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Bhatia M, Sharma N, Saifi S, Parashar S, Nisha N, Srivastava R, Jain M. Evolution of tobacco control in India: a narrative review of the legislative and regulatory approach. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:1-12. [PMID: 36103211 DOI: 10.1515/reveh-2022-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Tobacco is the only consumer product that kills half its users yearly. The challenges posed by tobacco control are limitless especially in a country like India where in addition to smoked forms, other smokeless forms of tobacco are also highly prevalent. Apart from being a health hazard tobacco is also a great environmental hazard. Policies for controlling tobacco use also include policy to prevent people from second hand smoke, which is aimed at improvement of air quality. According to the National Non-Communicable Disease Monitoring Survey, 2017-18, daily tobacco use was 32.8% in adults (18-69 years) and 3.1% in adolescents (15-17 years). Overall reduction in tobacco users by 8.1 Million was seen from GATS-1 to GATS-2, and prevalence amongst youth decreased from 18.4 to 12.4%. GYTS-4 (2019) revealed that 8.5% of students, 9.6% of boys and 7.4% of girls-currently used any tobacco products. This makes tobacco control a priority in India. Tobacco control consists of different approaches such as educational, healthcare, legislative, regulatory and fiscal. In the present article we traverse nearly five decades and decode the evolution of legislative, regulatory and fiscal approaches to Tobacco Control in India. A critical evaluation of all these approaches is described in the format of the MPOWER strategy for Tobacco Control which stands for Monitoring Tobacco use, Preventing people from Second Hand Smoke, Offering help to quit, Waring regarding ill effects of tobacco, Enforcing bans and Raising taxes on tobacco products.
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Affiliation(s)
- Muskan Bhatia
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nikita Sharma
- Manav Rachna Dental College and Hospital, Faridabad, India
| | | | - Swati Parashar
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nisha Nisha
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Roomani Srivastava
- Faculty of Dental Sciences, Manav Rachna Dental College and Hospital, MRIIRS, Faridabad, India
| | - Meena Jain
- Department of Public Health Dentistry, Faculty of Dental Sciences, Manav Rachna Dental College, MRIIRS, Faridabad, India
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Halder M, Kasemi N, Majumder M. Tobacco use and its associated factors among middle and old-aged women in India using LASI wave-1 data. PLoS One 2024; 19:e0298663. [PMID: 38442117 PMCID: PMC10914294 DOI: 10.1371/journal.pone.0298663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Despite a global decline in tobacco use reported by the Global Adult Tobacco Survey (GATS), India stands out for its high number of tobacco users. While research in India often focuses on tobacco use among young adults, there's a notable lack of studies addressing tobacco use among middle and old-aged women. However, the national prevalence of tobacco use among middle and old-aged (45 years and above) women in India is 18.2%. Thus, this study seeks to identify the factors influencing tobacco consumption among middle and old-aged women in the country. METHODS The study has utilized secondary data from Longitudinal Aging Study in India (LASI) conducted in 2017-18. This study exclusively included a total of 38,180 middle and old-aged women who reported tobacco use. The analysis encompassed the utilization of Chi-square tests and Binary logistic regression to pinpoint the risk factors linked to tobacco use among middle and old-aged women. RESULTS Our study reveals a heightened likelihood of tobacco use among middle and old-aged women residing in the northeastern region of India. The study underscores the imperative to direct targeted efforts toward middle and old-aged women who fall into specific categories, including those who are widowed, separated, or unmarried, individuals who consume alcohol, those with lower socioeconomic and educational standings, residents of rural areas, those living in solitude, individuals experiencing depressive symptoms, and those who self-report poor health. CONCLUSION Given the heightened susceptibility of these demographic groups to tobacco use, it is crucial to prioritize tobacco prevention and cessation initiatives specifically tailored to their needs and circumstances.
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Satpathy N, Jena PK, Epari V, Yadav A, Jena S, Pradhan SP, Dash S. Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India. Cureus 2023; 15:e51206. [PMID: 38283487 PMCID: PMC10818163 DOI: 10.7759/cureus.51206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Background Graphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention to warn consumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methods From August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City. Using multistage random sampling 18 schools were selected in Bhubaneswar City. Areas within 100 yards (91.44 meters) of each school were mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study. The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessment of the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. Results Within 100 yards of 18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbranded tobacco products were identified from 2135 packets collected from 57 vendors. Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLT products such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of the eight unique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. Conclusion Tobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning label rules in Bhubaneshwar.
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Affiliation(s)
- Nancy Satpathy
- Community Medicine, Siksha 'O' Anusandhan Deemed to be University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
- Public Health, Indian Council of Medical Research, New Delhi, IND
| | - Pratap K Jena
- Health Care Management, Swiss School of Business and Management (SSBM) Geneva, Geneva, CHE
- School of Public Health, Kalinga Institute of Industrial Technology (KIIT) Deemed to be University, Bhubaneswar, IND
| | - Venkatarao Epari
- Community Medicine, Siksha 'O' Anusandhan Deemed to be University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Amit Yadav
- Tobacco Control, International Union Against Tuberculosis and Lung Disease (The Union) South East Asia Office, New Delhi, IND
| | - Shubharanjan Jena
- Community Medicine, Siksha 'O' Anusandhan Deemed to be University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Smruti Priyambada Pradhan
- Community Medicine, Siksha 'O' Anusandhan Deemed to be University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Samarendra Dash
- Orthodontics and Dentofacial Orthopaedics, National Aluminium Company Limited (NALCO), Bhubaneswar, IND
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Jain YK, Bhardwaj P, Joshi NK, Singh PK, Lal P, Kapoor S, Gupta MK, Goel AD, Sharma PP, Singh S. Estimating the weight of consumed tobacco product waste in various Indian states: a novel method to assess the potential burden of tobacco product waste. Tob Control 2023:tc-2023-058118. [PMID: 37734958 DOI: 10.1136/tc-2023-058118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The direct morbidity and mortality caused by tobacco are well documented, but such products also contribute to a range of environmental pollutants resulting from tobacco product waste. No previous studies have yet quantified tobacco product waste in a low-income and middle-income country (LMIC). This study estimates the potential annual waste generated due to consumption of smoked and smokeless tobacco products in India and its states. METHODOLOGY We systematically collected samples of smoked and smokeless tobacco products from 33 districts of 17 Indian states/union territories. Stratified weights of plastic, paper, foil and filter packaging components, and gross empty package weights were recorded. Prevalence of smoking and smokeless tobacco use at national and state-level estimates was derived from the Global Adult Tobacco Survey (2016-2017) to quantify waste potentially generated by tobacco products. RESULTS We included 222 brands of tobacco products (70 cigarette, 94 bidi and 58 smokeless tobacco brands) in the final analysis. A total of 170 331 (±29 332) tonnes of waste was estimated to be generated annually, out of which 43.2% was plastic, 3.6% was foil and 0.8% was filter. Two-thirds of the overall waste was contributed by smokeless products alone. Maximum waste was generated in Uttar Pradesh (20.9%; 35 723.7±6151.6 tonnes), Maharashtra (8.9%; 15 116.84±2603.12 tonnes) and West Bengal (8.6%; 14 636.32±2520.37 tonnes). CONCLUSION This study provides first of its kind national-level evidence on the types (plastic, paper, foil and filter) and quantity of waste potentially generated by use of tobacco products in India. Similar studies from other LMICs can serve to raise consciousness about many negative environmental impacts of tobacco products and need for policies to address them.
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Affiliation(s)
- Yogesh Kumar Jain
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nitin Kumar Joshi
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Pranay Lal
- Tobacco Control Department, International Union Against Tuberculosis and Lung Disease, New Delhi, Delhi, India
| | - Shivam Kapoor
- Tobacco Control Department, International Union Against Tuberculosis and Lung Disease, New Delhi, Delhi, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prem Prakash Sharma
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shalini Singh
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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E-cigarettes: A continuing public health challenge in India despite comprehensive bans. Prev Med Rep 2023; 31:102108. [PMID: 36820378 PMCID: PMC9938321 DOI: 10.1016/j.pmedr.2022.102108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023] Open
Abstract
India has introduced comprehensive e-cigarette bans focused on protecting youth from vaping-related harm. Despite these bans, educated young people appear to be a relatively high user group, although little is known about their usage patterns. The aims of the present study were to examine educated young adults' e-cigarette-related attitudes and behaviors and their support for various e-cigarette control policies. In total, 840 tertiary-educated young adults completed an online survey. Demographic characteristics, e-cigarette and tobacco use, beliefs about e-cigarettes, exposure to e-cigarette advertising, sources of access to e-cigarettes, numbers of family members and peers who vape, and support for a range of e-cigarette policies were assessed. One-third (33%) reported never having heard of e-cigarettes/vapes, 23% reported ever using e-cigarettes, 70% reported ever using tobacco, and 8% were dual users of both e-cigarettes and tobacco. Only 8% of e-cigarette users reported daily use. Vapers sourced e-cigarettes from retail outlets (vape shops, tobacconists) and their social networks (friends, siblings). Just under two-thirds of those who were aware of e-cigarettes believed them to be harmful and to contain chemicals. Among non-users, 31% were curious about using e-cigarettes and 23% intended to use in the following year, indicating high levels of susceptibility. The results suggest that despite a complete ban, young people are still able to access e-cigarettes in India. Greater education about harms associated with vaping and more intensive monitoring and enforcement could assist in reducing uptake in relatively high-prevalence groups such as educated young adults.
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Nair S, Singh L, Deepani V, Alee NT, Sharma S, Ovung S, Hijam M, Singh SR, Aheibam S, Singh KJ, Haobijam N, Kaur H, Vardhana Rao MV. Predictors of smokeless tobacco use among the adult population of north-east India during 2009-2017: A decomposition analysis. Indian J Med Res 2022; 156:330-338. [PMID: 36629193 PMCID: PMC10057354 DOI: 10.4103/ijmr.ijmr_3229_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background & objectives Contrary to overall declining trend in smokeless tobacco (SLT) use in India, an increase is observed in north-east (NE) India. This study examined the predictors of daily SLT use by gender and assessed the demographic and socio-economic characteristics that contribute to gender differences in SLT use in NE India. Methods Data collected from 15,259 and 13,574 adults in the two rounds of Global Tobacco Adult Survey 1 and 2 for NE India during 2009-2010 and 2016-2017 were analyzed. Relative change, multivariable binary logistic regression and Blinder-Oaxaca decomposition analysis were used for analysis. Results The findings suggest that among women in NE India, the daily SLT use significantly increased by 58 per cent between 2009-2010 to 2016-2017. Women residing in Nagaland, Manipur, Mizoram and Tripura were 3.5 and 2.5 times, respectively more likely to be daily SLT users compared to those in Assam. While age, education and wealth were the significant predictors of SLT use in both women and men, increased odds of SLT use were observed with women's type of occupation and the State of residence. The majority of the gender differences in daily SLT use was explained by differences in work status (44%), age (26%), education (14%) and wealth status (9%) between men and women. Interpretation & conclusions Increasing prevalence of SLT use amongst women in the NE States necessitates integration of gender-specific messages on harmful effects of SLT in the ongoing tobacco control programmes and development of culturally appropriate community-based interventions for cessation of SLT use.
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Affiliation(s)
- Saritha Nair
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Lucky Singh
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Vijit Deepani
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Nongzaimayum Tawfeeq Alee
- ICMR-National Institute of Medical Statistics, New Delhi; Department of Psychology, Amity Institute of Behavioural & Allied Sciences, Mumbai, Maharashtra, India
| | - Saurabh Sharma
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Senthanro Ovung
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Meena Hijam
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | | | | | | | - Nirendra Haobijam
- Department of Community Medicine, Jawaharlal Institute of Medical Sciences, Imphal, Manipur, India
| | - Harpreet Kaur
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Nayak R, Kamath A, Li J, Kulkarni MM, Kamath VG, Kumar P, Naik A, Parrott S, Mdege ND. The association between the retail price of manufactured cigarettes and bidis on current smoking status in India. Tob Induc Dis 2022; 20:43. [PMID: 35600725 PMCID: PMC9074849 DOI: 10.18332/tid/146904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In India, the retail prices of bidis and cigarettes varied between the two Global Adult Tobacco Surveys (GATS) conducted in 2009-2010 and 2016-2017. The relationship between the retail price of smoked tobacco products and their use is unclear for India. Our study thus aimed to use available datasets to investigate the association between the retail price and current smoking status of bidis and cigarettes in India. METHODS Current smoking status data for bidis and cigarettes were obtained from the two GATS rounds. The average state-level retail prices of bidis and cigarettes were obtained from India's Consumer Price Index- Industrial Workers database. Descriptive statistics were used to describe current smoking status patterns. Generalized Linear Mixed Models were used to investigate the association between the retail prices and current smoking status of bidis and cigarettes. RESULTS For cigarettes, an increase in the average retail price by one Indian Rupee was associated with a reduction in the odds of being a current smoker of 7% (OR=0.925; 95% CI: 0.918-0.932, p<0.001). For bidis, the association between the retail price and current smoking status was not statistically significant (OR=1.01; 95% CI: 1.00-1.02, p=0.082). CONCLUSIONS Current increases in the retail prices of tobacco products in India seem to have an impact on the use of cigarettes but not bidis. This highlights the need for tobacco product tax increases that result in sufficient retail prices increase to make all tobacco products less affordable and reduce their use.
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Affiliation(s)
- Radhika Nayak
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, United Kingdom
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath Naik
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noreen D. Mdege
- Department of Health Sciences, University of York, York, United Kingdom
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Lal P, Kapoor S, Dhankhar A, Yadav A. Raising the legal age for purchase and use of tobacco to 21 years: A step towards tobacco endgame in India. Indian J Tuberc 2021; 68S:S65-S70. [PMID: 34538394 DOI: 10.1016/j.ijtb.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Globally, policies to counter targeting of young people by the tobacco industry have proven to be effective and a key determinant of reducing the magnitude of tobacco epidemic. This paper presents a case for increasing the minimum legal age to access tobacco to 21 years in India. METHOD We analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009-10) and GATS-2 (2016-17). We segregated data for two categories of tobacco consumption (smokers and smokeless tobacco users) at the age of initiation (<18, 18-21 and >21 years) and analysed for their consumption patterns found during the time of the survey (current daily, current less than daily, former and ever users) from GATS-2 (2016-17). Further, we compared the projections from the sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users between the two survey rounds. RESULT Nearly 77% of smokers and 75% smokeless tobacco users in India initiate tobacco use before or until the age of 21 years. Many large, most populous and high tobacco prevalence states had higher than national mean (14.1%) of youth initiating into tobacco use before 21 years. Overall, as compared to GATS-1, there is a perceptible increase in the prevalence of underage tobacco use in most states. CONCLUSION Global best practices and the significant number of young tobacco users in India call for increasing the age of access to tobacco from the current 18 years to 21 years. This will help in reducing the overall adult tobacco use prevalence in the longer run in India.
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Affiliation(s)
- Pranay Lal
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, C-6, Qutub Institutional Area, New Delhi, 110016, India
| | - Shivam Kapoor
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, C-6, Qutub Institutional Area, New Delhi, 110016, India.
| | - Anushikha Dhankhar
- Employees' State Insurance Corporation Model Hospital cum ODC, MIDC Central Road, Andheri East, Mumbai, Maharashtra, 400093, India
| | - Amit Yadav
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, C-6, Qutub Institutional Area, New Delhi, 110016, India
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