary institutions. These aim to help State governments and universities frame appropriate rules and policies.

Background: Promoting multidisciplinary institutions was a key recommendation of the National Education Policy 2020.

Key Highlights:

• Academic collaboration through clusters: The UGC has suggested academic collaboration between institutions through “clusters” of higher education institutions (HEIs) in order to promote multidisciplinary education and research in online and offline moder
• Cluster system Importance:
  
  • The cluster system will help single-stream institutions with poor enrolment.
  • Such centres will improve the grades in National Assessment And Accreditation Council (NAAC)
• Affiliated colleges during the initial phase: The member colleges in a cluster will continue to function as affiliated colleges under the university in the initial phase
  
  • After the initial years, the affiliating university may affiliate the cluster of colleges as a single unit
• The merger of single-stream institutions, with other multidisciplinary institutions under the same management or different management
• Expanding the number of departments in a college or university: By adding new subjects such as languages, literature, music, Indology, sports, etc.
• Credit mobility: Students opting for courses offered as a result of collaborations and mergers can also avail of credit mobility between partnering institutions
  
  • The National e-Governance Division of MeitY has developed the ABC platform:
    
    • Which allows students to open an academic account
    • Add HEIs of interest
    • Store credits earned from them for receiving degrees and diplomas.
  • Student orientation programmes: The guidelines also identify student orientation programmes as an important element to familiarize them with the new options available to them.
  • Capacity-building for faculty: It suggests capacity-building for faculty so that they can teach, train and research in multi-disciplinary academic programmes such as Annual Refresher Programme in Teaching (ARPIT) as well as investment in learning assessment tools.
  • Setting up Education Departments in universities and colleges: They will teach curriculum design, pedagogy, communication and writing to future teachers.

Question 202

Suicide rates in India?

Answer 202

NCRB 2022:

• Suicide: 120 deaths per mn population (the highest level ever recorded)
• At the national level, the number of suicides increased by 7.17 per cent from the years 2020 to 2021.
• Daily wage earners remained the largest profession-wise group among suicide victims in 2021
• The overall share of “Persons engaged in the farming sector” among the total recorded suicides stood at 6.6 per cent during 2021
• Maximum suicide in Maharastra
• Reasons: Mainly being Pandemic-induced mental health issues, Family Problems (other than marriage-related problems), Marriage Related Problems, and Illness.

Question 203

Cervavac?

Answer 203

India’s first indigenously developed quadrivalent human papillomavirus (qHPV) vaccine for the prevention of cervical cancer.

India accounts for about a fifth of the global burden of cervical cancer, with 1.23 lakh cases (One lakh twenty-three thousand) and around 67,000 deaths per year.

Question 204

“Global Hunger Index is riddled with inadequate and poorly described data and a lack of conceptual clarity”

Answer 204

Recently, Concern Worldwide released the Global Hunger Index. India ranked 107 out of 123 countries, dropping from the rank of 101 in 2021.

• about a third of the index rests on the Food and Agricultural Organisation’s estimates of the proportion of undernourished in the population. Digging deep, we see that these estimates are based on Gallup World Poll’s survey of 3,000 households in India (and 1,000 households in smaller countries). In addition to its small size, the Gallup sampling methodology does not follow the usual processes used in India. This suggests a need to evaluate the representativeness of the sample.
• To ensure transparency, it is essential that international agencies only use data that are freely available in the public domain along with key characteristics such as education, residence and age of the respondents. In this case, the uncritical use of questions is particularly problematic because FAO has not released standard errors for their estimates, making it difficult for us to evaluate whether the growth in the proportion of households experiencing hunger in India, from 14.8 per cent in 2013-15 to 16.3 per cent in 2019-21, is statistically significant. This is very important given the difficulties in collecting data during the pandemic.
• the larger question: Is this index genuinely measuring hunger, or is it lumping together various indicators with only a weak relationship with hunger? The index rests on four indicators: Proportion of undernourished in the population, under-five mortality rate, prevalence of stunting and wasting among children under 5. How good are these indicators in picking up on hunger? While the first, if well collected, could presumably identify the proportion experiencing hunger, the latter three are only partially related to hunger. Child mortality depends heavily on a country’s disease climate and public health systems. Today, 40 of 1,000 children in India die before their fifth birthday; 27 of these deaths occur in the first month of life. This suggests that many child deaths are associated with conditions surrounding birth, congenital conditions, or delivery complications. These are not necessarily markers of hunger. Similarly, the relationship between stunting (low height-for-age), wasting (low weight-for-height), and hunger is not apparent. As UNICEF notes in an article titled ‘Stop Stunting’, poverty is not a clear cause of stunting as there are stunted children even among the wealthiest households. Various factors contribute to stunting, such as infant and child care practices, hygiene, dietary diversity and cultural practices surrounding maternal diet during pregnancy. Food insecurity contributes to child stunting, but its relative importance in determining stunting is not established. Wasting is associated with both recent illnesses and low food intake. The two are closely related; children suffering from diarrhoea are less likely to eat, and poor nutritional status makes them more susceptible to disease.
• Thus, while all three indicators of child health are related to poor food intake, none of them is solely determined by hunger. Moreover, trends in all three reflect somewhat different patterns. Between 1998-99 and 2019-21, National Family Health Survey 2 and 5 show that the child mortality rate fell from 95 deaths per thousand to 40 per thousand. This is a significant improvement attributable to improved immunisation coverage and increased hospital delivery. Child stunting decline was also substantial, from 51.5 per cent to 35.5 per cent, possibly due to improved water and sanitation systems. Wasting has not changed, barely budging from 19.5 per cent to 19.3 per cent.
• In an intriguing article published in 2009, Angus Deaton and Jean Dreze try to reconcile these puzzles and find that average caloric intake has severe limitations as a nutrition indicator. They argue that “close attention needs to be paid to other aspects of food deprivation, such as the intake of vitamins and minerals, fat consumption, the diversity of the diet, and breastfeeding practices.” A NCAER study found that holding household incomes constant, with access to the public distribution system, skewed consumption towards cereals, reduced dietary diversity, and failed to improve anthropometric outcomes.
• The problem with indices of this type is that it directs governmental attention to cross-national comparisons, sometimes resulting in the rejection of underlying issues and sidetracking the public discourse. In a way, this episode illustrates the concern that Amartya Sen, one of the principal consultants to the Human Development Report, 1990, expressed. He has argued that concentrating too much on the Human Development Index or any other index would be a great mistake. The Global Hunger Index is one example in which the weapon has backfired, detracting attention from the very real challenges of improving nutrition and reducing child mortality.