Indian Council of Medical Research (ICMR) has given its nod to Diagnostic machines used to test drug-resistant tuberculosis (TB) for conducting Covid-19 tests. In this regard, Truenat beta CoV test on Truelab workstation will be used for screening test of COVID-19. A total of 800 truenat machines are available in India.

Currently India is using real time Polymerase Chain Reaction (RT-PCR) testing approved by United States and Food and Drug Administration (FDA).

About Truenat:

• It is a battery operated small machine that requires minimal training and gives the result between 30-60 minutes.
• The sample of the throat and the nasal swab is collected by the trained technicians wearing personal protective equipment.
• There are two-way and four-way Truenat machines. Four-way Truenat machines can run 32 to 48 samples of multiple diseases – COVID19, HIV and TB, while two-way can handle 16 to 24 samples.
• The cost of a test on Truenat machines will be of Rs 1000-Rs.1500.

Indian Council for Medical Research

• ICMR is India’s apex scientific body for the formulation, coordination and promotion of biomedical research.
• It was established in 1911 as Indian Research Fund Association (IRFA) making it one of oldest and largest medical research bodies in the world.
• The ICMR functions under Department of Health Research, Ministry of Health and Family Welfare.
• It is headquartered in New Delhi.
• Its Governing Body is presided over by Health Minister.
• Director General– Prof. Balram Bhargava
• It is assisted in scientific and technical matters by Scientific Advisory Board comprising eminent experts in different biomedical disciplines.
• ICMR’s research priorities coincide with national health priorities such as control and management of communicable diseases, fertility control, maternal and child health, control of nutritional disorders, research on major non-communicable diseases like cancer, cardiovascular diseases, diabetes and mental health research and drug research (including traditional remedies) and developing alternative strategies for health care delivery.

• India has the highest burden of tuberculosis (TB) in the world.
• Even as the government was pushing to end TB by 2025, the COVID-19 pandemic has caused a massive disruption in TB services.
• TB case notifications across India have dropped by over 50% since March, with an estimated 3,00,000 missed case notifications (until May 30).
• This is worrisome, since undiagnosed TB can worsen patient outcomes and increase transmission in the community.
• As the lockdown ends, we will see a big surge in people seeking care with TB and COVID-19 symptoms.
• However, people will struggle to get care because the public sector is still dealing with the pandemic, while the private sector is not functioning at normal capacity or is reluctant to manage people with fever and cough.
• To find the missed TB patients, we will need to find ways to rapidly resume public TB services, integrate TB and Covid-19 testing and be creative about engaging the private health sector to augment public TB services.
• It is critical for the National TB Elimination Programme to resume routine TB services, which include diagnostic services, such as microscopy and rapid molecular testing, as well as drug-susceptibility testing.

Dual testing

• Since fever and cough are symptoms of both TB and COVID-19, simultaneous screening and testing can be encouraged. Thankfully, India has access to three existing technologies that permit dual testing for both infections.
• The first is the digital chest x-ray (CXR), which could be deployed along with artificial intelligence (AI) based tools for both TB and COVID-19.
• AI-based algorithms are now available that obviate the need for trained radiologists to read the x-rays. If a CXR is suggestive for TB on the AI algorithm, then a confirmatory test such as GeneXpert can be done to confirm TB and also detect drug-resistance.
• One such AI-enabled screening tool is called qXR, developed by Qure.ai, an Indian company. Several studies show accuracy that is comparable or better than human radiologists.
• The screening tool, qXR, has now added the capability of detecting signs of COVID-19 from the x-rays images.
• Based on an estimated 3,00,000 missed cases during the national lockdown, around 10,50,000 CXR (assuming 70% of these are pulmonary TB cases and 5 CXRs are needed to detect one patient with pulmonary TB) will be required for detecting TB cases.
• This is an overwhelming figure for any health system especially during a pandemic. However, a dynamic partnership with 80,000 licensed diagnostic radiology facilities will help combat this.
• CXR screening will require confirmatory testing for both diseases, and molecular testing is the most accurate and rapid option. There are two technologies already in use in India that could be leveraged for simultaneous testing of sputum samples for both infections.
• One is called GeneXpert. India has over 1,100 of these systems in use. A large number of private labs, too, have this technology. On this platform, TB can be detected using a cartridge called Xpert MTB/RIF and COVID-19 by using the Xpress SARS-CoV2 cartridge.
• The second molecular platform is called TrueLab, developed by an Indian company – Molbio Diagnostics.
• This technology is already being used in some states and in private labs to test for TB using a chip called Truenat MTB.
• Molbio now has a chip called Truenat Beta CoV that can be used for COVID-19. This chip, along with Xpress SARS-CoV2 cartridge, has been approved by ICMR for emergency use for COVID-19 testing.
• Typically, TB testing requires sputum sample. Now, SARS-CoV-2 testing is done using nasopharyngeal swabs, but there is no reason why sputum samples cannot be used, since sputum is generated deeper in the lungs. However, it is important to validate both test molecular platforms for simultaneous testing using the same sputum sample.

Campaign for Medicinal Plants on 75000 ha of land

• The National Medicinal Plants Board (NMPB), Ministry of AYUSH has launched a national campaign to promote the cultivation of medicinal plants in the country as part of the Azadi Ka Amrit Mahotsav.
• This will help in increasing the income of farmers and realize the dream of Green India.
• Under this campaign, the cultivation of medicinal plants will be done on 75,000 hectares of land in the next year across the country.
• The program has been started in Saharanpur in UP and Pune in Maharashtra.
• This program is the second in the series of programs being organized by the Ministry of Ayush under the 'Azadi Ka Amrit Mahotsav'.
• A total of 7500 medicinal plants were distributed to 75 farmers on this occasion. A target has been set to distribute 75 thousand saplings.
• Medicinal plants were distributed free of cost to 150 farmers who came from many nearby districts.
• These included mainly 5 species of plants - Night-flowering Jasmine (Parijat), Golden Apple (Bel), Margosa Tree (Neem), Indian Ginseng (Ashwagandha) and Indian Blackberry (Jamun). 750 Jamun saplings were separately distributed free of cost to the farmers.
• Union AYUSH Minister Sarbananda Sonowal has said that the country has immense potential in the field of medicinal plants and the cultivation of medicinal plants on 75000 hectares of land will ensure the availability of medicines in the country and it will be a big source of income for the farmers.
• This will make the country self-reliant in the field of medicines.
• Significantly, in the last 1.5 years, the market of medicinal plants has increased in a big way not only in India but all over the world.
• This is the reason that Ashwagandha has been the third best-selling product in America.
• Further programs being held under 'Azadi Ka Amrit Mahotsav' include the launch of the Y Break App, distribution of Prophylactic Ayush Drugs, 'Ayush Aapke Dwar' and lecture series for school and college students.

Shailendra Singh wins Behler Turtle Conservation Award

• Indian biologist Shailendra Singh has been awarded the Behler Turtle Conservation Award for bringing three critically endangered turtle conservation species back from the brink of extinction.
• A press statement issued by the headquarters of the Turtle Survival Alliance earlier this week said: “For some species, such as the red-crowned roofed turtle (Batagur kachuga), northern river terrapin (Batagur baska), and black softshell turtle (Nilssonia nigricans), Dr. Singh and his team’s efforts are the last hope for their wild survival in the country.”
• The award has been bestowed by several global bodies involved in turtle conservation such as Turtle Survival Alliance, IUCN/SSC Tortoise and Freshwater Turtle Specialist Group, Turtle Conservancy, and Turtle Conservation Fund.
• In just 15 years, there are few individuals that have made such monumental contributions to turtle conservation as Shailendra Singh.
• He and his team’s efforts now span much of India, impacting well over half of its turtle and tortoise species, many of which are among the most endangered turtles on the planet.

POSHAN Abhiyan, 2018

• It is a flagship programme of the Ministry of Women and Child Development launched from Jhunjhunu in Rajasthan.
• It is a multi-ministerial convergence mission initiated after NITI recommendations to reduce the problem of Malnutrition.
• Govt is implementing several schemes under ICDS as direct target intervention.
• Provisions
  • Aim is to generate Jan Andolan towards Nutrition. Use of technology, Reduce stunting, Under nutrition, Anaemia, Low birth weight, focus on Adolescent girls and P&LW.
  • It ensures convergence with various programs like Anganwadi Services, PM Matru Vandana Yojana, Scheme for Adolescent Girls, NHM, Swach Bharat Mission, PDS, MGNREGA etc.
  • Goals = It is a comprehensive approach to improve nutritional status of Children from 0-6 years, Adolescent Girls and Pregnant Women and Lactating Mothers in 3 years from 2017-18.
  • It will strive to reduce stunting, undernutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per year for 3 years.
  • Mission 25: It would strive to reduce Stunting target from 38.4% (NFHS – IV) to 25% by 2022.
  • 3 things = Technology, Behavioural Change and Targeted Approach.
  • Decentralized Governance and Good Governance.
  • 7 Components = Grievance redressal, Convergence, ICDS, Behavioural change, Incentives, Innovation, Training and capacity building.
  • Integration with Digital India = VHSN - Very high speed network.
  • Anganwadi Workers is integrated in this scheme.
  • Also include Breastfeeding.
• Funding: For 3 years from 2017-18 with a Budget outlay of 9046 crore.
  • 50% of 9046 crore is through Budgetary support with 60:40 (Center: States) for States; 90:10 Northeast and Himalayan and 100% for UTs without legislature.
  • The rest 50% will be given by World Bank or other Multilateral Development Banks.
• > 10 crore poeple will be benefited. All States and UTs covered.

National Nutrition Mission

1. It is perhaps the most ambitious Program of Central Government. Need for NNM
   1. Current efforts are fragmented. There is a need to bring together all relevant stakeholders on a single platform.
   2. The mission sets specific targets and a timeline for it.
   3. It has targeted Strategy consisting of a plan of actions and interventions.
   4. It targets behavioral change by social awareness and by creating a mass movement.
2. It has intro Central nodal agency with extensive financial resources to coordinate C-S schemes and imbue additional financial resources. Total outlay = 9000 Cr over 3 years.
3. Decentralized Governance.
4. Encourage local Solutions. Improving post harvest management.
5. Aims:
   1. Overcoming Calorie Deficiency - use NFSA.
   2. Protein Hunger - Milk, Pulses, Poultry consumption and Production.
   3. Hidden Hunger - Micronutrient deficiency by Genetic Garden of Bio-fortified plants and Farming System of nutrition Programme.
   4. Clean drinking water, Sanitation, PHC, Nutritional Literacy.
   5. Create a cadre of Community Hunger Fighters.
   6. Specific targets / Decline annually
      1. Stunting = 2%.
      2. Under nutrition = 2%.
      3. Low birthweights = 2%.
      4. Anemia = 3%.
   7. Key Implementation Strategy
      1. Outcome Orientation
      2. Incentives based on outcomes
      3. Data collection and monitoring.
      4. Coordination between different programs.
      5. Geographical convergence.
      6. Behavioral change through Jan Andolan.

National Nutrition Strategy by NITI Aayog

1. The nutrition strategy envisages a framework wherein 4 proximate determinants of nutrition – uptake of health services, food, drinking water and sanitation and income and livelihoods work together to accelerate decline of under nutritionin India.
2. Decentralized efforts: The Strategy envisages a Kuposhan Mukt Bharat – linked to Swachh Bharat and Swasth Bharat. Focus on behavioural change.
3. The aim is to ensure that States create customized State/ District Action Plans to address local needs and challenges with a greater role for panchayats and urban local bodies.

The Integrated Child Development Service (ICDS) Scheme, 1975 (Flagship)

• The Scheme has been renamed as Anganwadi Services. It is 1 of the World's largest programmes providing for an integrated package of services for the holistic development of the child.
• Funding: Centrally Sponsored Scheme. All components of ICDS except Supplementary Nutrition Programme (SNP) are financed through a 60:40 ratio. For SNP = 50:50. The North East states have a 90:10 ratio.
• Coverage: The scheme is universal covering all the districts of the country. Both Urban and Rural India.
• Objectives
  1. To improve the nutritional and health status of children in the age-group 0-6 years;
  2. To lay the foundation for proper psychological, physical and social development of the child;
  3. To reduce the incidence of mortality, morbidity, malnutrition and school dropout;
  4. To achieve effective co-ordination, implementation and enhance the capability of the mother.
• Components:
  1. Beneficiaries: Children of 0 - 6 years; Pregnant women and Lactating Mothers (PW&LM)
  2. 6 Services under ICDS: Provided at Anganwadi centers through Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs) at grassroots level.
     1. Supplementary Nutrition, Pre-school non-formal education, Nutrition & health education
     2. Immunization, Health check-up and Referral services. They are provided through NHM. Auxiliary Nurse Midwife.
  3. There will be 1 Anganwadi centre (AWC) for population of 400-800; 2 AWCs for 800-1600; and thereafter in multiples of 800 -1 AWC.
  4. The AWWs and AWHs are paid fixed salary of Rs.4,500/- and Rs.2250/- per month respectively. Workers of Mini-Anganwadi Centres are being paid honoraria of Rs.3500/-. In addition, monthly performance linked incentive of Rs.250/- is also being paid to AWH.
  5. Anganwadi Workers work in ARSH, SABLA and ICDS.
• Wheat Based Nutrition Program (WBNP)
  1. It is implemented by Ministry of Women and Child Development.
  2. Foodgrains are given to ICDS for providing food to children from 2 to 6 years and pregnant/ lactating women.
• ICDS Systems Strengthening and Nutrition Improvement Project (ISSNIP): To improve nutritional and early childhood development outcomes of children in India. To strengthen ICDS policy framework.
• ANGANWADI:
  1. Anganwadi is a type of rural mother and child care centre in India.
  2. It was started in 1975 as a part of ICDS to combat child hunger and malnutrition.
  3. It provides basic healthcare include contraceptive counseling and supply, nutrition education and supplementation, as well as preschool activities.
  4. It may be used as depots for oral rehydration salts, basic medicines and contraceptives.
• Anganwadi Worker responsibilities according to MoWCD rules:
  1. Community support, conduct regular quick surveys, pre-school activities.
  2. Provide health and nutrition education to families especially pregnant women on how to breastfeed, etc.
  3. Motivating families to adopt family planning.
  4. Educating parents about child growth and development.
  5. Assist in the implementation of Kishori Shakti Yojana (KSY) to educate teenage girls and parents. Identify disabilities in children, and so on.
• Anganwadi Worker (AWW) guides ASHA in performing activities such as importance of nutritious food, personal hygiene, care during pregnancy, importance of immunisation etc. Anganwadi worker is a depot holder for drug kits and will be issuing it to ASHA.
• ICDS Scheme Analysis:
  1. There are 13.79 lakh Anganwadis in the country out of which 9.31 lakh centers are linked to Government's web enabled data entry system called Rapid Reporting system. Out of them, only 1.09 lakh centers are in urban areas.
  2. For every 100 Anganwadi beneficiaries, only 7 are in urban areas. Because of lack of Anganwadis in cities, leading to poor coverage.
  3. World Urban Prospects 2018 given by UN DESA (Dept of Economic and Social Affairs) estimate urban population in India which, at present is 34%, will be 40% by 2030 and 50% by 2050. The need for Anganwadis in urban India is high.
• Center seeks to revamp child care scheme in urban areas
  1. NITI Aayog will develop draft policy. Urban areas are likely to receive a renewed focus under the govt’s ICDS programme, which provides for anganwadis or day-care centres for delivery of nutrition and pre-school education. Health and ICDS models that work in rural areas may not work in urban areas because of higher population density, transportation challenges and migration.
  2. 2018 Govt data says, of the 14 lakh anganwadis in India there are only 1.38 lakh anganwadis in urban areas.
  3. The CNNS Survey highlighted that malnutrition among children in urban India is characterised by relatively poor levels of breastfeeding as mothers have to travel long distances for work. It also found a higher prevalence of obesity because of relative prosperity and lifestyle patterns, along with iron and Vitamin D deficiency.