Bringing Health Care Closer to People - A Review of Various Telemedicine Models under the National Health Mission in India

Understanding the Socio-Economic Vulnerability in Child Malnutrition Between Migrants and Non-Migrants Children (12-59 Months) in India: Evidence from a Cross-Sectional Study

India has witnessed increasing trends in internal migration over the last three decades. In India, migrant children are not a homogeneous group and their reasons for movement and vulnerabilities vary across socio-economic stratum. For some children, migration may open possibilities and is associated with expanding social and economic spheres, but for many others, it may bring serious risks. Therefore, the study has been carried out to understand socio-economic vulnerability in child nutrition with migration status and other contributing factors in India. This study used data from the National Family Health Survey, the fourth in the NFHS series which was conducted in 2015-2016 (NFHS-4). We were interested in looking at the children age 12-59 months for their nutritional indicators such as stunting and underweight across migrants and non-migrants children. This resulted in a sample of 199,448 children in selected age group and among them 33.1% children belongs to the migrant family as compared to 67% of non-migrant children. Overall, 44.2% of children were stunted and 39.5% were underweight among non-migrant children as compared to 37.4% & 32.8% of migrant children were stunted and underweight respectively. Further, the results showed that among the social groups, scheduled caste children were found a high variation in underweight (34% vs. 41.6%) and stunting (36% vs. 46%) between migrants and non-migrants children. Similar trend of malnourishment is found in the poor wealth quintile, for rural residents and low educated women with non-migrant status. Those children who were poor but non-migrant were more likely to be malnourished as underweight [aOR; 1.15, CI: 1.11-1.18] and stunted [aOR; 1.17, CI:1.13-1.20] as compared to migrant status children in the same category of the household. Similarly in reference to scheduled caste migrant group, the scheduled caste non-migrant were more likely to be underweight [aOR; 1.15, CI: 1.09-1.20] and stunted [aOR; 1.18, CI: 1.12-1.23] than the children with migrant status. There were huge differences between migrant and non-migrant children in nutritional statuses. Education, caste and wealth index are found to be an important variables to explain the differential between migrants and non-migrants in child's nutritional aspects. Children associated with poor socio-economic vulnerability and non-migrant category need to be taken care of more and a community targeted approach is required to understand the gaps. The programs such as ICDS, and Poshan Abhiyan need to be revamped adding the migration aspect of the families and children in terms of their health and nutritional aspects.

Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study

BACKGROUND

Burn care in India is limited by multiple constraints. The COVID-19 pandemic and the containment measures restricted access to non-COVID emergency conditions, including burns. The aim of this study was to explore the impact of the pandemic on burn care in India.

METHODS

Using the qualitative exploratory methods, we conducted in-depth interviews (IDI) with plastic and general surgeons representing burn units from across India. Participants were selected purposively to ensure representation and diversity and the sample size was guided by thematic saturation. Thematic analysis was undertaken adopting an inductive coding using NVivo 12 Pro.

RESULTS

19 participants from diverse geographic locations and provider types were interviewed. Three major emerging themes were, change in patient and burn injury characteristics; health system barriers, adaptation, and challenges; and lessons and emerging recommendations for policy and practice. There was change in patient load, risk factors, and distribution of burns. The emergency services were intermittently disrupted, the routine and surgical services were rationally curtailed, follow-up and rehabilitation services were most affected. Measures like telemedicine and decentralising burn services emerged as the most important lesson.

CONCLUSIONS

The ongoing pandemic has compounded the challenges for burns care in India. Urgent action is required to prioritise targeted prevention, emergency transport, decentralise service delivery, and harnessing technology for ensuring resilience in burns services.