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Scaling up core micronutrient interventions: It’s $12 bn vs $574 mn

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Malnutrition

New Delhi, Sep 12: Buzz Aldrin, the second man on the moon, was quoted as saying: “If we can conquer space, we can conquer childhood hunger.” Sadly, even today 248 million children across the globe are suffering from one or the other form of malnourishment — stunting, wasting and obesity. It accounts for 45 per cent of child deaths.

The significance of the problem is relatively higher in India as, with 20 per cent of the world’s child population, it has one of the world’s highest malnutrition rates. The root of the problem lies in gross negligence of public investment in healthcare facilities, let alone a focused intervention in child health amenities. Public expenditure on health, as a percentage of total health expenditure, has hovered between 25 and 30 percent in the last decade, while the world average stood at 60 percent. As a matter of fact, only 16 countries have a lower public expenditure on healthcare than India.

The inadequacy of government intervention is clearly reflected in the country’s performance on child health indicators. As an extension of the fact that the country has the highest levels of malnutrition, India also has the highest number of stunted children in the world. The other aspects of malnutrition are no better off. A high proportion of children with anaemia, low weight, lower levels of breast feeding and evolving problems of obesity are also equally of concern. The percentage of anaemic children, although depicting a declining trend, is still at 58.4; the percentage of overweight children increased to 6.1 in 2014; and finally, there has also been a rise in wasted children by 1.2 percentage points during the last decade.

Over the years, India has suffered heavy economic losses due to such absurd levels of malnutrition. Any aspect of malnutrition directly impacts a person’s productivity levels, affecting his economic viability. According to World Bank estimates, productivity losses due to malnutrition are more than 10 per cent of lifetime individual earnings or about 2-3 percent of the GDP. Annually, India loses over $12 billion in GDP to vitamin and mineral deficiencies.

This is because children who are undernourished show lower activity levels and reduced attention. Studies show that low weight at birth and stunting can reduce a child’s IQ by five points. In addition, anaemia and other deficiencies can have irreversible damage on a child’s ability to learn. A recent World Bank study found that stunting among children in India reduces their per capita income by 13 per cent. Since two-thirds of India’s current workforce was stunted in childhood, the economic losses that the country has borne due to it through generations is unimaginable.

The issue gets even more complicated for nutritional deficiencies in a girl child. Malnourishment in a girl, combined with the Indian trend of early marriage, has a cascading effect of health complexities across generations. Data by National Family Health Survey suggests that 26.8 per cent of the women in India are married before 18. Childbearing at an early age can cause nutritional deficiencies in the womb and increase the risk of death by 2-10 times. Moreover, 41.4 per cent of the mothers do not receive any antenatal care during their first trimester. This induces other risks associated with mineral deficiencies in the womb such as blindness, dwarfism and also chronic diseases like diabetes in adulthood.

There is also a tendency among Indians to avoid hospitals due to the high out-of-pocket expenditure during delivery. The average out-of-pocket expenditure per delivery in a public healthcare system in rural areas is almost Rs 3,000 ($47), where 75 per cent of the population earns less than Rs 5,000 a month. Such excessive costs of child and maternal care lead to a widespread inclination to evade hospitals for childbirth, which results in health complications among children and even death.

The potential gains from addressing these issues will far exceed the costs incurred. As against the $12 billion that the country loses to nutritional deficiencies each year, scaling up core micronutrient interventions would cost less than $574 million annually. Research suggests that $1 spent on nutritional interventions in India could generate $34.1 to $38.6 in public economic returns, three times more than the global average. This makes boosting nutrition levels across the country one of the biggest low hanging fruit in the Indian public policy sphere.

 

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Health

High Vitamin D levels may reduce breast cancer risk

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vitamin D

New York, June 16: Higher levels of Vitamin D among women may reduce their risk of developing breast cancer post menopause, claimed a new study.

The study found that women with blood levels of serum 25-hydroxyvitamin D (OH) — the main form of vitamin D in blood — above 60 ng/ml (nanograms per millilitre) had one-fifth the risk of breast cancer compared to those with less than 20 ng/ml.

Thus, researchers from the University of California-San Diego determined that the minimum healthy level of 25(OH) in blood plasma should be 60 ng/ml, instead of the earlier recommended higher than the 20 ng/ml.

“Increasing Vitamin D blood levels substantially above 20 ng/ml appears to be important for the prevention of breast cancer,” said lead author Sharon McDonnell from GrassrootsHealth, a non-profit public health research organisation.

The study, published in the journal PLOS ONE, analysed data from two randomised clinical trials with 3,325 combined women and a prospective study involving 1,713 women with average age of 63.

Participants were free of cancer at enrollment and were followed for a mean period of four years. Vitamin D levels in blood were measured during study visits.

“This study was limited to postmenopausal breast cancer. Further research is needed on whether high 25(OH)D levels might prevent premenopausal breast cancer,” said Cedric F. Garland from UC-San Diego.

IANS

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Congenital Heart Disease Often Lead To Mental Illness

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WORLD HEART DAY

More than 1.5 lac infants are born in India annually with congenital heart disease. Around 78,000 infants die of congenital heart disease in India every year.

So What Is Congenital Heart Disease?

Congenital Heart Disease (CHD) is when a child is born with an abnormality in his/her heart. It could be abnormal in the way it’s structured (have parts of the organ missing, have functional problems and/or holes in the chambers. Doctors are often able to diagnose CHD while the child is still in the womb of the mother. CHD is considered to be a life threatening illness and hence can cause emotional turmoil in parents of the child, which in turn affects the psychological development of the unborn child.

Additional alterations immediately after birth for a child can prove to be traumatic, and cause PTSD like symptoms later on in life. For example, a child is often separated from the child’s mother and placed in intensive care immediately after birth, and then they are subjected to invasive medical procedures and tests. An infant with CHD goes through a traumatic event which is often reflected in feeding problems, nightmares and over all behavior of the infant.

According to Dr.Vihan Sanyal, psychotherapist, “Parents of children with CHD can seek the help of a skilled psychotherapist for their children’s psychological health while they are children. This will give the therapist to address the issue early on and help improve the quality of life of the child well into adulthood”

Early stressful experiences of a child can alter the child’s brain development, affect their immune system (the child tends to fall sick more often) and disturb the way a child reacts to stressful events in future life. Studies have proven that children who have been exposed to highly stressful environments early on in childhood often have issues with cognition and in processing of emotions.

Neonatal care, pediatric care, adolescent years and adulthood of a person diagnosed with CHD is often complex and challenging for the person. The psychological impact this creates is profound and can lead to suicide in adulthood if not managed properly.

Dr.Sanyal explains: “Children with CHD have difficulties with motor skills, speech, focus & attention, executive functioning, impulse control, management of emotions and behavior. The change in the structure of the brain and in brain chemistry can tarnish the image a child has of himself. He can quickly form an opinion of himself as being “abnormal”, leading to self esteem issues. It is important for children to be helped by a skilled psychotherapist, who is proficient in dealing with psychological issues of children living with CHD. Timely therapeutic intervention can provide the support a child requires in coping with the emotional challenges of CHD.”

Psychiatric disorders, in particular mood and anxiety disorders are more frequent in Adults with CHD compared to Non-CHD adults.

Life threat to the fetus is an important key factor for emotional disturbance during pregnancy for the parents. It is also an indication of long term psychological disorders faced by the parents of the child with CHD.

Studies have indicated that more than 30% of parents with children who have been diagnosed with CHD show signs of Post Traumatic Stress Disorder (PTSD). 50% of them have shown to have anxiety and depression. More than 80% of these parents have tested positive for psychological stress related disorders.

“MNLP & other modalities of psychotherapy can help the parents of those who have recently been diagnosed with CHD. MNLP can help in building resilience in the parents and equip them to face the challenges which lay ahead without disintegrating emotionally. Hypnotherapy can be used to promote relaxation and to address issues of trauma in the subconscious” Say’s Dr.Sanyal

Contributory Factors While Pregnant Which Can Result In CHD

· Smoking during pregnancy

· Consuming alcohol during pregnancy

· Exposure To Poor Air Quality (pollution)

· Exposure to Toxic Chemicals (Even common household chemicals like toilet cleaners and detergents)

· Exposure to pesticides and insecticides

· Medicines not meant to be consumed during pregnancy

· Obesity in mothers

In addition to the above list, symptoms of anxiety and depression in pregnant women often go undetected and hence, remain untreated. It is also important to mention that a range of symptoms of stress, anxiety and depression, marital harmony and quality of relationship the parents share with each other all have an effect on the fetus’s psychological health.

Dr.Sanyal says: “Many pregnant women of our country are unaware of some of the precautions they need to take during pregnancy. More importantly, they are unaware of the harmful effects the unborn child could face due to their habit and behavior. Many psychological disorders and mental illnesses can be prevented by pregnant women choosing to lead a balanced and a relatively stress free life during their pregnancy.”

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Health

Can sleeping more affect your heart?

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world sleep day

Seoul, June 13: If you thought that only less hours of sleep would affect your health, then you are wrong. Sleeping more than 10 hours per day is also associated with metabolic syndrome, raising the risk for heart diseases, according to a new study.

Those who slept for over 10 hours daily were at risk of elevated waist circumference, high triglyceride levels — a type of fat, low levels of “good” cholesterol, hypertension as well as high fasting blood sugar — referred to as metabolic syndrome and associated with increased risk of cardiovascular diseases.

While sleeping more raised triglycerides levels in both men and women, in women it led to higher waist circumference, blood sugar as well as lower levels of “good” cholesterol.

Conversely, getting less than six hours of sleep was associated with higher risk of metabolic syndrome in men and higher waist circumference among both men and women, researchers said.

“This is the largest study examining a dose-response association between sleep duration and metabolic syndrome and its components separately for men and women,” said lead author Claire E. Kim from Seoul National University College of Medicine in South Korea.

The study, published in the journal BMC Public Health, included data from 1,33,608 participants aged between 40-69 years. The results showed that the prevalence of metabolic syndrome was just over 29 per cent in men and 24.5 per cent in women.

“We observed a potential gender difference between sleep duration and metabolic syndrome, with an association between metabolic syndrome and long sleep in women and metabolic syndrome and short sleep in men,” said Kim.

IANS

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