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 INDIAN JOURNAL OF PUBLIC HEALTH
(Quarterly Journal of Indian Public Health Association)

Journal Advisory Committee Vol. 52 No.2 April-June 2008

Dr. Deoki Nandan Coference Issue
Dr. Sandip Kumar Ray (52nd All India Annual Conference of IPHA 2007)
Dr. Ranadeb Biswas
Dr. F. U. Ahmed
Dr. J. Ravi Kumar
Mrs. Shuva Kumari

Editorial Board
Chief Editor
Dr. V. K. Srivastava
Editor
Dr. Samir Dasgupta
Associate Editor
Dr. R. N. Chaudhuri
Dr. Sanjay Chaturvedi
Joint Editor
Dr. D. K. Raut
Dr. A. B. Biswas
Assistant Editor
Dr. Kaushik Mishra
Dr. Prabir Kumar Sen
Indian Journal of Public Health is published quarterly by Indian
Managing Editor Public Health Association.
Dr. Dilip Kumar Das
Assistant Managing Editor Manuscripts and correspondence should be addresed to : Managing
Dr. Rabindra Nath Sinha Editor, Indian Journal of Public Health, 110 Chittaranjan Avenue
(3rd floor), Kolkata-700073, West Bengal.
Members
Dr. D.H. Ashwath Narayana Manuscripts, written in English, should be submitted in triplicate.
Dr. (Lt.Col.) Atul Kotwal One copy must also be submitted in electronic format to:
Dr. B. M. Vashisht ijph2005@yahoo.com, ijph@iphaonline.org
Dr. N. K. Goel
Dr. Prasant Kr. Saboth Papers submitted to the journal must be accompanied by a
Dr. D. M. Satpathy Certificate signed by all authors.
Dr. Chitra Chatterjee
Dr. Rabindra Nath Roy
Dr. Ashok Kr. Mallick Editorial Office:
Dr. Kunal Kanti Majumdar 110, Chittaranjan Avenue, Kolkata - 700 073
Secretary General (Ex-officio) Phone : 32913895 (033)
Dr. (Mrs.) Madhumita Dobe E-mail: ijph2005@yahoo.com / ijph@iphaonline.org
 Indian Journal of Public Health
Vol.52 No.2 April - June 2008

Contents
Editorial
Strengthening Public Health Education in India: New Initiatives 55
Dr. Faruqe U Ahmed
Dr. B. C. Dasgupta Memorial Oration
Efficient Management of Public Health Workforce 58
G.K. Ingle
Dr. A. L. Saha Memorial Oration
Continued Use of Asbestos: Market’s Signature on Science 61
Sanjay Chaturvedi
Dr. P.C. Sen Memorial Award Paper on Rural Health Practice
An Epidemiological Study of Low Birth Weight Newborns in the
District of Puruliya, West Bengal 65
R. Biswas, A. Dasgupta, R. N. Sinha, R. N. Chaudhuri
S. D. Gaur Best Paper Award on Environmental Health
Incidence of Summer Associated Symptoms, Host Susceptibility and
Their Effect on Quality of Life among Women 18 to 40 Years of Age
in an Urban Slum of Delhi 72
Pragya Sinha, D. K. Taneja, M. Dhuria, R. Saha
Annual Report of the Secretary General for the Year 2007 76
Minutes of the 52st Annual General Body Meeting 90
Audit Report 95

Special Article
Contemporary Issues in Public Health Governance – an Indian Perspective 96
S. P. Zodpey, H. N. Negandhi
Climate Change and Health: Methodological Issues and
Introduction to Climate Epidemiology 100
Atanu Sarkar
Short Communication
Leptospirosis among Patients with Pyrexia of Unknown Origin
in a Hospital in Guwahati, Assam 107
Juri B Kalita, H. Rahman
Letter to the Editor:
Presence of Food-Borne Microorganisms in Milk in and Around Guwahati city 110
A.G. Baruah, A.Z. Das, Chandana C. Barua, B. Nath
Salmonella Paratyphi A: An Important Cause of Typhoid Fever in Ludhiana 111
Aroma Oberoi, Aruna Aggarwal
55
Editorial
Strengthening Public Health Education in India:
New Initiatives
To strengthen the public health practice &
education, Government of India initiated establishing
a powerful body - the Public Health Foundation of
India (PHFI). The cabinet committee on Economic
Affairs contributed a corpus of Rs.200 Crores for the
purpose and the PHFI came into existence on March
28th 2006. It is an autonomously governed public
private partnership initiative. The Foundation is
managed by a fully empowered, independent
governing board that is represented by multiple
constituencies. PHFI basically aims to improve the
public health human resources capacity in India by
strengthening education in Public Health. The strategies
adopted for achieving the same are building new world
class institution(s) of public health in India,
strengthening existing institutions both within the
Government and outside & creating a critical mass of
high quality faculty in the field of public health. The
other objectives are to set standards in Public Health
education & improve quality of Public Health
education by clearly defining academic standards in
public health education, to strengthening research &
policy in Public Health by conducting high impact, India
relevant research in Public Health; using the research
findings to empower National program and enable
appropriate policy formulation & working with the
Government (Central and State), as also the private
sector, to create meaningful career tracts for Public
Health professionals. This was an epoch making
decision by the highest decision making body of the
country. It is also unique in its nature as it involves
both public & private and is fully autonomous in nature.
The members selected are the best in their fields but
only one of them is a trained practicing public health
professional. Besides the government official of the
department of health, no public health academician
or any educationist of repute public or private found a
place in the policy making body. As an afterthought
one public health teacher and a public health consultant
was employed after a considerable period. Though
PFHI’s main mandate is to improve public health
education & training and improve the quality of public
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
health practice & research, it ignored the existing public
health academicians and practitioners. The body never
tried to find out from these experienced teachers and
practitioners about the existing program and its lacunae
and how to strengthen it. The body can not deny the
fact that India have best of the indigenously trained
public health experts and also have a strong public
health teaching training program in the premiere
medical colleges of the country. It may not be adequate
to cater to the needs of the country. The body also
ignored the faculty members, present and past of one
of the most prestigious public health institute of the
South East Asia i.e. All India Institute of Public Health
& Hygiene. This institute along with the School of
Tropical Medicine contributed to the growth and
development public health not only in India but also
to many of the South East Asian Countries. The
decision of not involving the existing or past faculty
members & practitioners of public health and ignoring
them in the process of revolutionizing the public health
education and practice in the country is a great mystery,
which the most erudite members of the PFHI can only
answer. One reason may be that the PFHI want to
start the process on a clean slate. Or they are totally
influenced by the effectiveness of the public health
system of developed countries like USA, Australia and
they want to transplant the same models in our country.
But one should remember that public health in those
countries have achieved the present status when other
public services also have grown simultaneously and it
evolved according to the emerging pattern of public
and private governance and peoples’ socio-economic
and educational status. One should also consider the
fact that whenever such attempt was made to implant
any system without involving the existing system or
tailor it according to the local conditions it failed
miserably. Even Lord Macaulay felt the difficulty in
implanting the British model of education when British
sovereigns ruled the country! The rulers had to face
many trials and tribulation. Fortunately we are a
democratic country and any organs of government or
private organization is answerable to the civil society.
65 Editorial: Strengthening Public Health Education in India
It will be not so easy to impose a system without the
consensus of the civil society. The disadvantages of
transplanting a professional educational model from
an alien country are many. The foremost of those is
that the manpower thus trained may not be suitable to
our health system or their participation may change
the time-tested system to such an extent that may not
be suitable to our country. The rabid critics may say
that this tantamount to introducing a Trojan horse in
the health system of India to Americanize the system
without anybody’s knowledge. The other concern is
the standard of training. By taking out Public health
training out of the Health Universities are we not
committing the same procrustean crime which the
American Public Health Association has already
committed and now facing the consequences. It
reminds us the prophetic comments made by Mr.
H.S.Pritchett ,the president of Carnegie Foundation in
1914 on the separation of medicine and public Health.
He lamented the isolation of the hospital “the medical
school and hospital ought to form the very heart of
those agencies by which the state undertakes to deal
with the public health” But unfortunately the medical
and public health education came to be rigidly
separated in the early 20th century in USA. The “Welch-
Rose report of 1915” is often looked to as critical
moment in the history of institutional schism. In
America it was the faculty member of the Preventive
medicine & hygiene who endorsed the schism. Dr.
Milton Rosenau, professor of Preventive Medicine and
Hygiene at Hravard Medical School explained the need
for separate public health schools in the Journal of
American Medical Association (LXV, July 24,1915:321)
“ The teaching of hygiene is becoming increasingly
difficult… It is slowly be recognized that the training
received for an MD degree even in our best medical
schools does not properly fit a man to enter public
work” At that period to define a distinctive boundary,
public health leaders urged the establishment of
independent schools and a separate profession. It was
the fear among the leaders of public health education
of becoming “appendages” to medical school
prompted them to separate public health education
from medical schools. In India over the years we have
evolved a system of training basic doctors with training
in public health as well as train postgraduates in public
health in a medical schools. The momentum of the
training program has just started and showing results,
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a high-powered body created by the Govt. of India
decides to separate it from the medical education. The
current system is also covered by a regulatory body,
which maintains the standards, but for the newly
created institution, which will be the regulatory body
to ensure the standard and quality of the training and
its relevance to the country. All the above speculation
may also be wrong. It is only the members of the PFHI
who can clear all the queries any citizen may have.
PFHI is a public institution suppor ted by the
Government of India and is definitely answerable to
the civil society about its functioning and its contribution
towards improving public health. The web site did not
say anything except for the news of training some
Doctors in some prestigious public health schools of
USA and some meeting and the partnership with some
international NGOs for research funding etc and also
advertisement for the post of Director for some Schools
of Public Health in some States. It is high time that
PFHI should share their plans and programs so that
all the apprehension may be removed. This will help
in building a trust between the existing public health
academician, practitioner and other health
professional. We as public health practitioners and
academicians in the country should also oppose tooth
& nail the attempt of dichotomizing Medical education
and Public Health education by a group of non public
health persons. It will be disastrous to our health
programs and plan. This is also the time for the public
health academician, researchers and practitioners of
India to come forward forgetting ones’ personal and
altruistic motive and join hands to work together to
improve the Indian Public Health. But these platforms
were made available to us by other organization. The
only organization for Public Health academician and
practitioner is “Indian Public Health Association”. The
members of the IPHA over the years deliberated the
improvement of the public health in India as well as
education by ad hoc committees but it was not a
continuous process and we did not have a permanent
platform to deliberate on the current public health
issues, programs and policies and its impact on public
health as well as suggest evidence based appropriate,
universally accessible, acceptable and affordable
program as per the communities need. To achieve the
same, a platform “Indian Academy of Public Health
(IAPH)” has been established by the generous support
of all the members of IPHA in the last meeting of IPHA
75 Editorial: Strengthening Public Health Education in India

at New Delhi. The IAPH is the platform of the public
health professionals of India to improve the quality of
public health education, conduct research on issues of
public health importance, help the central & state
government to plan, implement different national
health programs as a group and also critically analyze
the health problems and existing intervention and
suggest the most effective measure suited to the
community at large. They should also as a group be
vigilant and resist any move to destabilize the existing
health system by bifurcating public health education
from medical education by any organization. All the
public health professionals trained in India and are
practicing in India who has given their sweat in
achieving the public health goal in India should be
proud of their past contribution and also be active in
furthering the cause of public health teaching and
practice in India. As public health professionals we are
open to listen to the others point of view and lend our
hand if we are convinced that it is furthering the interest
of Public health at large. Our collaboration in the
successful implementation & substantial contribution
to the Integrated Child Development Scheme (ICDS)
and IndiaCLEN Program Evaluation Network (IPEN)
is a glowing example of joint collaboration in furthering
public health cause in India. Members of IPHA should
also remember that whatever difference may have
aroused between Public Health and Medicine in the
20th. Century, the new millennium reflects a promising
opportunities for an effective partnership to achieve
the millennium goal through the effective collaboration
between public health and medicine.
Dr. Faruqe U Ahmed
Principal, Khaja Bandanwaj Institute of
Medical Sciences
Gulbarga, Karnataka.

Announcement for Awards

1. P. C. Sen Best Paper Awards on Rural Health Practice
2. S. D. Gour Best Paper Awards on Environmental Health
Members interested to participate in the competition for these awards are requested to send six
copies (along with a floppy/CD) of the article with a certificate stating that paper has neither been
published nor been considered for publication in any journal any where.. The paper should be
sent to the Secretary General at the IPHA HQ, Kolkata by 30th September 2008. Papers will be
screened by the Award Committee and sent to a panel of reviewers for assessment. If the article
obtains 50% marks then this will be allowed to be presented during the conference. Presentation
will once again be judged by a panel of judges and marks will be alloted upto a total of 50. Best
paper will be judged out of 100 marks with a minimum eligibility criteria of 50 marks. These
criteria subject all to periodic revision by the Award Committee.

Prof. Madhumita Dobe

Secretary General, IPHA

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85 Editorial: Need for Citizens Group to Monitor NIDDCP in India
Dr. B.C Dasgupta Memorial Oration
Efficient Management of Public Health Workforce
G.K. Ingle*
Situational Analysis:
The rank of India on human development index
scale 128 out of a total of 194 countries does not reveal
a very healthy public health situation and the Health
profile of the country shows concern. A number of
policies are outlined for improving health of the people
and programs are being implemented but achieving
the goal of health for all or millennium development
goals seems to be difficult in near future. Except for a
few health indicators viz. the crude death rate and life
expectancy at birth, we could not achieve any of the
targets laid down in relation to health indicators for
reduction in mortality, reduction in morbidity, utilization
of health care ser vices, etc. The quantum of
achievements is still not comparable to the developed
world. Health of the people is determined by large
number of factors namely age, sex, constitutional
factors, individual life style factors, social and
community networks, agriculture and food production,
education, work environment, living and working
conditions, unemployment, water and sanitation,
housing, general socio-economic, cultural and
environmental conditions and health care services etc.
At best, the health care services can only contribute
twenty percent in achieving the goal of health of the
people. For remaining eighty percent other enumerated
factors are responsible.
The health care delivery system in India is
mixed type of system where public, private, non-
governmental agencies, defence, railways and many
other agencies are involved in providing health care
to the people. As public health professionals, we play
a significant role in management of health care delivery
system particularly the public sector health care delivery
system. For best possible health care management,
resources adequate in terms of quality and quantity
are required. Resource allocation, distribution and
efficient utilization are of vital importance in the best
*Director Professor and Head, Community Medicine, Moulana Azad Medical College, New Delhi.
Correspondence: inglegk@gmail.com
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management of health care system. Out of various
resources such as money, material, manpower,
minutes, machines, methods, marketing, the
manpower resource is the most important resource.
The allocation of resources is under political and
bureaucratic control. We, the public health
professionals have to manage within the constraints
of the limited resources provided to us. All of us are
working as managers at various levels of Health care
delivery system. There is a general perception and to
a great extent a reality that the health work force
particularly working in the public sector is working at
a very low efficiency level. If we learn to manage the
available resources efficiently, then significant positive
impact can be made on the health of the people and
Nation building. Efficiency of the Health work force
can be enhanced by getting right people for the right
jobs, providing proper leadership, motivating,
supervising and building the capacity of the health work
force, providing guidance and counseling as and when
necessary and thus improving the outcome.
Leadership for efficiency:
Leadership in the health system occupies a special
place in the management of the health workforce. The
definitions of ‘leader’ are multiple but all have a
common characteristic – A leader has the ability to get
the best out of the people. This particular characteristic
goes a long way in improving efficiency and motivating
people. The dual-fold role of a leader i.e. his ability to
develop the subordinate group by identifying the
competence / deficiencies and making optimal use of
these on the one hand and on the other, taking steps
in order to rectify and address these deficiencies, is of
vital importance. A leader with clear vision who
empowers the team members to actively participate in
the program and is able to direct the process and
achieve consensus can make a significant impact. In
the existing situation, the health system needs
95 Ingle GK: Efficient Management of Public Health Workforce
leadership at various levels of health care delivery
system to achieve the long term goals and objectives.
There are many theories and models of
leadership. The situational leadership model of
Blanchard based on supportive behavior and directive
behavior proposes four distinct leadership styles like
delegating, supporting, coaching and directing
depending on the combination of situations. These
styles can simply be translated and effectively utilized
by understanding the level of willingness and ability of
the health personnel. For example, delegating style of
leadership is most appropriate for a person or a group
of people where the level of willingness to work is high
and the ability is also of high level. Similarly, coaching
style of leadership is very effective when the willingness
is high but the ability is low. A low willingness – high
ability situation demands participating style of
leadership while directive style is best suited for low
willingness – low ability situations.
According to the X & Y theory propounded by
McGregor, Theory X assumes that “Man is inherently
lazy and avoids responsibility” and theory Y assumes
that “Work is a natural human activity capable of self-
fulfillment”. The chief task of the leader is to create a
favorable climate for growth and hence a positive
attitude is indispensable in leading and motivating
people.
Motivation has important role to play:
For a required outcome, the work-force needs to
work efficiently and for efficiency the person needs to
feel motivated continuously. Out of many theories of
motivation the ‘Theory of Need Hierarchy’ postulated
by Abraham John Maslow and the ‘Two-Factor Theory’
of Herzberg are very simple to understand. Different
people have different needs and different factors
motivate them. Within the given environment, the
needs require to be identified and fulfilled. The higher
needs of people do not become operative until lower
needs have been met and at the same time a need
that has been satisfied is no longer a motivating force.
According to Herzberg, if adequate hygiene factors
such as security, salary, etc. is not given then the person
will definitely feel de-motivated however providing
these factors may not necessarily result in motivation.
On the other hand, motivational factors such as
recognition, job-satisfaction, or feeling of
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
accomplishment will always motivate the people to
work. The manager should study these theories of
motivation and utilize them effectively. The key is
identifying “what makes people work?”
Communication for efficiency:
During the course of time it often appears that
nothing seems to work in some situations – it is then,
that the true importance of communication is revealed.
Considering the fact that middle and top level
managers devote sixty to eighty percent of their total
working hours to communication it is rightly said that
a good communication is the foundation for sound
management. Almost all issues can be addressed
sooner or later if there is a proper, two-way
communication. It is also the key in resolving any
conflict situation in an organization. These situations
are estimated to take up around twenty percent of the
time in an organization and can be quite a nightmare
for the manager. The best alternative would be to
prevent the occurrence of conflicting situations, which
is far easier said than done, but simple things like giving
due consideration to human elements and reducing
disparity among “likes” often go a long way towards
this end. Conflicts arising despite these preventive
measures should be resolved with a “win-win” situation,
as far as possible. The communication should be of ‘I
am OK You are OK’ kind as each person has validity,
importance and equity of respect. It is a simple but
powerful concept that a manager needs to understand.
Conflict management for efficiency:
Counseling of the aggrieved parties and
encouraging the use of stress management techniques
like Yoga and Meditation can prevent the occurrence
and recurrence of such situations as well as help in
creating an environment conducive to work. Conflicts,
which have been traditionally viewed as ‘always
harmful’ are now being accepted as logical and even
inevitable. The task of a manager therefore should not
be to eliminate conflict but to manage it in such a way
that its beneficial effects are maximized and negative
or harmful effects are minimized.
Other measures:
There are other important issues related to the
efficiency of the health work force. It should be ensured
06 Ingle GK: Efficient Management of Public Health Workforce
that people are entrusted with responsibilities which
suit their attitude as well as aptitude. The health
manager should ensure that the responsibilities should
be clearly chalked out and there should be no
ambiguity whatsoever. At the same time it is essential
that the scalar chain in the organization should be
realistic and the supervisor should not be directly
responsible for the supervision of more than eight
subordinates.
The use of monitoring tools like the Gnatt Chart
and Work Plans by the supervisors & managers and
the work force in consortium, helps in achieving time
bound targets, increasing the overall efficiency. The
supervision should never be a “fault-finding-mission”
and instead an opportunity to reward the performers
while contemplating disincentives for the non-
performers. The scope for the personal development
and skill improvement should always be provided to
the employees.
Although we speak of the health work force
striving towards a common goal, the concept of a
“Health team” has not really found ground in the
Indian scenario. A team spirit becomes all the more
essential in Public Health wherein people with widely
different skills, abilities and competence levels have to
work together towards some common goals. Whenever
a group is assigned some task, it goes through various
phases viz. forming, storming, norming and
performing. The understanding of these characteristics
of group dynamics is important for continuation of the
task and the achievement of the desired objectives.
Networking assumes a central role in identifying
like minded individuals who can ultimately form an
efficient health team. In a larger perspective,
networking between public health bodies can aid in
arriving at a consensus on a variety of issues of Public
Health Importance and provide guidelines and
framework for implementing government policies.
Challenges:
The challenges to improve efficiency of the health
workforce particularly in the Public Health Sector are
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many. Perhaps the biggest challenge would be
addressing the attitude of the health work force. A
positive attitude is essential for any successful future
endeavor and it becomes imperative to instill this into
the minds of the health team. Perception goes hand-
in-hand with the attitude and is an important
determinant of efficiency. In addition, the public sector
including the Health, is plagued by problems related
to the Unions and politics that arises from them. Vested
interests of people at various levels result in creation
of obstacles in implementing sound managerial
decisions.
Keeping these in view, it is a formidable task for
the managers to provide an environment that is
conducive to work and development of the
organization. Nonetheless, a never-give-up attitude of
the managers is a necessary pre-requisite in addressing
these challenges.
Role of Medical Colleges:
The medical colleges and the professional bodies
have a larger role to play in producing quality managers
for Public Health. The departments of community
medicine should organize short term training courses
for various levels of health functionaries. This includes
managerial trainings and courses for various categories
of health personnel thereby bridging the gap between
demand and supply of quality managers. At the same
time it should be ensured that these managers are
provided the right platform to per form. The
professional bodies can lobby for the creation of a
separate public health cadre thereby increasing the
opportunities available to fresh public health graduates.
The issues raised in the preceding sections are by
no means a comprehensive description of the existing
situation and the solutions needed. It is only an attempt
at providing the guidelines that a manager has to be
well versed with. Innovative solutions catering to the
demands of the situation and replication of successful
models elsewhere are much needed.
16
Dr A. L. Saha Memorial Oration
Continued Use of Asbestos: Market’s Signature on Science
Sanjay Chaturvedi*
Enormous and continued release of several
carcinogens in the environment is being justified as
price of development. Weak politics, weak legislation,
half-hearted enforcement and strong and defiant
corporate may be some of the reasons behind such a
situation. But can all this happen without weak science
or collaboration of some sections of civil society and
scientific establishment? The case of asbestos is a
specimen that gives us some insight. Information
showing asbestos-cancer relationship was available as
early as the 1940s. During next 2 decades, enough
epidemiological as well as experimental evidence was
generated to prove this relationship. For half a century
the asbestos industry, in collaboration with some of
the leaders of occupational and respiratory medicine,
was able to suppress most of this data. Meanwhile,
millions of people were exposed to this proven
carcinogen and hundreds of thousand died. Now we
have a job on our hands - for a century - to combat
the insult. The knowledge that asbestos causes cancer
became public in the 80s - not because of scientific
community but as a result of prolonged struggle and
legal actions by ordinary people. Isn’t it a profound
statement on our governance, our corporate, our
science and to an extent – our romantic faith in civil
society?
Background
The basis and the level of carcinogenicity of
fibrous minerals has been a matter of intense enquiry
all through the latter half of twentieth century. An
important group of such minerals is known by the
generic term asbestos. There are four commercially
important forms: chrysotile; crocidolite; amosite; and
anthophyllite. Of them, the chrysotile alone accounts
for 95% of global asbestos production and most of it
comes from the province of Quebec, Canada.
Chrysotile is a fibrous hydrated magnesium silicate.
*Professor of Community Medicine, University College of Medical Sciences and GTB Hospital, Delhi.
Correspondence: cvsanjay@hotmail.com
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There are several accompanying minerals in the fibrous
ores, and fibrous amphibole may be among them -
especially the highly carcinogenic tremolite. Low
concentrations of chrysotile are found throughout the
global crust (air, water, ice caps and soil) but the human
activities contributing to fiber aerosolization and
distribution in the environment are chiefly occupational.
Asbestos cement industry is the largest user (85% of
total use) of chrysotile fiber.
History of corporate interests
Release of information on carcinogenicity of
asbestos which had previously been suppressed by the
industry has raised several questions about the
credibility of bio-medical research that is being
sponsored or indirectly promoted by market-centric
forces. Following sequence of events, revealed during
the court proceedings, investigations, and the case
study conducted by Lilienfeld, DE illustrates the
powerful role of the industry, and its major actors in
scientific establishments while dealing with the matters
related to peoples’ health:
• In early 1900s, academic leadership in
occupational medicine begun to emerge. Dr.
Anthony Joseph Lanza established himself as an
expert on pneumoconiosis.
• In the wake of legal challenge from workers, the
mining industry started questioning the diagnosis
of dust induced pulmonary diseases. In 1920
Lanza left Public Health Service and was hired
by corporate agencies.
• Until late 1934, the efforts of the industry were
directed at keeping the research findings
confidential. When Saranac Laboratory released
some data unfavorable to the industry, Lanza
pulled up the Saranac Laboratory for this release.
· Outright deception by the industry began in 1934.
26 Chaturvedi S: Continued Use of Asbestos: Market’s Signature on Science
• After his retirement in 1948, Lanza founded the
Institute of Industrial Medicine at New York
University, built a team of experts and kept his
connections with the corporate alive.
• Industrial Commission of Illinois promulgated a
rule that the substances harmful to employees’
health should be duly labeled. Asbestos
companies were asked to comply. For unknown
reasons, the warning label was not added to the
bags for another thirteen years.
• Dr. A.J. Vorwald, the successor of pioneer work
by Gardner and colleagues, attempted to
investigate fur ther the asbestos-cancer
relationship. After ending his tenure at Saranac
Laboratory, he sought employment as a professor
at a California institution. Lanza flew to California
to prevent the offer. The expenses of the trip were
paid by industry. Dr. W. Smith also met with a
similar fate.
• By early 1960s, the industry and its associates
succeeded in suppressing much of the information
on asbestos and cancer, generated during
previous twenty years.
• During the same period, a parallel stream of
academic scientists and physicians, like Selikoff
and Wagner, kept publishing their data
establishing the relationship between asbestos and
malignancies.
• By the late 1970s, the industry was under attack
in the press and in the courts. Members of
Congress started calling representatives of
industry as “liars”. Legal proceedings that
followed, made many confidential documents
public.
• Lilienfeld writes that the degree to which scientific
fraud permeated published reports is also of
concern. He also asserts that unemployment or
withdrawal of research support may be the
ultimate ‘reward’ for those who do not participate
in such activities.
Today we have sufficient epidemiological and
clinical evidence that besides causing a progressive
fibrotic disease of lung called asbestosis, asbestos also
causes: cancer of lung; malignant mesothelioma of
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
pleura and peritoneum; cancer of larynx; and some
gastrointestinal cancers. The nature and amount of
evidence goes beyond any scientific controversy and
in acknowledgment of this body of evidence, the
Environmental Protection Agency (EPA) and the
WHO’s International Agency for Research on Cancer
(IARC) have declared asbestos a proven human
carcinogen. When doubts were raised against the
approach of declaring all forms of asbestos as
carcinogenic and it was suggested that some particular
asbestos-types might not be causing cancer, the issue
was carefully considered among the wider scientific
community. In the light of hard scientific evidence
IARC-WHO acknowledged that all forms of asbestos
are known carcinogens. All have been shown through
epidemiological, clinical and laboratory studies to be
fully capable of causing lung cancer, mesothelioma and
a whole range of asbestos related diseases. WHO
Environmental Health Criteria 203 states that no
threshold has been identified for carcinogenic risks i.e.
no exposure can be considered as safe.
Since the asbestos use is being made increasingly
difficult in developed world, the global asbestos
corporate is trying to create new markets in the
countries with weak legislation. Over 42 countries have
banned all forms of asbestos, including chrysotile.
Others have planned a 3-5 year phase-out of asbestos
use. The deadline for prohibiting the new use of
chrysotile was 1st January, 2005 - other forms of
asbestos having been banned previously - in all 25
member states of the European Union. In contrast, the
Indian asbestos companies continue to flourish in pro-
asbestos climate. Rapid growth potentials are being
used as a ploy to stall the process of asbestos-ban.
Market stakeholders have a strong incentive. They are
influencing policy to ensure a constant reduction in
asbestos custom duties. Rising revenue and increasing
manufacturing capacity of all major asbestos players
make asbestos a ‘good investment’ in share market
according to financial analysts and advisors. New
production units of asbestos cement products are
getting operational every 2-3 years. Vast majority of
this hazardous produce (80%) is used for rural low
cost housing, schools and industrial structures.
Recently, efforts were made to use asbestos products
in the rehabilitation work for the tsunami victims, even
when safer, non-inflammable substitutes existed.
36 Chaturvedi S: Continued Use of Asbestos: Market’s Signature on Science
Abuse of mass media
To dominate the Indian asbestos agenda, a
corporate-sponsored misinformation campaign has
taken aggressive mode in public domain. We have seen
a media blitzkrieg of pro-asbestos propaganda in 2003-
2004. Initially it started with full page advertisements
in most of the national dailies and magazines,
appearing on regular basis. Then came the spate of
special supplements, full page features and news
stories. They were apparently authored by the asbestos
cement manufacturers but the credit line was either
anonymous or belonged to the newspaper, providing
much needed reach and credibility to the industry. Most
of them have misreported scientific papers and
proceedings. One such specimen is illustrated here.
On 15 Jul 2003, a leading and highly respected
national daily of India – The Indian Express published
a full page (coloured) feature entitled - ‘Blast those
myths about asbestos cement’ in its main edition. It
was published as a special feature by The Indian
Express. There was no credit line, and nowhere was it
written that the feature is contributed by asbestos
manufacturers. The feature, illustrated by coloured
photographs, had 2 five column articles, 1 triple column
article, and 2 box items - full of misleading and quasi-
scientific information.
Let us examine some key assertions made in the
feature. While arguing - “mesothelioma is not reported
when only chrysotile is used”; “this conforms to western
studies where no increased risk of lung cancer is focused
in asbestos cement factories where only chrysotile fibre
is used”; and “asbestos sheets are of non-toxic nature”,
the Express feature ignores WHO Environmental
Health Criteria- 203 as well as IARC-WHO
recommendations. In fact, it goes on to rationalize its
stand on asbestos, by asserting further - “..disease
would occur with a prolonged exposure of 5 to 20 fibers
per cc over a period of 40 years. The current Indian
exposure is less than 1 fiber per cc”. This is also in
contradiction with the WHO Environmental Health
Criteria-203.
The writer of this article made all of these facts
available to The Editor, Indian Express, and argued
that: a. the readers of Indian Express have a right to
know about these facts as well; b. since it was not made
clear that the feature was contributed by industry,
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
readers will take it as an Express feature, and unless
scientific facts are made available to them – it will only
serve the purpose of industry by providing them
podium, credibility and reach of The Indian Express;
and c. such type of one sided coverage can hardly be
called a debate either. The newspaper did not respond
to repeated communications and rejoinders from the
speaker (Jul 18, Jul 24, Aug 5, and Nov 17, 2003).
Nor did it publish the scientific facts countering its
feature. While expressing her disappointment on
publication of the feature, the guest editor of the
asbestos issue of International Journal of Occupational
and Environmental Health wrote to Express on Aug 4,
2003: “…With time, Western countries realized that
asbestos was a lethal substance and banned its use.
Unfortunately, global asbestos producers decided to
continue their trade in this class1 carcinogen and
targeted users in developing counties. It is appalling to
realize that a substance which is mined in Canada and
is deemed too hazardous to be used at home is
exported to India. The Canadian asbestos industry
continues to profit while workers and the public in India
continue to die from asbestos-related disease. There
is no excuse for the continued use of this material. In
September, 2003, Canadian and international experts
will be attending a conference in Ottawa……I suggest
that if your journalists truly wish to appreciate the extent
of the damage done by asbestos, they cover this
conference…” This letter too failed to generate any
response from the newspaper. After good five months
- on Dec 11, 2003, the newspaper published a small
double column piece in its middle pages, providing
some scientific facts. This may be purely incidental since
the piece had no reference to the Express feature on
asbestos. The damage was already done.
The unabashed abuse of clout and money by the
Indian asbestos industry continues under the garb of
freedom of expression. Web-based electronic news
papers are following such stories. Counterpoints and
protests are either ignored or marginalized to small
inconspicuous letters. We can’t expect a dramatic
change in the character of big media. It is not a simple
case of funding alone. In fact, the corporate owns most
of the channels of mass communication by proxy.
Financers have acquired a direct control over editorial
policies and space for independent opinion has been
pushed to margins. In this climate, there are no level
playing fields and asbestos industry is likely to enjoy a
46 Chaturvedi S: Continued Use of Asbestos: Market’s Signature on Science
huge clandestine support by hidden persuaders. A false
propaganda is being played out in public, without any
visible opposition. The only way out seems to be an
organised intervention by academics and health
professionals along with systematic partnership with
people. It would be fatalistic to say that academics don’t
stand a chance against media onslaught. Even a single
vote matters and can start a critical motion for huge
changes.
Newer developments
Consequent to the newer debates about chrysotile
form and significant decline in high-dose asbestos
exposure, at least in the developed world, the focus of
research is now shifting towards supposedly low level
of carcinogenicity of a particular type of asbestos and
its effects with non-occupational low-dose exposure.
The scientific basis behind EPA’s recommendations has
also been challenged. It has also been suggested that
there may exist a threshold level of exposure to asbestos
below which no carcinogenicity is seen. These newer
interests create a space for further research. However,
the situation may take a worrisome turn when some
of these scientific inquiries are used by the industry to
its advantage. The lure of sales may prompt corporate
forces to turn this scientific curiosity into profitable
confusion.
Efforts have been made by the academic
community to make a considered opinion and settle
the issues revived or created by the newer debates.
Through an editorial, the NEJM quotes landmark
research conducted by Selikoff and colleagues to prove
the point that chrysotile, like all other forms of asbestos,
is a potent human carcinogen. The editorial concludes
that the amount of chrysotile already released in the
environment creates a situation where its exposure
remains the leading cause of mesothelioma in the
world. A commentary in The Lancet counters the
suggestion that chrysotile could be commercially used
with very little health risk. As for the lung cancer, the
basis of assertions about safety of chrysotile is very
precarious. Though these fibers are not commonly
found in large quantity at necropsy for they are rapidly
cleared from human lung, their carcinogenicity in
animal models is well established. As already been
mentioned, the confusion created by the arguments of
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
safe limits has also been settled by WHO
Environmental Health Criteria – 203, while rejecting
the idea of threshold.
A word of caution!
Cessation of further release of asbestos in the
environment is one important goal to be accomplished.
However, a studied restraint is needed while dealing
with the asbestos that remains as a legacy of past
construction practices in millions of schools, homes and
commercial buildings. This is to be borne in mind that
manipulation of friable asbestos products may be an
important source of chrysotile emission in the
environment. Mistakes have been made in the past
while handling the asbestos already used in buildings.
Asbestos containing materials that have already been
installed in a building should be protected from
manipulation, periodically inspected for deterioration
and be left alone undisturbed as long as they are intact.
Where do we go from here?
The empirical evidence is compelling to argue
against any relaxation of public health control over
any type of asbestos. Recent efforts to portray chrysotile
asbestos as safe, are inaccurate - and the assertions
that chrysotile asbestos can be used without risk are
contrary to facts and extremely dangerous. On the
positive side, it is getting clearer that the most dire
predictions about an epidemic wave because of non-
occupational exposure to chrysotile have shown little
evidence of materializing. The risk is low but not nil
Scientific inquiry must proceed but as long as safer
substitutes exist for almost all asbestos products, the
proposition of releasing more asbestos in the
environment, or of relaxing pressure will be disastrous.
India imports as well as fabricates asbestos. Imports
are likely to continue under the pressure of domestic
demand unless we promote and popularize safer
substitutes e.g. PVC, steel, PVA, aramid, cellulose. Cost
considerations are often used as a deterrent. In certain
cases, substitutes may be costlier initially but with the
increasing demand and mass production, the cost will
rapidly come down. The argument of substitution cost
needs to be seen in the perspective of the total cost of
asbestos related burden on health.
56

Dr. P.C. Sen Memorial Award Paper on Rural Health Practice

An Epidemiological Study of Low Birth Weight Newborns in the
District of Puruliya, West Bengal
*R. Biswas1, A. Dasgupta1, R. N. Sinha2, R. N. Chaudhuri3
Abstract
Background: A community-based epidemiological study on birth weight of newborns was
undertaken in the rural domain of a backward district of West Bengal. Objectives: To find out
the magnitude of low birth weight (< 2.5 kg.) newborns and to highlight association, if any, of
the socio-demographic, maternal and obstetric factors with birth weight of newborns. Methods:
The study was undertaken in 30 sub-centre areas (cluster), selected by ‘30 clusters sampling
technique’, in the rural area of Puruliya district. An adequate sample of 512 newborns (466 plus
10% extra allowance) delivered in those selected clusters (17 consecutive deliveries in each cluster)
were to be studied. But, due to inability to record birth weight within 48 hours (in home deliveries)
and other reasons, 487 newborns were included in assessing magnitude of the LBW problem. In-
depth information on several variables was obtained from 439 mothers of the newborns. Health
Workers (F), Anganwadi Workers, Trained dais and Health Supervisors -(F), specially trained
for the survey, collected information by using pre-designed and pre-tested proforma. Results &
conclusion: The incidence of LBW was 31.3%. Among different variables studied, statistically
significant association was found in case of educational level of mothers and also place of delivery
of newborns. More such community-based studies should be conducted
Key Words: Birth Weight, Newborns, Low birth weight, Factors, Community based study

Introduction: common among LBW neonates5. LBW infants who

Birth weight is a reliable and sensitive predictor
of a newborn’s chances for survival, growth and long-
term physical and psychosocial development. A low
birth weight (LBW) baby is one weighing less than 2500
gm. at birth 1, which may result from either short
gestation (prematurity) or from intrauterine growth
retardation (IUGR), or both. In our country about two
thirds of LBW babies are born at term but are small
for dates whereas in the developed countries, the
overwhelming majority of low LBW babies are
preterm2, 3. Babies with low birth weight are at greater
risk of dying during infancy and at significant risk of
increased morbidities during childhood2, 3,4,5. Nearly
80 percent of neonatal deaths and 50 percent of infant
deaths occur among LBW neonates2. Major perinatal
– neonatal problems such as asphyxia, infections,
hypothermia and malformations are remarkably more
1Professor,
Department of Preventive and Social Medicine; 2Assistant Professor, Deptt. of Maternal & Child Health,
3Professor,
Deptt. of Maternal and Child Health, AIIH & PH, Kolkata.
*Corresponding author: biswas_ranadeb@rediffmail.com
survive the birth asphyxia are liable to develop
malnutrition, recurrent infections, and neuro-
developmental handicaps2,5. Increased susceptibilities
of LBW and IUGR babies to suffer from diabetes
mellitus, hypertension, stroke and coronary heart
disease in later life are amply documented in recent
literature2, 3, 6.
At the family level, the cycle of poor nutrition
perpetuates itself across generations. Low birth weight
girls, in the absence of positive intervention to break
the cycle, grow poorly, become stunted women and
are more likely to give birth to LBW babies7. LBW
prevalence of a country is a good summary measure
reflecting its public health problems and has been used
as a very sensitive public health indicator for all the
developing countries, including India 4.
Globally, 15.5% of newborns are of low birth

8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI

66 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal
weight. In developing countries, LBW problem is more
than double (16.5%) the level in developed regions
(7%) 4. In India, over 30% of newborns are born
LBW2.A multicentric ICMR study revealed incidence
of LBW as high as 38.1% in rural population and
41.4% in urban slum population 5. National Family
Health Survey, 1998-99 revealed that among children
for whom birth weight were reported, 23% weighed
< 2.5 kg, which was higher in rural areas (24%) than
urban areas (21%) 8. Statewise, in West Bengal, one
fourth of the babies (25%) were low birth weight (urban
21% and rural 29%)14.
LBW remains a major public health problem in
many developing countries, including India.
Recognizing the impor tance of birth weight
measurement, the 34th World Health Assembly, in
1981, included it as one of the global indicators for
monitoring of health of the community 9. Again,
reduction of LBW babies by at least one third of the
current rate between 2000 and 2010 is one of the major
goals in ‘A World Fit for Children’, the Declaration and
Plan of action adopted by the United Nations General
assembly special Session on Children in 2002 4. At
the national level, both in the Child Survival and Safe
Motherhood Programme and Reproductive and Child
Health Programme in India, the need of reduction of
LBW problem, early identification of LBW babies
delivered at home and their appropriate management
either by supervised domiciliary care or referral to
health institutions have been reiterated10, 11.
Birth weight is routinely measured and recorded
in babies delivered at health institutions. In most of
the developing countries, majority of newborns are
delivered at home and are unlikely to be weighed4, 6.
Available data on magnitude as well as risk factors of
LBW from different parts of the world are based on
institutional deliveries and thus cannot be considered
representative of the large population born at home.4,6
In India also, household survey data as per
National family Health Survey of 1998-99 shows that
only 34 % births took place in health institutions. In
rural areas only one-quarter deliveries were in health
facilities8. But, more disturbing reality is that only 30%
of babies born in the three years preceding the survey
were weighed at birth8. Even for babies that were
weighed, some mothers did not remember the birth
weights. Among children for whom birth weights were
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
reported, 23% weighed < 2.5 kg (LBW), which was
higher in rural areas (24%) than in urban areas (21%)
8. A critical examination of nationally representative
Demographic and Health Surveys (DHS)6 conducted
between 1990 and 2000 revealed that babies whose
birth weights are not recorded tend to be of lower
socioeconomic status, and tend to have lower birth
weights. Births that were weighed were more likely to
involve mothers who were better educated and resided
in urban areas. They were also more likely to be
delivered in a medical facility and with assistance from
skilled health personnel. These characteristics are
generally associated with higher birth weights and,
therefore, the resulting estimates were likely to
underestimate the level of low birthweight6. There is a
genuine concern whether estimates of LBW from health
facilities and / or from nationalized surveys in
developing countries are representative of the large
population born at home.
Risk factors of LBW in the form of determinants
of prematurity and IUGR have been identified12. But,
as system of birth weight recording of babies delivered
at home is almost non-existent in developing countries
research studies were mainly facility based. There is a
great need of conducting community-based studies to
find risk factors of LBW.
With the above background and in the light of
relevant literature, a community-based epidemiological
study was undertaken in the rural domain of one of
the backward districts of West Bengal to find out the
frequency of LBW newborns delivered at home or in
health institutions and also to find out association, if
any, with sociodemographic and obstetric factors and
birth weights of newborns. Dietary habits of pregnant
mothers were also looked into.
Materials and Methods:
This community-based epidemiological study on
LBW was undertaken in the rural communities of
Purulia District of West Bengal during the year 2004-
05.
Study area13: Purulia is a border district of West
Bengal closed to Ranchi district of the state of
Jharkhand of India. It has a difficult, rocky terrain
and considered as a dry district. The district is relatively
less populous (25.35 lakh), less urbanized (10% only),
76 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal
sharing 7.05% of land area and 3.16% of the state
population. Population density, 405 per sq. km., is
the lowest among all the districts. People are mostly
Hindu (83.4%), Muslims constitute 7.1% only.
Scheduled tribe population of the district (18.3%) is
much higher than that of West Bengal (5.5%). Literacy
rate is relatively poor (55.6%) in comparison to the
state level (68.6%). Female literacy rate in Purulia (and
Uttar Dinajpur district) is lowest of all the districts
(36.5%), the state female literacy rate being 59.6%.
Administrative units of the district include three sub-
divisions, three municipalities, 2683 villages located
in 20 community development blocks. The network of
primary health care facilities consists of 5 Rural
hospitals (Community Health Centres), 15 Block
Primary Health Centres, 53 Primary Health Centres
and 485 Sub-centers. Study was conducted among
rural population only. All the live born babies delivered
during the one year period of data collection were
considered as study population.
Sample size & Sampling Technique: A random
sample of 30 sub centers was selected from the 485
sub centers of the district by following 30 clusters
sampling technique’. Assuming prevalence of LBW
babies as 30%, allowable error 20% and design effect
of cluster sampling as 2, a random sample of about
512 live newborns (466 plus 10% extra allowance)
was found to be adequate and statistically valid for
assessing the low birth weight problem in the
community. A total of at least 17 consecutive live born
babies in each selected cluster (sub center area)
delivered during study period required to be included
in the study sample.
Process of birth weight recording: Birth weights
of babies delivered at home were recorded within 48
hours (as recommended in CSSM Programme)10 by
trained field workers by using portable spring balance
weighing scale (UNICEF supply). Anganwadi Workers
(AWWs) or Multi Purpose Heath Workers (Female) or
Trained dais of the selected sub-center areas was
trained for the purpose. The predefined and relevant
variables were recorded by them also. Birth weight of
babies delivered in health facilities were collected from
available documents/ certificates or from health facility
records.
Pre-survey organizational matters: A set of study
tools was developed and pretested. Meeting was held
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
with the district health officers including Chief Medical
Officer of Health (CMOH) of the district to finalise the
calendar of activities, training of field staff, and other
administrative matters.
Training: Training of Health Workers (F), Health
Supervisors (F), AWWs, and Trained Dais of the
selected sub-center areas was undertaken in three
different venues of the district. Demonstration and
hands-on training for measuring the weight of
newborns delivered at home was the main purpose of
the training. Training was conducted in labor room of
the hospitals with live newborn babies. Necessity of
recording birth weight within 48 hours of birth, zero
adjustment of the spring balance, appropriate handling
of the neonates and measuring of birth weight,
checking accuracy of the scale with standard weights,
recording of birth weight and other data in appropriate
proforma and transmission of data to the supervisor
levels were also emphasized. They were instructed to
prepare list of pregnant women in their respective areas
and to maintain close contact with the families so that
birth weight of all newborns delivered at home could
be recorded within 48 hours of delivery. For babies of
the selected clusters delivered in health facilities, they
are to collect birth weight information from the facilities
or from birth weight documents available with the
families. Public Health Nurses and Medical Officers of
the respective Primary Health Centres /Block PHCs /
Rural Hospitals were also requested to attend the
training sessions to make them aware about the
purpose and procedure of the study.
Data Collection: In each cluster, within 48 hours
of home deliveries trained AWWs or HWs (F) visited
the households for measuring and recording birth
weights and filling basic information like date and time
of birth, date and time of birth weight recording,
mother’s name and address, sex of the new-born etc.
In some areas, sometimes Trained Dais measured and
recorded the birth weights. Birth weights of institution
borne babies were also collected by them and recorded
in the supplied proforma. A second proforma was used
by the trained Health Workers (F) to collect information
from the mothers (in-depth interview) regarding
different socio-demographic and maternal variables of
birth weight. Filled-up proforma were submitted to
trained Health Supervisors (F) who in turn conducted
supervisory visits, checked for the completeness and
86 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal

correctness of the information. In case weight recording Table 2: Characteristics of mothers of

was not done within 48 hours these were discarded. newborns
All the filled up proformae were submitted to the Characteristics Mothers (%)
Block PHNs. Senior faculties from All India Institute of
Hygiene and Public Health, Kolkata and Post-graduate Age at marriage < 18 years 25.1
trainees frequently gave supervisory visits during the Teen age mothers 11.6
period. During supervisory visits dietary habits of the Age 20 -29 years 72.0
newly delivered mothers during pregnancy were also
enquired. Hindu 88.8
Muslim 8.9
Results: Maternal literacy 49.5
Out of estimated sample of 512, birth weight of Joint family 70.1
487 newborns were found appropriately recorded. House wife 92.7
Other 25 records were rejected due to several reasons Agricultural workers / daily labourers 5.4
like weight recording not done within 48 hours of
Service / teacher 1.2
delivery etc. In-depth information of maternal and
socio-demographic variables of birth weight was Tobacco addiction 23.3
collected by trained Health workers (F) from 439 Antenatal check-up: Nil / < 3 40.8
mothers of newborns. Information of dietary intakes Home delivery 55.4
during pregnancy was collected from 390 mothers of
the newborns. and 260 female (53.4%) constituted the sample
population. Mean birth weight was 2592±453 gm.
Out of the 487 newborns 270 (55.4%) were for the total sample, 2636 ±433 gm. and 2547±461
delivered at home and 42.9% in Govt. health gm. for male and female newborns. The differences
institutions and the rest (1.6%) were in private nursing were not significant statistically. A total of 152 babies
homes. Birth weighs were recorded mostly by AWWs (31.3%) had Low birth weights (< 2.5 kg. at birth).
(50.9%), followed by nurses of health facilities (32.7%). LBW among male and female newborns were 29.5%
Health Workers (F) recorded 14.3% whereas Trained and 32.6% respectively. The difference was not
dais recorded the rest. significant statistically.
Table - I shows distribution of birth weights of
Distribution of normal and LBW (<2.5kg.)
male and female newborns. Total 227 male (46.6%)
newborns in relation to different variables of mothers
(Table - 3) like maternal age (years),
Table 1. Distribution of newborn babies by sex and height (<145 cm., ≥145 cm.), religion,
birth weight type of family and tobacco addiction
revealed no statistically significant
Birth Wt (gm.) Male Female Total differences. However, the mean birth
No. (%) No. (%) No. (%) weight of newborns of mothers with
secondary or higher education was
<1800 3 (1.3) 13 (5.0) 16 (3.3) significantly higher than mean birth
1800 - < 2000 3 (1.3) 10 (3.8) 13 (2.7) weights of illiterate and preprimary level
2000 - < 2500 61(26.9) 62 (23.8) 123 (25.3) educated mothers.
2500 - < 3000 110 (48.5) 124 (47.7) 234 (48.0) Table - 4 shows distribution of
≥ 3000 50 (22.0) 51 (19.6) 101(20.7) normal and LBW babies in relation to
Antenatal care received by mothers.
Total 227 (100) 260 (100) 487 (100)
None of the variables studied were found
Mean ± SD 2636 ± 433 gm. 2547 ± 461 gm. 2592 ± 453 gm. to be significantly associated with birth

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96 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal

Table 3: Distribution of Low birth weight (< 2.5 Kg.) and normal normal and LBW
birth weight newborns in relation to socio-demographic and newborns (p <. 05)
biological characteristics of their mothers Survey of dietary
habits during pregnancy, in
Variables Birth weight of newborns Statistical tests
terms of frequency and / or
<2.5Kg. ≥2.5 kg. Total amount of dietary intake,
No. (%) No. (%) No. (%) revealed that out of 390
Age of mother (year) mothers as high as 81.5%
did not consume any extra
≤19 16 (31.4) 35 (68.6) 51 χ2 = 0.03, df=2
diet in terms of extra
20 -29 100 (31.6) 216 (68.4) 316 p>.05 amount over routine diet
≥ 30 22 (30.5) 50 (69.5) 72 and/or at least one extra
Total 138 (31.4) 301 (68.6) 439 meal during antenatal
Height (cms.) period. Only 11.0%
<145 43 (37.7) 71 (62.3) 114 χ2 =2.13, df=1 mothers reported to have
≥ 145 91 (30.2) 210 ((69.8) 301 p>.05 taken adequate rest and
Total 134 (32.3) 281 (68.7) 415 sleep (≥10 hours) during
antenatal period.
Religion
Moreover, Table - 4 shows,
Hindu 128 (32.8) 262 (67.2) 390 χ2=3.64, df=2
at least 10 hours average
Muslim 7 (17.9) 32 (82.1) 39 p>.05 duration of rest and sleep
Others 3 (30.0) 7 (70.0) 10 was very low among
Total 138 (31.4) 301 (68.6) 439 mothers of LBW babies
Type of family (32.6%) compared to that
Nuclear 49 (37.7) 81 (62.3) 130 χ2=3.30, df=1 of the mothers of normal
Joint 88 ((28.9) 217 (71.1) 305 p>.05 birth weight newborns
Total 137 (31.5) 298 (68.5) 435 (61.7%). However, the
difference was not
Tobacco addiction
significant statistically (p >
Addicted 33 (32.4) 69 (67.6) 102 χ2=0.51, df=1
.05).
Not addicted 105 (31.2) 232 (68.8) 337 p>.05
Total 138 (31.4) 301 (68.6) 439
Discussion &
Literacy* Conclusion
Illiterate1 78 (35.9) 139 (64.1) 217 χ2=5.72, df=3
Pre-primary2 15 (34.1) 29 (65.9) 44 p>.05 Birth weight is
Primary3 32 (26.9) 87 (73.1) 119 considered as the single-
Secondary & above4 8 (20.0) 32 (80.0) 40 most crucial determinant of
Total 133 (31.7) 287 (68.3) 420 chances of survival,
freedom from morbidity as
* Mean birth weight ±S.D. (kg.) = 2.54±0.451, 2.54 ± 0.412, 2.63±0.473, well as healthy growth and
2.82± 0.464, 2.59±0.46 (total). development of a new
ANOVA: F=4.81, df =(3,416), p <. 05; 4 vs1: p<. 01, 4 vs 2: p<. 01, 4 vs 3: born. Magnitude of LBW
p <. 05, others not significant is a sensitive indicator of
public health. Recording of
birth weight is expected to be done in 100% of the
weight. However, only in case of place of deliveries deliveries. But, in the developing countries, including
(home / health facility) a statistically significant India, majority of deliveries are conducted at home
difference was found to exist in the distribution of where birth weights are mostly not recorded. National

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07 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal

Table 4: Distribution of Low birth weight (<2.5 kg.) and normal the differences of mean
birth weight newborns in relation to antenatal care received by birth weight of male and
female newborns, nor that
their mothers and place of deliveries.
of normal and LBW
Care received Birth weight of newborns Statistical tests population were
by mothers <2.5Kg. ≥2.5 kg. Total statistically significant. This
No. (%) No. (%) No. (%) signifies that the cut-of
point of 2500 gm birth
No. of antenatal checkup weight may have only
<3 64 (35.7) 115 (64.3) 179 χ2=2.62, df=1 statistical significance.
≥3 74 (28.4) 186 (71.6) 260 p>.05 WHO, in the 34th World
Total 138 (31.4) 301 (68.6) 439 health Assembly, 1981,
included this criteria as one
Time of registration (week)
of the global monitor of
< 12 31 (30.7) 70 (69.3) 101 χ2=1.11, df=2
health of the community.
12-16 17 (26.1) 48 (73.9) 263 p>.05 This was necessary for
>16 70 (33.0) 142 (67.0) 46 inter- country comparison
Total 118 (31.2) 250 (68.8) 410 and to monitor the trend.
Duration of rest & sleep
In the present study,
< 8 hours 30 (29.7) 71 (70.3) 101 χ2=1.39, df=1,
the frequency distribution
8-10 hours 82 (31.2) 181 (68.8) 263 p>.05 of normal and LBWs was
> 10 hours 15 (32.6) 31 (67.4) 46 studied according to a large
Total 127 (31.0) 211 (69.0) 410 number of maternal, socio-
Place of delivery economic and obstetric
Home 96 (35.6) 174 (64.4) 270 χ2=5.32, df=1, variables, but with a very
Health Institution 56 (25.8) 161 (74.2) 217 p<.05 few exceptions, none of
Total 152 (31.2) 335 (68.8) 487 the variables were found
significantly associated
with birth weight of the newborns. Educational level
Family Health Survey in India (NFHS- 2), revealed
of mothers was found to have statistical significance
that 70% of babies were not weighed at birth. Even for
on birth weight of newborns.
babies that were weighed, some mothers did not
remember the birth weights. Such limitations of birth Another significant factor was place of delivery
weight data necessitate conduction of community- of newborns. As per NFHS-2 findings 31% of deliveries
based studies to assess the true magnitude of LBW in rural areas of West Bengal were conducted in health
problem and the associated risk factors. facilities14. The present study revealed 44.6% deliveries
occurred in health institutions. LBWs were significantly
Puruliya, the district where the study was
lower in institutional deliveries than that of Home
conducted, is one of the most backward districts of
deliveries. This may be due to contact effect during
West Bengal, due mainly to inaccessibility, infertile
antenatal visits of these mothers in the health facilities
land, lack of industrialisation, and adverse climatic
where appropriate guidance was available. But most
conditions. A large proportion of Scheduled Tribe
of the home delivery mothers are usually non-
population (18.3%), very poor female literacy rate
13 attendants to any health institutions for antenatal care
(36.5%) etc. contributes to the vulnerabilities of this
also. NFHS 2 findings also documented that
poverty stricken district.
institutional deliveries are least prevalent (7% only)
Magnitude of the problem of LBWs (31.3%) in among births to mothers who did not receive any
the studied district was a little higher than that of rural antenatal check-ups8. However, need of extra diet
India (24%)8 and rural West Bengal (29%)14. Neither during pregnancy should also be emphasized.

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17 Biswas R et al: Low Birth Weight Newborns in Purulia,West Bengal
Operational researches are necessary to increase
institutional deliveries and training of both the
caregivers in institutions or at least training of skilled
birth attendants.
Acknowledgement:
The authors are grateful to UNICEF, Kolkata for
financial assistance to carry out this study.
References:
1. World Health Organisation, International Statistical
Classification of Diseases and Health Related
Problems (Tenth Revision), Geneva, 1992, Vol.-
1: 772 -773
2. Paul VK, Deorari AK, Singh M,: Management of
Low Birth Weight Babies; in IAP Text Book of
Pediatrics, 2nd edition, Jaypee Brothers Medical
Publishers Pvt. Ltd., 2002, p- 60-61
3. Gopalan C, Low Birth Weight: Significance and
Implications, in - Nutrition in Children Developing
Country Concerns Editted: Sachdev HPS,
Choudhury P. Dept. of Pediatrics, Maulana Azad
Medical College New Delhi, 1994, 1-33,
4. United Nations Children’s Fund and World Health
Organization, Low Birth Weight: Country,
regional and global estimates. UNICEF, New York,
2004, p1-9
5. Ghai OP, Gupta P. Essential Preventive Medicine
– A Clinical and Applied Orientation, Vikash
Publishing House Pvt. Ltd., Jangpura, New Delhi,
1999, p-524-25
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6. Blanc AK, Wardlaw T, Monitoring low birth
weight: an evaluation of international estimates
and an updated estimation procedure, Bulletin
WHO, 83 (3), March 2005
7. UNICEF, The State of World’s Children, 1998
8. International Institute for Population Sciences
(IIPS), National Family Health Survey (NFHS -
2), 1998-99, India, Mumbai, India, 2000
9. World Health Organisation, Development of
Indicators for Monitoring Progress towards
“Health for All by year 2000”., Health for All
Series , No.- 4, 1981, Geneva
10. Govt. of India, Min. of Health & FW, MCH
Division. National Child Survival and Safe
Motherhood Programme – Programme
Interventions, Safe Motherhood Newborn Care,
New Delhi, 1994.
11. National Institute of Health & Family Welfare,
Reproductive & Child Health Module for Medical
Officer (Primary Health Centre) MO (PHC),
Integrated Skill Development Training, New
Delhi, 2002.
12. Singh M. Care of the Newborns, 6th edition, Sagar
Publications, New Delhi; 2004,p-65.
13. State Bureau of Health Intelligence, Directorate
of Health Services, Govt. of West Bengal, Health
on the March 2003 -04, Swastha Bhawan, Salt
Lake, Sector – V, Kolkata.
14. www.nfhsindia.org/data/wb/wbchapter8.pdf,
accessed on 30.4.2008
27

S.D. Gour Best Paper Award on Environmental Health

Incidence of Summer Associated Symptoms, Host Susceptibility
and Their Effect on Quality of Life among Women 18 to 40 Years
of Age in an Urban Slum of Delhi
Pragya Sinha1, *D. K. Taneja2, M. Dhuria3, R. Saha4
Abstract
Objectives: To study whether individual susceptibility plays a role in the occurrence of summer
associated symptoms (dizziness, giddiness, fainting and weakness) among women 18-40 years
of age and their effect on the quality of life. Methods: It was a prospective community based
study carried out in an urban slum of Delhi as a follow up of an earlier study. All women who
had “given symptoms” during summer in the earlier study and a sample of those who were
asymptomatic were included in the current study. Both the groups were studied for the occurrence
of “given symptoms” and quality of life during next summer and winter using a pre structured
questionnaire and WHOQOL- BREF. Results: Incidence of “given symptoms” during summer
was more than three times among women who were symptomatic earlier compared to women
who were asymptomatic. The incidence of these symptoms was significantly higher among the
former across different age groups and BMI categories. Their physical domain of quality of life
was also adversely affected. Conclusions: Continued high incidence of summer associated
symptoms with adverse effect on their physical quality of life, among women who were
symptomatic earlier too, points to individual susceptibility rather than random occurrence. This
aspect requires for further studies.
Key words: Quality of life, Summer associated symptoms, BMI, Normotensive women

Introduction: responsible for these symptoms. Therefore, this

It has been often observed in the clinic setting in
Delhi that women commonly complain some non-
specific symptoms such as dizziness, giddiness, fainting
and weakness during summer. The patients usually
attribute these symptoms to their low blood pressure.
The problem was informally discussed with some
general practitioners and medical officers and they
admitted to having seen women with such complaints
and were either not aware of the cause or attributed
these symptoms to lowered blood pressure. A study
was undertaken to find out if there is any relationship
of these symptoms with lowering of blood pressure
during summer. The results of the study did not show
any relationship between these symptoms and change
of blood pressure during summer, indicating
mechanisms other than change in blood pressure are
1SeniorResident, 2 Professor, 3Senior Resident, 4Asstt Professor (statistics), Department of Community Medicine,
Maulana Azad Medical College, New Delhi-110002. *Corresponding author: dktaneja@rediffmail.com
prospective study was planned to see whether the
individual susceptibility plays a role in occurrence of
these symptoms and to study the effects of these
symptoms on the quality of life of affected women.
Materials and Methods:
Study setting: The study was carried out in an
urban slum located in eastern part of Delhi. The area
was chosen, as it is the field practice area of the
department of Community Medicine, Maulana Azad
Medical College, where the study was conceived. The
area has four blocks with 19,316 populations living in
3672 households. People in this area live in single room
houses with 12.5 square metre plot area. Most of them
use electric fans and few of them use air coolers during
the summer months to combat the heat.

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37 Sinha P et al: Incidence of Summer Associated Symptoms in Delhi
The city is hottest in the month of May and June
(mean maximum and minimum temperature in the
study year was 39.4±2.15 °C& 26.6±2.27 °C). The
coolest months are December and January (mean
maximum and minimum temperature in the study year
was 20.45±2.36 °C & 7.12±2.51 °C). Relative
humidity was high in the months of December-January
(Maximum: 91.48±2.59%, Minimum: 46.28±15.84%)
and low in the months of May-June (Maximum:
71.56±11.8%, Minimum: 38.42±7.83%).
The study was carried out during summer and
winter of 2006 as a follow up of an earlier study carried
out during 2004, involving 132 normotensive women
18 to 40 years of age. During the earlier study it was
observed that out of 132 women 43(32.57%) had one
or more symptoms like dizziness, giddiness, fainting
and weakness during summer. In the follow up study
two of them could not be contacted because they had
shifted their residence to a new colony. Therefore, only
41 of these women could be taken up for the follow
up study (Group A). Along with these, a sample of 41
women was drawn on a simple random basis out of
89 asymptomatic women (Group B). Both the groups
were followed up in the next summer and winter to
study the occurrence of ‘symptoms’. This was elicited
by personal inter views using a pre-structured
questionnaire.
Body Mass Index of the women was computed
using standard protocol1. Quality of life was assessed
using Hindi version of WHOQOL-BREF 2-3. The
questionnaire on QOL was translated in Hindi and
pretested. It was administered to both the groups of
women twice i.e., during summer and winter to assess
the effect of summer associated symptoms on quality
of life. The questionnaire had a total of 26 questions
pertaining to four domains, viz. physical, psychological,
social and environmental. The physical domain had
questions pertaining to pain, energy, sleep, work and
activities. Questions in psychological domain were on
positive and negative feelings and body image. Social
domain had questions per taining to personal
relationships and social support. Questions in
environmental domain were on home and work
environment, satisfaction regarding facilities such as
transport, health, living and financial arrangements.
The respondent was asked to reply these questions as
perceived by her on a five point scale wherein a score
of 5 was for the most positive response.
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Ethical considerations: Informed verbal consent
was taken from the participants and those who were
symptomatic were referred to the health center for the
further management.
Data analysis: Data was entered and analyzed in
SPSS version 11.01 for windows. For differences in
the categorical variables χ2 and Fisher exact test for
independent groups and McNemar test for dependent
groups were used. To see the difference between the
mean scores in various domains of quality of life
independent sample t-test and paired t-test was used.
A value of p < 0.05 was considered statistically
significant.
Results
In winter out of 41 women in group A there was
a loss to follow up of one woman as she had left the
area. All 41 women in group B were available for follow
up, during summer as well as winter.
Table 1 shows that the incidence of summer
associated symptoms during the summer of follow up
period in group A was more than three times (87.80%)
than that of group B (26.82%). This difference was
statistically highly significant (χ 2 = 31.16, df-1,
p<0.0001). During following winter only one-fourth
(22.5%) group A women who were symptomatic during
summer had symptoms such as dizziness, giddiness,
fainting and weakness. The difference in incidence of
these symptoms between summer and winter in group
A was highly significant (McNemar test, p<0.001).
Table1 also show that during summer symptoms were
significantly higher in group A than group B in the age
group 18-24 years (p< 0.001) and 25-34 years (χ2 =
14.85, df =1, p<0.0001). Although symptoms were
higher in the age group 35-40 years also, but the
difference was statistically not significant.
Table 2 shows that during the follow up summer
women in group A in all the categories of BMI were
more often symptomatic than group B (Underweight:
p<0.001; normal: χ2 = 10.25, df=1, p<0.001;
overweight: p<0.01). Similarly women in group A in
all the categories of BMI were more often symptomatic
during summer than winter.
The mean score of the physical domain of quality
of life was significantly lower in the group A than group
B during summer. Similarly when the mean score of
47 Sinha P et al: Incidence of Summer Associated Symptoms in Delhi

Table1: Incidence of summer associated symptoms in two groups of women by age

Age (Years) Summer Winter

Group A Group B Group A Group B
N No (%) N No (%) N No. (%) N No. (%)

18-24 8 8 (100) 14 3 (21.43) 8 3(37.50) 14 2(14.28)

25-34 25 22 (88) 19 6 (31.57) 24 4(16.66) 19 2 (10.52)
35-40 8 6 (75) 8 2 (25.0) 8 2(25.00) 8 0
Total 41 36(87.8) 41 11(26.82) 40 9(22.50) 41 4(9.76)

Group A: women who were symptomatic in phase I.

Group B: women who were asymptomatic in phase I

Table2: Incidence of summer associated symptoms in two groups of women by BMI

Category Summer Winter

as per BMI Group A Group B Group A Group B
N No (%) N No (%) N No. (%) N No. (%)

Underweight 11 11(100) 07 1(14.28) 11 01(09.09) 07 02(28.57)

Normal 21 17 (80.95) 24 8 (33.33) 20 04(19.05) 24 02(8.30)
Overweight 09 08 (88.88) 10 2(50.00) 09 04 (44.44) 10 0
Total 41 36(87.80) 41 11(26.82) 40 09(22.50) 41 04(9.76)

Group A: women who were symptomatic in phase I

Group B: women who were asymptomatic in phase I

Table3: Quality of life of the women in the two groups by seasons

Summer Winter
Domain Group A Group B Group A Group B

Physical* 10.04±0.81 12.34±1.00 11.90±1.01 12.39±1.03

Psychological 12.54±0.73 13.34±1.20 12.51±1.03 14.23±1.51
Social 15.28±1.03 15.17±1.27 15.37±1.12 15.10±1.31
Environmental 12.90±0.77 13.47±1.60 13.08±1.43 13.52±1.20

Paired t-test in Group A between summer and winter t= 9.5, df = 39, p<0.01 (0.00)
Independent sample t- test in Group A and Group B in summer t=11.65, df= 78, p<0.01

the physical domain of quality of life for the group A in
summer and winter was compared it was observed
that the score was significantly lower (p<0.01) in
summer than the winter (Table 3). The mean score for
the psychological, social and environmental domains
did not show any significant difference between group
A and group B in both the seasons. Lower physical
score among group A women indicate negative effect
of summer on their quality of life in terms of limitation
of physical activity, disturbed sleep, reduced work
capacity and increased need of medicines.

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57 Sinha P et al: Incidence of Summer Associated Symptoms in Delhi

Discussion Since in Phase I, the hypothesis that lowered

The study shows that about one third of women
in the study during summer had symptoms such as
weakness, dizziness and blackout. This results in
limitation in their daily activities as brought out by lower
scores in physical domain of quality of life.
Lower scores in physical domain reflect increased
need of medicines, loss of energy, fatigue, decreased
mobility, pain and discomfort, disturbed sleep and
reduced work capacity2.
As majority of the women in group A (all
symptomatic during the summer of Phase I) were
symptomatic again during next summer compared to
only 22.5% during the next winter, it indicates
consistency of occurrence of seasonal variation in these
symptoms.
Three times higher incidence of these symptoms
in group A women than Group B (asymptomatic in
Phase I) in the next summer indicates the possibility of
individual susceptibility.
As this trend was maintained across different age
groups and BMI categories, it indicates consistency of
association independent of age or BMI.
blood pressure is related to summer associated
symptoms has been refuted and in view of possible
individual susceptibility there is need to probe host
factors associated with ‘symptoms’ as these are present
in about one third of women and lead to considerable
physical debility during the summer months. There is
also need for similar studies at different places with
harsh summers as the current study is first of its kind
and carried out in a part of Delhi only.
References:
1. Bonita R, Decourten M, Dwyer T, Jamrozk K,
Winkelmann R. Surveillance of risk factors for
non-communicable diseases:The WHO
STEPwise Approach. Geneva, WHO 2001.
2. WHOQOL-BREF, Introduction, Administration,
Scoring and the generic version of assessment,
Field trial version, Programme on Mental Health,
Geneva, WHO 1996.
3. Saxena S, Chandiramani K, Bhargava R.
WHOQOL- Hindi: A questionnaire for assessing
quality of life in health care settings in India. The
NMJI 1998; 11:160-5.

Fellowship Award to Life Members

Nominations are invited for the award of fellowship from life members along with biodata in duplicate
duly proposed & seconded by “Fellow Members”, as per norms.
Please enclose the following in the biodata: Name of the candidate, date of birth, qualifications, present
position and scale of pay, total professional experience in years, membership record in the IPHA,
membership particulars of other association / society, awards, achievements and fellowships of other
associations, publications and any other.
The nomination should reach Secretary General, IPHA HQ, Kolkata. The last date of submission of
nomination is 30th September 2008. Applications should be accompanied by supporting documents.
Please note application format is available in the IPHA website.

Prof. Madhumita Dobe

Secretary General, IPHA

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67

Indian Public Health Association

(Official Publication: Indian Journal of Public Health)
Headquarters Secretariate
110, Chittaranjan Avenue, Kolkata 700 073
Registered under Society Act No. S/2809 of 1957 - 58

Annual Report of the Secretary General, for the year 2007

Hon’ble Chair Person, President Prof. T.S.R. Sai and distinguished members of the Indian Public Health
Association, I will now present the annual report of the association along with the reports of the state and local
branches for the year ending 31st December 2007.
At the outset, let me place on record our respectful remembrances of those members who have left us for their
heavenly abode during 2007. We sincerely pray that their soul rests in peace and that with their blessings we
carry the association to greater heights of glory.

Meetings held during 2007

During 2007, the newly elected Central Council conducted 4 Central Council meetings and 2 emergent Central
Council meetings in different parts of the country. The minutes of all the Central Council meetings have already
been circulated. Meetings of the Academic Committee, Public Health Cadre Committee, Oration Committee,
Awards Committee and Fellowship credential committee were held as follows:

Sl. Meeting Members Date & Venue

Present
1. Newly Elected Central Council Meeting 27 20th January 2007 at 04.00 pm in
the S.N. Saha Hall, Science City,
Kolkata
2. 145th Central Council Meeting 15 9th April, 2007 at 05.00 pm in IPHA
Bhaban, Block AQ-13/5, Sector-V,
Salt Lake, Kolkata
3. 146th Central Council Meeting 17 1st August, 2007 at 02.00 pm in the
seminar room of the Dept. of
Community Medicine, Maulana
Azad Medical College, New Delhi.
4. 147th Central Council Meeting 13 19th January, 2008 at 12.00 Noon
in the Seminar Hall of IPHA
Bhaban, AQ 13/5, Sector-V, Salt
Lake, Kolkata-
5. Two Emergent Meeting of Central Council 815 13th September, 07 in the Osmania
Medical College, Hyderabad5 th
Feb,08 in the Principal’s Office,
NRS Medical College, Kolkata
6. Meeting of IPHA Oration Committee 4 28th November 2007 at 06.30 pm
at NIHFW, New Delhi
7. Meeting of IPHA Fellowship Credential Committee 4 7th December 2007 at 02.30 pm at
IPHA HQ, Kolkata.
8. Meeting of IPHA Award Committee 4 7th December 2007 at 03.30 pm at
IPHA HQ, Kolkata.
9. Meeting of Public Health Cadre Committee 6 Office Room of IPHA HQ, Kolkata.
10. Meeting of IPHA Academic Committee 5 IPHA HQ, Kolkata.

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77

Reports of Committees:
• Academic Committee:
In continuation of the mandate accorded by the GB at the Annual G B Meeting, the Academic Committee has
been working on the proposed Academy. A Concept Note on “Indian Academy of Public Health” has been
formulated by the Chairperson Prof. S K Ray and Advisor Professor Farouq Ahmed . This has been circulated
among the CC members for their comments and suggestions. A presentation in this regard will be made during
the AGB meeting for further deliberation and discussion on this issue before finalization of the draft.

Concept paper on public health academy

In the context of historical development of public health in India, the need for a national forum of public
health workers on all India basis was strongly felt.The concept of such an association was first mooted
out at the All India Institute of Hygiene and Public Health, Calcutta, in 1935 and the INDIAN PUBLIC
HEALTH ASSOCIATION was formed. Its first meeting was inaugurated, on 29th September 1956, by
the Union Health Minister Smt. Rajkumari Amrit Kaur, in the presence of large number of national and
international dignitaries in the field of public health. The uniqueness of this association is, it comprises of
members from medical, dental, Engineering, Nursing, Veterinary sciences, Sociology, Statistics or
Behavioral & allied sciences, who were considered as a professional of Public Health.
The members of IPHA since its inception have effectively contributed in communicable disease control,
& disease prevention. The challenge for public health practitioners is to cope with conflicting priorities
for improving the health of populations, and the increasing need to show that potential solutions are not
just effective, but are also cost effective. As the scope of public health challenges broadens it becomes
impossible for any one individual to have a complete grasp of the knowledge needed to identify, analyze
and tackle the problems that influences their populations’ health. Public health practitioners’ therefore
need a broad range of skills and selective depth in specialist knowledge areas. The focus of public health
specialist on a population and its health needs should persist, even while other professional groups are
specializing and sub specializing to cope with the exponential growth of knowledge.
It is imperative that the present day public health specialists have to improve old skills, and learn new
skills, all of which are needed to address the big public health challenges, both local and global, in the
21st. century. It is also a fact that most of the public health action around the world including India The
role of public health teachers and practitioners has become critical for addressing the current and future
challenges. The big task facing the public health practitioners to day, is clarity of purpose and attention
to detail. This requires the skill of data, evidence and communication.
The members of IPHA felt that a combined effort of the public health academia and public health
practitioner is essential to arrest the gradual decline of the public health standards as well as popularize
evidence based public health practice. The other area of concern is to strengthen the present day teaching
& training of public health and make it more competence based. In the last IPHA Annual conference the
members deliberated on the issue and an Academic Committee was constituted under the chairmanship
of the Ex- Secretary General Prof. Sandip Ray. The committee discussed the matter threadbare and
proposed formation of Indian Academy of Public Health to address the above concern. This will be a
platform to encourage the public health specialist to study the evolution and contemporary development
of public health, perfecting the methods of developing evidence based health intervention as per the
health needs and improving the administration of the comprehensive health care package universally.
After thorough deliberation the members of the Academic committee have identified the following 12
core public health areas for action. (Contd. to next page....)

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87

1. Prevention of epidemics. (....Contd. from previous page)

2. Containment of epidemics.
3. Protecting the environment, (Physical, social & cultural) workplace, food and water.
4. Promoting health behaviour conducive to health and prevent disease.
5. Monitoring the health status of the population & pollution.
6. Mobilizing community for Health action.
7. Responding to disaster.
8. Assuring the quality, accessibility and accountability of medical care.
9. Reaching out to link high risk and hard to reach people to needed service.
10. Protecting the health of vulnerable (Physiological and Social) groups of population.
11. Researching to develop new insights and innovative evidence based solution.
12. Leading the development of sound health policy and planning.
Based on the core areas identified the following objectives of the Academy are suggested:
To encourage, foster and maintain the highest possible standards in public health practice
To undertake and assist statutory bodies like MCI in redesigning the existing curriculum of public health
as per the emerging health needs.
To undertake or assist others in undertaking training courses or other educational activities designed to
enhance the knowledge and skill of public health practitioners.
To encourage carrying on, by public health practitioners and others, of research on matters of health &
health systems with a view to the improvement of public health practice and to undertake or assist others
in undertaking such research.
To encourage the public health practitioner to do health system research and share the results with the
health providers (public & private) & public at large to improve the health condition of the community.
To assess the quality of health care package & practice by the health care providers and share the same
with the public & providers for providing the best evidence based & cost effective health care package
and its efficient utilization.
To standardize the methods of public health practices based on scientific evidence & logic.

• Oration Committee

The following were the major recommendations of the Oration Committee :

• Preferably no one should be nominated more than once to deliver any orations. e.g.B C Das Gupta
Oration, J E Park Oration - as this would facilitate other eligible members to be nominated for orations
• To ensure excellence and relevance of the orations it was suggested that Oration Committee or IPHA
Central Council should suggest the topics for Orations during annual conferences
• The final nominations for the orations at the 52nd Annual Conference at New Delhi were as follows:

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Oration Orator
B. C. DASGUPTA MEMORIAL ORATION Dr. G.K. Ingle Professor & Head, Dept. of
Community Medicine Maulana Azad Medical
College, New Delhi
A.L. SAHA MEMORIAL ORATION Dr. Sanjay Chaturvedi Professor Community
Medicine, UCMS
K.N. RAO MEMORIAL ORATION Dr. G. Ramana Senior Public Health
Specialist World Bank, New Delhi
J.E. PARK MEMORIAL ORATION Dr. N.K. Sethi Adviser (Health) Planning
Commission, New Delhi

• Awards Committee:
The Meeting of IPHA Awards committee was held on Friday the 7th December 2007 at the IPHA HQ, 110 C.R.
Avenue, Kolkata – 700073.
Following initial screening as per existing criteria, the following papers have been selected for presentation at the
respective award sessions of the 52nd All India Annual National Conference of IPHA. The final awards would be
given after final scoring following the presentations.

Award Title of paper Authors

Dr. P. C. Sen Best Paper An epidemiological study of Dr. Ranadeb Biswas

Award on Rural Health
Practice
S. D. Gaur Best Paper
Award on Environmental
Health
R. N. Roy Best Paper
Award for the best
original article published
in IJPH 2007
low birth weight newborns in Dr. Aparajita Dasgupta
the district of Purulia, West Dr. Rabindra Nath Sinha
Bengal Dr. Ramendra Narayan Chaudhury
Incidence of summer associated Dr. Pragya Sinha
symptoms, host susceptibility Dr. D. K. Taneja
and their effect on quality of Dr. Meera Shuria
life among women 18-40 Mrs. Renuka Saha
years of age in an urban slum
of Delhi
Evaluation of new Pre medication Dr. M. K. Sudarshan
Protocol for Administration of Dr. N. S. Kodandaram
Equine Rabies Immunoglobulin Dr. G. M. Venkatesh
in Patients with Hypersensitivity Dr. B. J. Mahendra
Dr. D. H. Ashwatha Narayana
Dr. B. G. Parasuramalu

• Fellowship credential committee:

Proposals for revision of criteria for award of fellowship were received from Dr D K Taneja, Dr Sanjay K. Rai, Dr
F U Ahmed and President Dr T S R Sai. The members of the committee discussed that since as per constitution,
in case of any change in recommendations by the Credential committee, it must be notified well in advance to
the members. This was further discussed during the CC meeting for Fellowship award and final proposal for
revision submitted for consideration at ACC and AGBM.

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The members pointed out that certain problems were being faced since no specific format for submission of
Honorary Fellowship proposals existed and last date of proposal of Honorary Fellowship was not specified. It
was decided that the last date for all Fellowship applications and nominations (Honorary Fellowships) should
be 30th September
These issues were discussed at length at the CC meeting held for Fellowship award. The members were of the
opinion that:
• Having both a scoring system and polling ballots was ambiguous – since the Constitution mentions election
by polling, the present system can be continued but a format has to be introduced incorporating as headings,
the criteria suggested and other criteria as felt necessary by the Fellowship Credential Committee in
consultation with the Constitution Advisory committee as per recommendation of the 145th CC meeting.
• Only sticking to the suggested criteria might leave out public health program managers and implementers
–due importance be given to the following clause in the Constitution – “The consideration should also be
made for those who are doing good public health work or who have contributed exceptionally to the
specialty of public health. For them, publication should not be mandatory for judgment by Credential
committee.”
• Format must have a record of the person’s contribution in IPHA and of specific contributions made in his/
her own public health specialty.
• Members present felt that if a suitable format is introduced, the screening will be easier and voting more
critical – hence this issue of limiting numbers need not be addressed immediately.
• It was decided that the Fellowship credential committee would take further action in consultation with the
Constitution advisory committee to finalize the proposed format.

Proposed Format for Fellowship Application

Name : Membership ID No :

Proposed by : Membership ID No :

Seconded by : Membership ID No :

Contribution to Public Health (Details to be provided) :

Public Health Awards:
Publications
Papers:
Books :
International Assignments :
Research / Project
Member of Committees :
Any other significant contribution :
Contribution to the IPHA: (Details to be provided)
Attended conferences:
Served as Office bearer:
Served in CC / committee:
Any other significant contribution:
Date of submission : Signature :

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Honorary Fellowships
Based on the nominations received for Honorary Fellowships, it was decided during the C.C. Meeting of IPHA
held on 5th February, 2008 at NRS Medical College, Kolkata, that this year the following distinguished public
health professionals will be awarded the prestigious IPHA Honorary fellowship.
1. Prof Sandip Kumar Ray Professor of Community Medicine Khwaja Bandanawaj Inst.
of Medical Sciences Gulbarga, Karnataka
2. Lt Gen J. Jayaram Director General Hospital Services (AFMS) Ministry of
Defence, M Block New Delhi-110001
3. Dr V Chandrashekhar Professor & Head Dept. of Community Medicine Rangaraya
Medical College Kakinada – 533001 (AP)
Fellowship Award :
14 applications were received for the IPHA Fellowship. After initial screening by the IPHA credential committee
on 7th December, 2006 the ballot papers were prepared and sent to all the fellow members of IPHA. Finally
ballots were counted during CC meeting on 5th February. The following life members were elected for the award
of fellowship.
1. Dr.Madhulekha Bhattacharya 2. Dr. Vijender Kumar Agrawal
3. Dr Sanjiv Kumar Bhasin 4. Dr. (Col.) P.K. Singh
5 Dr. G.V. Nagaraj 6. Dr Sanjay Kumar Rai
7. Col. Ashok Kumar Jindal 8. Dr. Vimal Kishore Gupta
9 Dr. Muralidhar P. Tambe 10. Dr. Mehar Singh Punia
Public Health Cadre Committee:
The Public health cadre committee has prepared a Draft Statement of IPHA on Public Health Cadre. A Presentation
of this draft has been scheduled on 8th March at 5.30 p.m. followed by discussion and deliberation for finalization
of the draft before taking further action at the Ministry.

Indian Journal of Public Health:

1. Journal office functioning:
Journal office functioning has improved. Computer based register for submitted articles with all related information
have been started.
2. Submission and review system:
Modified ‘instruction to authors’ is being regularly published in the Journal. We made electronic submission of
articles a must.
Every Monday peer group meeting has regularly been attempted for initial screening. Reviewers list has also
been updated. Articles are usually being sent to reviewers through e-mail. Thus faster communication and
response to the authors has been ensured.
3. Editorial Board Meeting:
Since last AGB four formal editorial board meeting have been held. All members have been informed the
agenda and points of discussion well ahead of the meeting. Many of the outside members who could not attend
the meetings, expressed their views and opinions on the issues. The minutes and important suggestions of the
meetings have also been regularly shared with them. Besides this, a meeting with the chief editor was also held.

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4. Present status of publication:

In 2007, four issues of the Journal has been published timely including one special theme issue on “Estimation
of HIV/AIDS’ sponsored by UNAIDS.
10 copies of the reprints of the published article are being provided to the corresponding author.
During 2007, we have received a total of 98 articles, of which 23 has already been published.
During the year many backlog articles of 2004, 2005 and 2006 have been cleared.
Submission of articles to the Journal is also increasing over the years. A comparative analysis of 4 years is
mentioned below:

Status of the articles

Year Published Accepted Rejected/ withdrawn Under review Total

2004 16 - 52 - 68
2005 25 - 47 - 72
2006 26 2 52 2 82
2007 23 5 52 18 98

5. Journal Advisory Committee:

Formation of a Journal Advisory Committee with the following members has been proposed and accepted by
the Central Council: Dr. Deoki Nandan, Dr. Sandip Kumar Roy, Dr. Ranadeb Biswas, Dr. F. Ahmed, Dr. J. Ravi
Kumar and Mrs. Shuva Kumari.

6. Revision of subscription rate, processing and reprint cost, advertisement rate:

Editorial board suggested revision of rates for subscription, processing and reprints as well as advertisement in
the journal and these have been accepted in the Central Council. Revised rates are as follows:
a. Subscription Rate:
Revised Annual (4 issues) Subscription Rate:

Subscription Category In India Foreign Countries

SAARC Countries Other Countries
Individual Rs. 600/- per year $ 50 per year $ 100 per year
Institutional Rs. 2000/- per year $ 200 per year $ 300 per year

Minimum subscription should be for one year. Publishers / subscription agencies may have 10% discount.
Without subscription, individual or institution may have issues of the journal on request subject to availability.
The rates are suggested as follows: For general issues - @ Rs. 200/- per copy for individual and @ Rs. 500/- per
copy for Institution. For Special issues rates would be negotiable.
b. Processing costs/reprint charges
For all publications in the IJPH, processing cost/reprint charge will be required except Editorial, Invited Articles,
Conference Proceedings and Orations/Award Papers and Letter to the Editor.

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Processing costs/reprint charges for 10 copies will be as follows:

Category of first author Original Article / Review Article / Short Communication

Special Article etc(4 printed page) (2 printed page)

Member of IPHA Rs. 1200/- Rs. 800/-

Non-Member Rs. 1500/- Rs. 1000/-

c. Advertisement rate:
No advertisement will be accepted for Back Cover. For other pages the revised rates are as follows:
2nd/3rd Inside Cover Only Full Page: Black & White: Rs. 7000/-; Colour: Rs. 10000/-
Text Page Only Black & White: Full Page: Rs. 5000/-; Half Page: Rs. 3000 /-

Full or part sponsorship of any issue of the Journal would henceforth be negotiable
7. Future plan of action:
• Developing online submission and reviewing system. Updating the Journal website.
• We have already received a package proposal from Med Know publishers which includes a dedicated
website; online submission, processing, reviewing, editing system; online publication of the journal followed
by print version, web connectivity; and sending the journal to members and subscribers. It also includes
endeavor for increasing subscribers and generation of advertisements. The proposal may be explored and
considered in future.
• Increase the number of subscribers, specially the institutional subscription. For this purpose, a detailed list
of institutions will be prepared which may be approached.
• Initiatives will be undertaken to publish special theme based sponsored issues.
• Improving the quality of the journal will be a top priority. Special articles from eminent public health
specialists will also be invited.
• A statewise list of Subscribers has been prepared and as suggested by the Chief Editor, has been circulated
to all the branches by the Secretary General, with an appeal to enhance subscribers through their efforts.

IPHA BHABAN :
We are grateful to all the following branches that have donated towards completion of the infrastructural facilities
at the Bhaban.
1. Faculty of Department of Community Medicine, S.V. Medical College, Tirupati, AP
2. IPHA-IAPSM Andhra Pradesh Chapter, Hyderabad, AP
3. IPHA East Godawari District Branch, Kakinada, AP
4. IPHA Maharashtra State Branch, Pube Maharashtra
Our members have helped us immensely with their advice and support. We earnestly solicit your co operation
and support in improving the facilities at the Bhaban.
In this regard, the donation of Rs 25,000 from Dr G Anjaneyulu, Past President IPHA is gratefully acknowledged.

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We appeal to all our members to use the facilities during their official and personal visits at Kolkata and to
generate further funds for the IPHA Bhaban.
We have plans for further activities at the Bhaban – IPHA is now involved in the RGI-CGHR PROSPECTIVE
STUDY OF CAUSES OF DEATH IN INDIA under Prof S K Ray Regional Coordinator – and has benefited
through acquisition of office equipment, telephone connection and rent of seminar hall.
We have also proposed for a Public Health resource Center at the Bhaban and gratefully acknowledge the
donation of a large number of books and journals by Prof. S K Ray (Immediate past Secretary General) for this
purpose.

CELEBRATION OF 52ND FOUNDATION DAY OF IPHA

The 52nd Foundation Day of IPHA was organized at IPHA Bhaban on 29th September, 2008. On this occasion,
a seminar was organized on “NACP III - Repositioning Prevention, treatment, care and support of HIV/AIDS“.
Dr R S Shukla Special Secretary GoWB and Project Director WBSAPCS delivered the keynote address. The
session was chaired by Dr Sanchita Bakshi, Director of Health services GoWB
A Health Camp for screening risk factors of Non communicable diseases was also organised at the IPHA Bhaban
on that day. Almost 50 IPHA members and a large no. of people from the local disadvantaged communities
attended the camp.

OTHER NOTABLE ACTIVITIES

On 24th March, 2007 - World TB Day – A Seminar was organized at IPHA Bhaban on this year’s
theme - “TB Anywhere is TB Everywhere” . The Honorable Mayor of Kolkata Sri Bikash Ranjan Bhattacharya,
was the chief guest on the occasion. The Seminar was chaired by bthe Mayor in Council Health – Dr Subodh
Dey. Experiences were shared by grass root level workers, supervisors and program managers, on the important
challenges confronting control of TB in West Bengal.
World Health Day was observed at IPHA Bhaban on 7th April, 2007. This year’s theme - International
Health Security: Invest in Health, Build a Safer Future was introduced to the members by the Secretary
general Professor M Dobe The issueof Emerging and rapidly spreading diseases,was discussed by Dr Dipankar
Mukherjee C C member, Academic Committee member and RC East NPSP.Professor Ranadeb Biswas Jt Secretary
Head quarters and In Charge of the WHO Disaster collaborating Center AIIH&PH discussed the issue of sudden
and intense humanitarian emergencies caused by natural disasters. Media representatives including DDG Press
Information Bureau Mr Santanu Palodhi attended the session. The event received good media coverage.
During World Breast feeding week, IPHA HQ organized a Consultative workshop on early initiation
of breastfeeding “Together we can achieve more” at the Auditorium, College of Nursing, Medical
College & Hospitals on 4th August, 2007. UNICEF, Kolkata Field Office, supported this program which
was attended by more than 150 participants including IPHA members and members of other associations like
IMA, IAP, TNAI, NNF,IAPSM etc. The workshop was inaugurated by Sri Anadi Sau Minister of State for Labour
GoWB. The guest of Honor Dr Sanchita Bakshi Director of Health Services GoWB urged the participants to
develop a roadmap towards successful early initiation at health care facilities.The special guest Sri Dilip Ghosh,
Jt Secretary Panchayat Dept. GoWB expressed that recommendations of the consultation should be shared with
the PRI who are now actively involved in planning and implementing public health interventions in the state.
Renowned paediatricians, gynaecologists, public health specialists and program managers along with nursing
personnel deliberated during the workshop and shared their recommendations in the final session chaired by
Ms. Della Sherratt, Senior International Midwifery Adviser and UNFPA Consultant, who emphasized the need
of introducing time of initiation of breastfeeding as an indicator in the labor room report & record· ·

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A Rally was also organized on the occasion and was participated by more than 150 members of participating
associations and students of nursing, health education and undergraduate medical courses. The rally went
around the Medical College & Hospital premises and evoked a lot of interest among patients and their escorts
and family members as well as among the hospital staff.
IPHA participated in the Public Information Campaign – Bharat Nirman Navodaya Utsav – an
innovative outreach strategy undertaken by PIB at Tehatta-I, Nadia District and Canning I Block in South 24
PGS and disseminated information on important public health issues
One day refresher training programs on Verbal Autopsy for RGI Supervisors were organized by IPHA
HQ, CGHR, Toronto and RGI, Govt. of India at Tripura & Kolkata along with a Coder’s Training Workshop at
Kolkata
World AIDS Day was observed on 1st December, 2007 at IPHA Bhaban and was attended by media
representatives and ICDS workers from the nearby Nayapatti. A participatory discussion was carried out by
members of IPHA and the ICDS workers clarifying issues & addressing the spread of HIV infection in the
community.
A Sensitization workshop was organized on Bird Flu at IPHA Bhaban on 6th February, 2008 - responding
to the local members demand for such a session in the wake of the recent bird flu epidemic in West Bengal.. Dr
Dipankar Mukherjee C C Member and Member Core Team ( West Bengal ) for responding to the bird flu
epidemic led the discussion and was helped by Dr A K Mallick and Dr N N Naskar members of IPHA, who had
participated in the rapid response team.. The experts drafted a short technical update on Bird Flu – the public
health response. This was communicated along with an alert to concerned State Branches and was greatly
appreciated. A press release was also circulated through PIB website.

NETWORKING :
IPHA has been signatory and partner in “Joint Statement on Infant and Young Child Feeding for ensuring
Optimal Infant Nutrition, Survival and Development”
Due to the initiative of our past president Dr Deoki Nandan, IPHA is a member of the Public Health Consortium
formed under leadership of NIHFW
Dr. Sanjay Chaturvedi represented IPHA in the Norwegian Indian Partnership Initiative at NIHFW.
IPHA is an active member of the India-Country Coordinating Mechanism (India-CCM) for the Global Fund to
Fight AIDS, Tuberculosis and Malaria (GFATM)
IPHA is collaborating with CGHR- RGI .
The Association has also provided Consultancy for otherNGOs e.g. CARE

PROPOSALS:
Several proposals have been submitted and are being processed – we hope to undertake these projects with
contributions from our esteemed members all over the country. We appeal to all our esteemed members to
involve the association particularly in multi centric public health projects for which this association has a unique
capacity and expertise.

ENDORSEMENTS:
IPHA had been approached by “Whirlpool “for endorsing their brand of water purifier but we are still under
agreement with HLL and hence could not accept the offer.

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Branch Activities:
Of 22 branches only 9 have submitted their report. Those who failed to submit report will not be considered for
recognition until and unless considered by the AGBM. The guidelines for Branches have been separately
documented by the group formed for this purpose at the 147th CCM and are available now. It will be distributed
to the existing branches as well as posted at the website for ready reference.
Delhi State Branch :
The branch was involved in many public health activities. The branch organized a symposium on “disaster
Preparedness” on 5th May, 2007 and was attended by many dignitaries and about 100 members. The branch
submitted all the requirements as per the format provided by the IPHA HQ. The branch organized it’s Annual
General Body Meeting 5th May, 2007. During the year the branch enrolled 61 new life members. Following are
the office bearers:
President Dr. Mahendra Dutta
Hon. Secretary Dr. G.K. Ingle
Two members in Central Council Dr. G.K. Ingle
Dr. S.K. Pradhan
GMC Chandigarh Branch:
The branch was involved in many public health activities. The branch organized a group discussion during the
world health day and breast feeding awareness camp during world breast feeding week. . The subranch submitted
their statement of accounts. During the year branch enrolled 7 new life members. The list of office bearers are as
follows:
President Dr. M.S. Kamboj
Hony. Secretary Dr. N.K. Goel
Two members in Central Council Dr. N.K. Goel
Dr. Neeraj Agarwal
Lucknow Branch :
This branch hold its last Annual General Body Meeting on 10th September, 2004. The total strength of the
members in the branch is 227. The branch submitted all the requirements as per the format provided by the
IPHA HQ. The list of office bearers are as follows:
President Dr. Rakesh Shamsheri
Hon. Secretary Dr. Uday Mohan
Two members in Central Council Dr. Anwar Rizwi
Dr. Usha Saxena
Maharashtra State Branch :
The Maharashtra State Branch of IPHA was involved in may public health activities. Branch hold its Annual
General Body Meeting on 11th August, 2007 at Pune. Branch organized inter collegiate public health quiz and
conducted many public health activities. The branch submitted all the requirements as per the format provided
by the IPHA HQ. The total strength of the membership of the branch is 549. This year the branch has submitted
application of 10 life members. The branch submitted their audit report. The list of the office bearers are as
follows :

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President Dr. Prakash Doke

Hon. Secretary Dr. (Lt. Col.) B.S. Nasir
Two members in Central Council Dr. S. S. Dodwad ?
Railway Service Branch :
This branch hold its last Annual General Body Meeting on 8th December, 2007. The branch also hold its annual
conference on 8-9 December, 2007 at Gorakhpur. The list of office bearers are as follows:
President Dr. (Mrs.) S.S. Jaitly
Hon. Secretary Dr. N.K. Depal
Two members in Central Council Dr. N.K. Depal
Dr. Mihir cowdhury
East Godavari District Branch, Kakinada :
This branch of the IPHA is well established and actively involved in various public health activities. The branch
holds his annual general body meeting on 29th December, 2007. The branch conducted health awareness
camps for fisher-men in association with reliance Industries, Kakinada. The banch also conducted school health
camps in tribal areas of E.G> district. During the year branch enrolled one new life member. Following are the
office bearers of the branch :
President Dr. V. Suryanarayana
Hon. Secretary Dr. S. Appala Naidu
Two members in Central Council Dr. N. Purusotham
Dr. Siva Prasad
West Bengal State Branch:
The branch held its annual general body meeting on 15th September 2007. The total strength of the members
in the branch is 1000. The branch was involved in may public health activities throughout the year. During the
year the branch enrolled 3 new life members. Following are the office bearers of the branch:

President Dr. S.P. Mukhopadhyay

Hon. Secretary Dr. (Mrs.) Dipika Sur
Two members in Central Council Dr. Sachhidananda Sarkar
Dr. Subhasish Saha
Barrackpore Sub Division Branch (Kolkata) :
This branch is one of the most active branches and is involved in a many public health activities throughout the
year. The branch organized a Joint Health Promotion and Awareness Camp at Palta, branch also organized a
BMI checking camp & exhibition on Tobacco control, blood group testing among 114 persons. Organized
seminar & exhibition on diabetes and nutrition The branch also organized a one-day sensitization workshop
among school students on life skills and their role in promoting healthy life style. The branch also observed
World Breast feeding programme, World AIDS Day and conducted awareness program on TB. The branch has
submitted their audit report. And participated all the programs of the HQ. The list of office bearers are as
follows :
President Dr. Kuntal Biswas
Hon. Secretary Mr. Barun Kumar Ray
Two members in Central Council Mr. Barun Kumar Ray
Ms. Manisha Kar

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South Kolkata Down Town Branch:

The branch held its last annual general body meeting on 26th May 2007. Total members in the branch are 78.
The Branch worked for manpower development and gave theoretical and practical training in the field of public
health and nutritional programs. The branch also observed No Smoking Day, conducted students health checkup
and one day workshop on immunization, conducted on day training program on Immunization. The branch
participated all the programs of the HQ. Following are the office bearers of the branch :
President Mr. Ajit Kmar Sur
Hon. Secretary Mr. Tapan Kumar Dutta
Two members in Central Council Mr. Tapan Kumar Dutta
Mrs. Manju Chatterjee

MEMBERSHIP:
During the year 2007 about 200 new life members have joined the association. All members are requested to
actively undertake membership drive.
The membership registry has been updated till date and is available at Conference venue - a CD has also been
prepared and is available@ Rs 50 each
A list has been prepared of silent members (whose journals are regularly returned by post) – this has been
circulate to all the branches for their feedback
The MIPHA scrolls have been prepared and will be distributed at the conference

WEBSITE :
As decided by the Central Council earlier, a group headed by Dr S S Basu CC member, guided by the Secretary
General, President and Treasurer, has been dealing with the development of the website. Proposals had been
invited for updating the website as well as incorporating revisions like dynamic pages etc. Three submissions
were short listed from Prism Online, Aeser Technology and Festoon Media – further verbal discussions point out
that Aeser Technology might be best suited in terms of professional capacity and quoted price for the proposal
made.

BROCHURE:
Since last annual CC meeting, the vision and mission statement of the association had been drafted and circulated
among the group designated at last annual CCM. A draft brochure has now been developed incorporating the
vision and mission statement. This is available for critical viewing by members participating at the Conference
and suggestions for improvement – for finalization after this conference.

FISCAL POSITION:
The Treasurer Dr Surajit Ghosh will present the detailed financial report. We are happy to note that our financial
position has improved further this year with active cooperation and support from the central council members,
the Immediate Past Secretary General and the past presidents.
FCRA :
As a significant step, the previous irregularities regarding FCRA were condoned by the untiring efforts of Dr D K
Taneja and our immediate past Secretary General Prof. S K Ray but we are not being able to undertake a new
Projects where it is mandatory to have the FCRA certificate for transfer of grants Since the earlier application
could not be traced at the FCRA office despite our continued efforts over last few months, a new application has
been made.

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CONFERENCES:
• 51st All India Annual Conference at Kolkata
The. 51st All India Annual Conference of IPHA was held from 19 – 21 January 2007 at Kolkata. The conference
was a grand success. Almost 700 delegates attended the conference and participated in a wide range of scientific
deliberations and discussions. Suggestion and recommendations have also been developed for further action in
relevant issues of the public health. The efforts of Prof. S.K. Ray and his team at Kolkata need special appreciation
for organizing this noteworthy event.

• International Conference
An International Conference on Health Promotion has been envisioned in 2009 .The overall mission of the
conference is to help set the course for navigating through the new challenges facing health promotion in South
Asia. Conference would be organized by the Indian Public Health Association (IPHA), at its Headquarters in
Kolkata, in collaboration with Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru
University, New Delhi and National Health Systems Resource Centre (NHSRC), New Delhi and shall be attended
by public health professionals from India and South Asian Countries A concept note has been prepared for this
and shared with the academic committee. This shall be further discussed during the conference for finalization
of the roadmap.

WFPHA:
The Indian Public Health Association maintained regular correspondence with World Federation of Public Health
Associations. The findings of a study on Home Hygiene conducted by IPHA have been published in the WFPHA
E Newsletter -March Issue 2007.
WFPHA has invited the BID for 13th World Congress on Public Health in 2012. Deadline for submission is April
1, 2008. IPHA needs to bid for the Congress in 2012.
The 12th World Congress on Public Health, organized by The World Federation of Public Health Associations
(WFPHA), will be held in Istanbul on 27 April - 1 May 2009. The Turkish Public Health Association will host the
Congress. Official web site of the 12th World Congress on Public Health is www.worldpublichealth2009.org.
IPHA will initiate communication with the Conference Secretariat to explore possibilities of participation of an
IPHA delegation at the 12th World Congress

ACKNOWLEDGEMENT:
I take this opportunity to gratefully acknowledge the overwhelming support and cooperation extended by one
and all in carrying out my duties and responsibilities – specially our immediate past Secretary General Dr S K
Ray, President Dr T S R Sai, Treasurer Dr S Ghosh, Editor Dr S Dasgupta, Managing Editor Dr Dilip Kumar Das,
all the Central Council members and our office staff – for helping me through all the initial trials and tribulations
with ease.
My final appeal today goes to all of you to get more involved in the association!
Share your experiences, suggestions and expertise – network with us at the headquarters and within branches.
Advocate strongly for and on behalf of the Association in every opportunity. Reach out and recruit other members
to participate in the activities of the Association. Your commitment and participation remains the source of
strength and success for the Association!
I sincerely hope that, together, we shall make all our dreams regarding the association, come true. This year, let’s
welcome the opportunities for us, to recommit ourselves to the growth and continued success of our organization.
Dr. Madhumita Dobe
Secretary General

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09

Indian Public Health Association

(Official Publication: Indian Journal of Public Health)
Headquarters Secretariate
110, Chittaranjan Avenue, Kolkata 700 073
Registered under Society Act No. S/2809 of 1957 - 58

Minutes of the 52nd ANNUAL GENERAL BODY MEETING

The 52nd Annual General Body Meeting of the
IPHA was held on 7th March 2008 at 18.00 hours at
the Auditorium, Maulana Azad Medical College,
Bahadur Shah Zafar Marg, New Delhi. The quorum
could not be achieved within the stipulated time and
after waiting for more than half an hour the meeting
was rescheduled at 18.30 hours at the same venue. A
total 104 members were present in the meeting.
The following discussion took place in the meeting
as per the agenda.
1. The election of the chairman (ACC), if necessary
(in the absence of the president and the vice-
president).
This was not necessary
2. Counting of ballot papers in election year.
This agenda was not relevant for this year.
3. Confirmation of the minutes of the previous
Annual Central Council Meeting.
Dr. Madhumita Dobe, Secretary General read the
minutes of the 51 st Annual Central Council
Meeting. Minutes of the meeting were confirmed.
4. To adopt annual report of the previous year.
Annual report was read, appreciated and
approved. Annual report of Secretary General for 2007
was unanimously adopted. Regarding incorporation
of the branch activities in the Annual Report, branch
representatives were reminded by the Secretary
General that of 22 branches only 9 have submitted
their report Those who failed to submit report will not
be considered for recognition until and unless
considered by the AGBM. She also reminded that every
branch should take prior permission from the IPHA
HQ before taking any grant or fund using the
Association registration number especially from the
Government and donor agencies. Lack of compliance
with this protocol was leading to difficult situations as
was recently experienced when NACO demanded the
audited statement of the Public Health Congress and
Annual Conference conducted by West Bengal State
Branch and no document is available at the
headquarters – this harms the credibility of the
association. The protocol / guideline for branches as
mentioned in the constitution is now available for the
branches and will be available for ready reference at
the website shortly. All branches should go through
the guidelines and follow them strictly. The members
once again emphasized that every state and local
branch should take prior permission for getting fund
from any govt. or non-govt. organizations.
5. Adoption of the audited statement of account
including assets and liabilities.
Audited statement of accounts was presented by
Dr. Surajit Ghosh, Treasurer of the IPHA and was
accepted by the members with the following comments:
The members opined that the balance sheet that
had been prepared by the auditor was not proper. They
pointed out that certain terms like “Profit” should not
be in the statement since IPHA is a non profit making
association.
There were several suggestions from the members
present regarding utilization of available funds. It was
decided that the Headquarters could think of further
development of the IPHA Bhaban, especially with the
donations specifically earmarked for this purpose. The
proposal of setting up a public health resource center
at the Bhaban, already ratified by the Academic

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19 Minutes of the 52nd Annual General Body Meeting
Committee was endorsed and it was decided that
necessary purchases would be made as per norms.
Members also endorsed that redesigning and updating
the website and printing of brochure could also be taken
up. Some expenses of hosting CC and other meetings
in different parts of the country for better involvement
of branches and members were also suggested.
6. To consider the budget estimate for the period
January-December 2008.
The budget estimate for the period January-
December 2008 was presented by the Treasurer and
was endorsed by the members.
7. To discuss the policy of IPHA regarding the current
Health Programs of national importance
The 51st Annual Conference had highlighted
many challenges in Public Health in India. Members
deliberated on the policy and role of IPHA in future in
view of these challenges. To address the existing
challenges of Public Health in India, two major
proposals evolved:
• Formation of a Public Health Cadre
To improve efficient and effective planning,
implementation and evaluation of the public health
services across the country a separate cadre of Public
Health professionals is the most appropriate option.
IPHA should submit a recommendation for Public
Health cadre to the Minister of Health & Family
Welfare, Govt. of India and to the Planning
Commission.
• Formation of a Public Health Academy
In the context of emerging public health challenges
the role of public health teachers and practitioners has
become critical. The members felt that a combined
effort of the public health academia and public health
practitioner is essential to arrest the gradual decline of
the public health standards and promote evidence
based public health practice. The focus should be on
strengthening the present day teaching & training of
public health and make it more competence based. In
the last IPHA Annual conference the members had
deliberated on the issue and an Academic Committee
had been constituted under the chairmanship of the
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Past Secretary General Prof. Sandip Ray. The committee
has discussed these issues and proposed formation
of an Academy of Public Health(an official body
of the IPHA) to address the above concerns
8. To consider the amendments of rules and
regulations, if any.
Secretary General informed that some change of
regulation had been unanimously approved by General
Body at 51st AGB meeting.
These changes have been submitted to the
Registrar of Societies for final approval. It is expected
that this process will take some more time. Hence it
was suggested that the CC might approve to the GB
that the existing body of Office bearers may continue
for three years This was unanimously approved by the
CC members.
9. To consider the resolution/s brought forward by
the individual members of the association for
improvement of public health and health policy.
No resolution was brought forward by any
member
10. To consider the repor ts of the functional
committee, if any.
• IPHA Academic Committee: In continuation
of the mandate accorded by the GB at the 51st
Annual General Body Meeting, the Academic
Committee has been working on the proposed
Academy. A Concept Note on “ Indian Academy
of Public Health ” has been formulated by the
Chairperson Prof. S K Ray and advisor Professor
F Ahmed . This has been circulated among the
CC members for their comments and suggestions.
A presentation in this regard was made during
the AGB meeting with further deliberation and
discussion on this issue for finalization of the draft.
The Academic committee also discussed and
agreed on the proposals for workshops on health
promotion, and international conference on health
promotion submitted by the Secretary General. They
also proposed that workshops on protocol preparation
/ Research Methodology could be organized for the
PGTs. The academic committee also proposed that
29 Minutes of the 52nd Annual General Body Meeting
text book edited by Dr. S.C.Seal, owned by IPHA
should be revised in the light of present public health
advancements. The members agreed with the
proposals and it was decided that Dr. F.Ahmed would
be entrusted with the responsibility of reviewing the
book and suggesting further action in this regard.
• Public Health Cadre Committee. In
continuation of the mandate accorded by the GB
at the 51st Annual General Body Meeting, the
Public Health Cadre Committee has been
working on the draft recommendation for a Public
Health Cadre with :
1. A rational cadre structure - need-based and
scientifically formulated
2. A well-defined recruitment policy – to attract
young and talented medical professionals
3. A rational promotion policy – to motivate the
officers. Seniority will not be the only criteria for
promotion, but qualification and performance
should also be considered.
A presentation in this regard was made during
the AGB meeting followed by deliberation and
discussion on this issue for finalization of the draft
• Oration Committee
The following were the major recommendations:
• Preferably no one should be nominated more
than once to deliver any orations. e.g.B C Das
Gupta Oration, J E Park Oration - as this would
facilitate other eligible members to be nominated
for orations
• To ensure excellence and relevance of the
orations it was suggested that Oration Committee
or IPHA Central Council should suggest the topics
for Orations during annual conferences
The members approved and accepted and
accepted the recommendations.
• Fellowship credential committee:
• The Committee received proposals for revision
of criteria for award of fellowship. The members
felt that if a suitable format is introduced, the
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screening will be easier and voting more critical
.The Fellowship credential committee in
consultation with the Constitution advisory
committee has proposed a format. This was
deliberated upon and it was decided that the
Committee would finalize it..
The members approved and accepted and
accepted the recommendations.
11. Declare results of the election, and taking up
necessary action for election of the office bearers,
central council and editorial board members, if
any as per the regulation and announcing the
names of the members so elected, in election year.
This agenda was not relevant for this year.
12. Proposal and finalization of orations and awards
of the Association.
Secretary General mentioned that Dr Mahendra
Datta President Delhi Branch had intimated that Dr.
Hem Sehgal had requested for a Memorial Oration in
the name of her husband Late Dr. J.K. Sehgal AVSM
and was willing to donate Rs 1,00,000 to IPHA for
this purpose. Members appreciated the gesture and it
was decided that this oration would be introduced from
next year. In this context Secreatry general proposed
that one oration every year may be held at different
places of the country during the foundation day
celebrations.It was also proposed that the Oration
Committee might discuss this issue and propose
accordingly for further ratification in CC .
Secretary General also stated that a proposal had
been received from Dr Kuntal Biswas Jt Secy East to
constitute an award for the best performing branch.
Members approved the Award committee in
consultation with Dr D K Taneja, Dr Sanjay Rai and
Dr V Chandrashekhar , would formulate the criteria
for the award.
13. To consider the information of election committee
in the year before the election year and provide
guidance based on the constitutional guidelines.
This is not applicable for this year.
14. To consider the appointments of Auditors
39 Minutes of the 52nd Annual General Body Meeting

(Charter Accountants). Subsequent work of printing, publishing, supply, and

distribution lies with the publishers. The entire
The President, Secretary General and the
investment after submission of manuscripts lies with
Treasurer expressed their grievance regarding the
publishers. Publisher and the author are bound by this
Auditor Mr S K Barasia – it was pointed out that the
agreement, which is to be continued. Dr Taneja also
Auditor’s office was negligent in the handling of
proposed that the book be adopted (endorsed) by
important official documents while in their custody
IPHA, retaining the name of the author and title of the
during the audit. One cheque was found missing from
book, as the book is already known with these names.
the cheque book. This had subsequently been forged
In return half of the royalty amount, will be shared
and an amount of Rs 20,000 withdrawn from the IPHA
with IPHA . He also suggested that the book should
account. An FIR has been lodged with the local Police
be updated every 1-2 years. IPHA could involve two
Station and a formal Complaint lodged with the bank
three other experts to contribute chapters. They can
for redressal. Members approved that the Auditor
be paid honorarium for this work. IPHA and Dr D K
should be changed immediately. Treasurar, Dr. Surajit
Taneja could pay the amount out of the royalty equally.
Ghosh proposed the name of Ms. Guin Nath and
Over a period of time (to be decided mutually) in a
Associates for the year 2008. The members approved
phased manner the book could be revised entirely by
this.
the authors chosen by IPHA. At that time Dr D K Taneja
15. To finalize date, venue and theme of the next would hand over full rights of the book to IPHA
annual conference including entire 10% royalty. The members greatly
appreciated this gesture and profusely thanked Dr D K
Secretary General informed that a proposal had
Taneja for this proposal, which was then accepted.
been received from KIMS Bangalore to host the next
( 53rd ) annual Conference – the members unanimously Dr. S.K. Ray informed the members that the
approved the proposal stating that it would be the first organizing committee of the 51st All India Annual
Annual National Conference hosted at Karnataka. Dr Conference is still to receive Rs. 3.25 Lakh from the
. V. J. Mahadik Jt Secretary, Railway Branch proposed Dept. of WCD, NACO and MCI. He requested that
that the next Conference could be hosted by the extension for carrying on the account be allowed till
Railway Branch. After discussions, members suggested receipt of pending dues. This is required for receiving
that since Dr Mahadik was due to be transferred to the funds, which will be issued in favour of 51st All
Mumbai by the end of this year it would be judicious India Annual Conference of IPHA. The members
to consider his proposal for the next (2010) Annual agreed to this proposal.
Conference. Members agreed that the dates, theme
Secretary General discussed the issue of renewal
and other relevant issues could be finalized following
of contract of honorary staff in view of the increased
subsequent proposals in this regard from the organizers
workload of the Journal Office. As proposed by the
16. Any other business with the kind permission of Secretary General in the Annual Repor t, the
the chairman. honorarium of Mr Soumya Chatterjee office assistant
was enhanced to Rs. 2,500. Due to failing health of
The Secretary General informed the members
Mr. B.K. Bhuiyan accountant he has expresses his
present that a proposal had been received by Dr. D. K.
desire to retire –after some discussion it was decided
Taneja regarding handing over the rights of his book
that Mr. Tapash Chakraborty who is currently working
“Health Policies and Programs in India” to IPHA. Dr
as office assistant (short contract) will be asked to
Taneja has proposed that currently M/S Doctors
undertake Mr. Bhuiyan’s responsibilities gradually in a
Publications Regd, Delhi, is publishing the book. There
phased manner –Treasurer proposed that till then, Mr
is an agreement with the publisher that he will pay
Bhuiyan should be requested to continue at least in
10% of print price of the book for the number of books
supervisory capacity. The members agreed to this
sold to the author as royalty. The authors are required
proposal.
to submit the write up and do the proof reading.

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49 Minutes of the 52nd Annual General Body Meeting

Website: As discussed in the Annual Report and journals by Prof. S K Ray (Immediate past
earlier, a group headed by Dr S S Basu CC member, Secretary General) for this purpose.
guided by the Secretary General, President and
IPHA Bhaban: Secretary General gratefully
Treasurer, has pointed out that Aeser Technology might
acknowledged the donations received from individuals
be best suited in terms of professional capacity and
and branches towards completion of the infrastructural
quoted price for the proposal made. Members
facilities at the Bhaban. She appealed to all members
approved that the work order may be issued based on
to use the facilities during their official and personal
the approval of the designated group.
visits at Kolkata and to generate further funds for the
Brochure: A draft brochure has been developed IPHA Bhaban.
and will finally be published after this conference. The
She also mentioned that through it’s involvement
members approved that the brochure be finalized and
in the RGI-CGHR PROSPECTIVE STUDY OF
printed as early as possible.
CAUSES OF DEATH IN INDIA under Prof S K Ray
Public Health Resource Center: Secretary Regional Coordinator – IPHA has benefited through
General informed that a public health resource center acquisition of office equipment, telephone connection
has been planned at the IPHA Bhaban. Applications and rent of seminar hall.
for Grants have been submitted; meanwhile some
The meeting ended with a vote of thanks offered
essential furniture, stationary, computers and
to the chairperson by the Treasurer Dr. Surajit Ghosh.
accessories etc need to be brought for this purpose.
Members opined that considering the present financial
position such purchases could be made immediately
Dr. T.S.R. Sai Dr. Madhumita Dobe
as per norms. The Secretary General gratefully
President Secretary General
acknowledged the donation of a large number of books

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59

Phone: 4005-1047
BARASIA & ASSOCIATES
ASSOCIATES Fax : 2231-6933
Chartered Accountant Mobile : 9831071902
3, Dr. Abani Dutta Road, Salkia, Howrah-711106 E-mail: srbarasia@vsnl.com

Audit Report
We have audited the Receipts & Payments, Income and Expenditure Account of various

units and Balance Sheet of M/s. Indian Public Health Association of 110, C. R. Avenue,

Kolkata-700073, for the year ended 31st December, 2007 and according to the best of our
knowledge and belief and according to Explanations given to us. We certify that the Receipts

& Payments, Income and Expenditure Account and Balance Sheet here in above stated

gives the true and fair view of the state of affairs of M/s. Indian Public Health Association
for the period hereinabove stated.

Dated: 29/02/2008

Place: Kolkata

For S. R. Barasia & Associates

Chartered Accountant

Sd/-
(Shiv Ratan Barasia)
Proprietor
Membership No.:059538

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69
Special Article
Contemporary Issues in Public Health Governance –
an Indian Perspective
*S. P. Zodpey 1, H. N. Negandhi 2
The global public health scenario is rapidly
evolving. Whilst the earlier decades were pre-occupied
with the communicable diseases, the past two decades
have witnessed a shift in the emphasis towards lifestyle
diseases and injuries. Simultaneously, public health
funding is gradually heading towards increasing focus
and coordination. The establishment of the Global
Fund to fight AIDS, tuberculosis and malaria; the
increasing World Bank attention to health status and
its links with productivity are both pointers towards
improving coordination of international assistance for
developing countries. The Disease Control Priority
Project (DCPP) highlights the compilation of effective
policies that rest on sound economics. The second
edition of Disease Control Priorities in Developing
Countries (DCP2) that includes updated information
about the global burden of diseases brought about by
tobacco, alcohol, psychiatric disorders, and injury,
which account for an increasing proportion of deaths;
is a step towards rationalizing the choice of
interventions in public health 1. The Indian Public
Health system is also reaping the boom of a strong
national market and the positive globalizing forces.
There is also an accompanying impetus on increasing
the accountability of the health system with several
initiatives expected to deliver the results in the
forthcoming decade. Civil society is also actively
engaging in specific health care issues but needs a
strong common platform to champion the greater
public health good. These changes represent the macro
dimension in which modern day public health is
functioning.
Indian health indicators have not yet
demonstrated a concomitant improvement parallel to
the national growth rates. However, the Indian health
system enjoys the advantage of a wide network of
health facilities across the country. The basic health
care infrastructure is housed within the broad ambit of
‘Primary Health Care’ as epitomized in the Bhore
1Director, Public Health Education, Public Health Foundation of India, Consultant2, Public Health Foundation of India,
New Delhi. *Corresponding author: spzodpey@yahoo.com
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Committee report and the Alma Ata declaration. The
country has an extensive network of public health
institutions for service, research, teaching and training.
There exists a public health infrastructure of 3,910
community health centres, 22,669 primary health
centres and 144,988 sub-centres beds2. In addition to
these health facilities, the state also provides care
through 4,256 rural and 3,300 urban hospitals, totalling
492,698 beds2. Although the latter works out to only
a single hospital bed for 2,257 people, it still denotes a
significant investment in infrastructure.
However, in-spite of this entire physical
infrastructure, it is universally acknowledged that
Indians still suffer from a multitude of communicable
diseases; those grounded in poor sanitary facilities and
an unreliable supply of safe water to all dwellings,
vector borne diseases and resurging diseases like
tuberculosis. The burden of acute respiratory infections,
diarrhoea, tuberculosis, malaria and vector borne
diseases were estimated to be 47% in India for 19983.
Outbreaks of water-related diseases still occur with
regularity in the summer months. The public health
system is now increasingly burdened with a rise in the
prevalence of chronic diseases, a consequence of the
increased lifespan and unhealthy individual
behaviours. The Indian health scenario bears the brunt
of this dual burden, with several health indicators
poorer than even the neighbouring developing
countries. The country plans and provides for several
policies housed in science, but the accrual of benefits
from any given intervention is slow. While there may
be several reasons for this slow accrual; ranging from
improper identification of the intervention, a poor
design of the intervention, operational and monitoring
issues, budgetary constraints; but a common thread
that runs through all these issues is the quality of the
governance. Just as health status is influenced by the
social factors that govern and regulate behaviour, so
also is the health system highly affected by the
79 Zodpey SP et al: Public Health Governance in India
surrounding environment. No modern system can
function in isolation. There is an increasing dependence
of every transaction on another complementary
system. The health system is no different and for its
optimal functioning, it needs the presence of several
important adjuncts. This surrounding environment that
contains these adjunct systems is broadly explained
by the term, governance.
But what really is governance? The word
governance derives from Latin origins that suggest the
notion of ‘steering’. One can contrast this sense of
‘steering’ a group or society with the traditional ‘top-
down’ approach of governments ‘driving’ society,
distinguish between governance’s ‘power to’ and
governments’ ‘power over’ 4. The UNDP defines
governance as ‘the exercise of political, economic and
administrative authority in the management of a
country’s affairs at all levels’5. The World Bank defines
it as ‘the manner in which power is exercised in the
management of a country’s economic and social
resources for development’6. It emerges from these two
well-accepted definitions that governance operates at
several levels and it concerns all levels of functioning;
local, regional and national. Governance thus relates
to both the public and private sphere of human activity,
and sometimes a combination of the two7. This is
achieved through the triad of polity, economy and
administration. All these efforts have the sole intention
of facilitating development.
Governance is known to have several
determinants: Service, quality, compliance, cost,
alignment and flexibility for change. These
determinants mutually influence each other and are
amenable to manipulation for optimizing the end result
of development. Health governance concerns the
actions and means adopted by a society to organize
itself in the promotion and protection of the health of
its population. The rules defining such organization,
and its functioning, can again be formal (e.g. Public
Health Act, International Health Regulations) or
informal (e.g. Hippocratic Oath) to prescribe and
proscribe behaviour7. There is wide role of governance
in Public Health encompassing planning, service
provision and policy formulation. It can be used for
the monitoring of health, provision of health promoting
materials and community empowerment. Governance
also plays a role in assuring a competent workforce. It
also provides the background which facilitates
evaluation and its consequent feedback into policies.
Public health experts are increasingly called upon to
function as managers in health programs and perform
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
roles related to one or several dimensions of
governance.
Several contemporary issues plague governance.
Their influence on health and programmatic outcomes
is generic and they operate through a select few
common channels. The health care expenditure
illustrates a very important governance issue. While
the share of the health budget has been a source of
great debate over the past one decade and is a
worthwhile cause, there exists a key governance issue
in the health care budget allocation. While the absolute
investment in heath is rising, the public expenditure
on health expressed as percentage of GDP is 0.9 for
India as per the 2007/08 report by UNDP8. It is about
half of what is spent by Sri Lanka and China; and a
fifth of what is spent by another large developing
country, Brazil8. In India, a point in question is the
ability of the health system to even absorb the money
that is allocated to it. The budget estimate for the
Ministry of Health and Family Welfare for 2007-08 was
14,363 crores. The revised estimates were however
lower and were 13,390 crores; an underutilization of
973 crores9. While this could represent an effective
utilization of the budgetary estimate by improved
planning, but it also underscores that of all the money
allocated to health, some amount is effectively unspent
and may be as high as 6.7%. While it may be physically
impossible to achieve an exact spending of the
estimated amount, a near complete utilization of this
amount is a governance issue. This can be facilitated
by improving the capacity of districts to utilize the
budget and by creation of additional demand from
the society.
The second governance issue that plagues the
health systems is the decision making process. While
there has been a shift from the earlier top down
planning approach to the decentralized approach in
health care planning, this exercise deserves greater
attention. The exercise of centralized planning must
address medium term and perspective issues. The short
term issues are best addressed by decentralized
planning. This is necessitated by the differences in the
problems and issues facing the districts. The wide
geographical and socio-cultural differences among the
districts yield unique health issues. A glance at the
health programme performance across the country will
show that a few select districts/ regions have poor
indicators across several health programmes. This is a
good justification for the shift in the decision making
to the grassroots as against the national level. This
existent decentralized participatory approach is further
89 Zodpey SP et al: Public Health Governance in India
expected to be strengthened under the National Rural
Health Mission and is a positive governance move.
The appointment of Accredited Social Health Activists
(ASHAs) at the village level is further proof of the
government’s recognition of strengthening the
grassroots. However, for accruing full benefits of
decentralized planning, there needs to be appropriate
devolution of authority as mandated under the
Panchayati Raj initiative. The 73rd amendment of the
Indian constitution has paved the way for ensuring
grassroots participation in governance through
Panchayati Raj10. But its implementation has been
variable across the states. While there are several
complex issues to be considered before
decentralization, a near completed process would make
the local health services directly answerable to the local
governmental representatives. This can be expected
to help tune the services to people’s needs. There is a
genuine apprehension among planners about the
capacity of the grassroots level to take effective
decisions.
Promptness in decision making also constitutes a
significant public health challenge in its own right. This
is because in today’s health scenario there are a
multitude of actors. These range from academic
institutions responsible for the generation of scientific
knowledge, developmental partners, governmental
agencies, the bureaucracy and the technocracy. In
health there is rarely a clear black and white answer to
a problem. Solutions are always tinged in shades of
grey. To identify the most appropriate solution in the
available resources and making a prompt decision is a
significant challenge. This promptness is acutely
necessary not only in emergency scenarios like
epidemics, but also in routine day to day programmatic
settings. The role of several stakeholders, while
ensuring a balanced view, can also considerably delay
the decision making process. There is also a
concomitant issue of ownership and responsibility in
multiple party negotiations. Fortunately, in public
health, all agencies have the greater societal good at
the forefront. Nevertheless, there is ample scope to
speed up this process.
The third key governance issue is related to equity
in service provision. While the number of rural hospitals
outstrips the number of urban hospitals in the public
sector, the number of beds shows a totally opposite
picture. While there are 4,256 rural hospitals versus
3,330 urban hospitals, there are only 132,375 rural
beds versus 340,308 urban beds2. With increasing
number of medical graduates settling in the urban
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
areas, it has spawned the establishment of private
health care facilities. While the creation of new facilities
is a welcome event in health care circles, their
inequitable concentration in the urban areas disturbs
the balance sought by primary health care. This not
only decreases the geographical access but also has a
detrimental effect on the economic access of health
care.
The fourth issue confronting governance deals
with reorienting public health to meet societal
expectations. Science cannot exist in isolation. It exists
for the society and it must be in sync with its
expectations. Scientific principles that are grounded in
social relevance have a wider acceptability than those
that are deemed foreign by the public. The relationship
between science, health and society is well summed
up by the words that ‘Health leaps out of science and
draws nourishment from the society around it’. These
words of the Swedish economist and Nobel laureate
Gunnar Myrdal highlight the social context in which
the health system must function. Only those policies
that are grounded in social reality are easily
implementable. However, this synchronization is not
easy to achieve and there is often a lag, sometimes
unacceptably long, between a scientific discovery/
observation and the design of a comprehensive policy.
This is true at the local as well as the global scene. The
path-breaking study on tobacco by Doll and Hill
predated the Framework Convention on Tobacco
Control by nearly half a century. Reducing such a long
delay in the translation of science into policy, while
adequately addressing societal sensitivity is the fourth
challenge faced by public health governance.
The fifth challenge in public health governance is
establishing best treatment protocols that are nationally
designed, widely circulated and strictly adhered. If the
recommendations can be well adhered to, they will
also facilitate an improved design of the essential drugs
list. While such guidelines exist for national health
programs, there is a need for their development for
the common conditions that affect health. The
emergence of new knowledge in medicine constantly
outstrips other scientific sectors. This mandates a
constant updating of knowledge by the physician to
be able to provide the most effective treatment to the
patients. The establishment of institutional mechanisms
to provide this update could be constituted by the local
medical associations. Although work has initiated onto
some of these agendas, it is worth remembering the
fact that these factors are mutually complementary and
will produce synergistic benefits in patient care. This
99 Zodpey SP et al: Public Health Governance in India
governance issue needs early addressing as the
ramifications could also produce a beneficial effect in
curtailing the rapidly rising costs of medical care.
The sixth challenge to governance is corruption.
While this issue is not separate from corruption
elsewhere, its presence in public health can be
extremely damaging. The consequences of corrupt
practices in say, vaccination campaigns or in a medical
inventory need no additional write up. Effective
governance thrives only in an atmosphere of honesty.
Weeding out corruption from the health sector; right
from the grassroots to the national level is mandatory
to justify people’s trust in the public health system.
Corruption is known to thrive in an atmosphere of poor
standards and the absence of effective auditing. It will
be higher where the citizen involvement is low. While
this issue is the most difficult to address, a mix of
strategies aimed at the enforcement of strict monitoring
and regular external auditing in the health sector may
help minimize corruption. The civil society has as
paramount role wherein it can effectively highlight
issues that the health system perceives as internal. The
use of the Right to Information act will subject the health
sector to even deeper scrutiny on this issue in the years
to come.
Facilitating the provision of these issues preclude
any health intervention. Though several other
determinants of governance exist and several other
factors can also be considered in the effective delivery
of health services, these six constitute the very basic
issues confronting ‘effective governance’. Public health
governance is the critical issue in the future
development of public health. This issue needs
continual deliberation at different fora and academic
platforms. It is important to realize that addressing these
core issues will not just synergistically benefit public
health action, but will also strengthen the very
foundation on which service delivery is founded. Their
facilitation in the public health context is the key
challenge faced today in governance; from the global
to the local levels. The future of population health will
greatly depend on the progress that we make on the
front of public health governance.
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
References:
1. Laxminarayan R, Mills AJ, Breman JG, Measham
AR, Alleyne G, Claeson M et al. Advancement of
global health: key messages from the Disease
Control Priorities Project. Lancet. 2006 Apr 8;
367(9517):1193-208.
2. Bulletin of the Rural Health Statistics in India.
Infrastructure Division, MoHFW, GOI; 2006.
[cited 2008 Apr 27]; Available from: URL:http://
mohfw.nic.in/dofw%20website/Bulletin% 20on%
20RHS% 20-% 20March,%202006%20-%
20PDF% 5CTitle% 20Page.doc
3. Peters D, Yazbeck A, Ramana G, Sharma R,
Pritchett L, Wagstaff A. Raising the sights: Better
health systems for India’s poor. Washington, DC:
The World Bank; 2001.
4. Governance [Online].[cited 2008 Apr 27];
Available from: URL:http://en.wikipedia.org/wiki/
Governance
5. UNDP Strategy Note on Governance for Human
development, 2004.
6. Governance and anti corruption [Online]. [cited
2008 Apr 27]; Available from: URL:http://
www.worldbank.org/wbi/governance/
7. Dodgson R, Lee K and Drager N. (2003) Global
Health Governance: A Conceptual Review.
Discussion Paper No. 1, WHO/London School
of Hygiene & Tropical Medicine, London.
8. Human Development Reports [Online].[cited
2008 Apr 27]; Available from: URL:http://
hdrstats.undp.org/indicators/50.html
9. Union budget and economic survey
[Online].[cited 2008 Apr 27]; Available from:
URL:http://indiabudget.nic.in/ub2008-09/bag/
bag4-2.htm
10. The Constitution (Seventy-Third Amendment) Act
[Online]. 1992 [cited 2008 Apr 27]; Available
from: URL: http://indiacode.nic.in/coiweb/amend/
amend73.htm
001

Special Article
Climate Change and Health: Methodological Issues and
Introduction to Climate Epidemiology
*Atanu Sarkar

Summary
Climate change is a major threat to the health of current and future generations. This paper
assesses the current estimations of adverse health outcomes of climate change and explores
methodological issues. The study is essentially based on literature review. The estimation of
disease burden does not portray an accurate picture of the problem due to methodological
constraints on account of de-linking several non-climatic factors. In particular, the developing
nations face greater challenges due to poor infrastructure, and lack of institutions and health
services. The concept of climate epidemiology can minimize the existing research gap by adapting
trans-disciplinary approach and it can establish as a new frontier for health advocacy in the
larger context of global environmental change.
Keywords: social dimension, equity, climate models, climate epidemiology

Introduction on three time scales, including a) impact of weather

The relationship between climatic change and
human health in the global context is now a well
established fact. The fourth assessment report of the
Intergovernmental Panel on Climate Change (IPCC)
has clearly stated the significant contribution of climate
change on the global burden of diseases and premature
deaths. Human beings are directly exposed to various
forms of changes in climate including temperature,
precipitation, sea-level rise, and greater frequency of
extreme events (heat waves, cyclones). Also, there are
a number of indirect changes in water, air, food quality,
ecosystems, agriculture, migration and habitation.
Projections of rising food insecurities, higher casualties
due to extreme events, and increase in vector borne
and other infectious diseases along with cardio-
respiratory diseases have already been made1, 2. It is
estimated that in 2000, climate change caused the loss
of 0.15 million lives and 5.5 million DALYs3. There
will be increase in burden of diarrhoeal diseases by 2-
5% in 2020 due to climate changes4.
Estimation of climate attributed disease burden:
current methods
Essentially climate change research is conducted
on health (as a short period), b) inter-annual events
like El Nino and La Nina events and c) long duration
(decades or centuries) time series studies linking climate
variables (temperature, precipitation, humidity etc) with
health. Woodward has mentioned that the third
category of research is the most troublesome for
standard epidemiological methods5. Although the time
series studies are the most frequently utilized methods
in climate change related health research, which
examines the association over time between the
frequency of some health events and meteorological
parameters measured at similar temporal resolution,
Wilkinson argues that it examines weather and health
relationships rather than climate and health. He further
states that the climate change and health consequences
can be investigated by comparing population health
from different geographical locations with differing
meteorological parameters6. However, there are some
major advantages of the time-series studies: easy to
control potential confounding factors (unlike
geographical comparisons) and applicability in short-
term fluctuations in meteorological conditions6, 7.
The IPCC report admits that little advancement
has been made in the development of climate health

1Department of Policy Studies, TERI University, The Energy and Resources Institute, India Habitat Centre, Lodhi Road,

New Delhi 110003. *Correspondence: contactatanu@yahoo.co.in

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101 Sarkar A: Climate Change and Health
impact models that project future health impacts of
the individual nations1. The World Health Organization
has suggested the inclusion of the total population of
the country in the analysis in order to develop national
policy. But the assessment needs to account for intra-
population variability in the exposure. One possible
approach is to combine the various effects to give an
approximation of the aggregate impact across the
whole country. Often, this method is applied to assess
regional and global burden of diseases. Despite being
comprehensive in nature, this approach has the
disadvantage of increasing uncertainty by extrapolating
throughout the populations. It also obscures effects on
particularly vulnerable populations. The possible
alternative policy might be through pre-selecting study
populations based on a priori information on
vulnerability and considerations of how public health
protection measures could be implemented8.
The general protocol for estimating the climate
attributed disease burden is as follows:
a) Selection of the scenarios (e.g. lower or higher
rates of emissions of greenhouse gases,
population growth etc.) and time period.
b) Obtaining measurements of the exposure by
utilizing a suitable global climate model describing
the changes in climate variables that are likely to
result from the scenarios selected, through time
and space.
c) For assessment to identify climate sensitive health
outcomes, which are likely to be significant causes
of ill-health within the study population over the
assessment period.
d) Quantifying the relationship between climate and
each health outcome
e) Linking the exposure measurement to the climate-
health model and coupling the climate projections
with the quantitative models to assess possible
relative changes in the health outcome.
f) Estimating the burden of disease in the absence
of climate change and projecting likely future
trends in disease burdens determined by non-
climate factors such as economic development
or future improvements in health interventions.
g) Calculating the climate change attributed
additional burden of specific diseases8.
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
The method utilizes spatial and temporal analysis,
which yields an estimated change in disease rates, or
in the probability of disease occurrence, for each unit
change in the climate variable (for instance, the increase
in diarrhoea incidence per year for each degree Celsius
increase in average ambient temperature). This can
also be used to calculate the relative risk of each health
outcome under each of the various future climate
scenarios.
Methodological issues
It is worth noting that in mainstream public health,
time series studies linking geographic spread of climate-
related diseases is a very familiar approach. Unlike
the conventional epidemiological approach, it is
difficult to find unexposed control population in climate
variability and health research and it is assumed to be
homogeneous or having little variation in exposure
between individuals in a specific geographical region.
There is no scope to test the hypotheses of the effects
of climate change on health, as Woodward comments,
….climate cannot be assigned at the whim of
investigator. However, the disease can be tentatively
predicted using models of future climate change based
on analogue studies, using past and present weather
variability. Any good climate model predicting health
should include scenarios of socioeconomic,
developmental and technological conditions, since they
are the important factors of causal pathways of various
climate attributed diseases5.
The climate change and health model has to
capture the individual human vulnerability and
adaptive capacity, which are related to household
resources, behaviour, physical and social
environmental, cultural norms, access to services and
living standards, nutritional status, age, disaster
management policies9. Therefore, the challenge facing
climate change and health research is the extreme
complex causal relationships that are not frequently
encountered in traditional epidemiology. There is no
agreement on a best practice approach for creating
models of the impact of climate change on diseases.
For instance, the rise in vector-borne diseases cannot
be scaled on the basis of temperature rise or
precipitation as an isolated causal factor. Rather, vector
population, vector susceptibility, human-vector
interaction are associated with complex ecosystem,
which is altered due to temperature, humidity, water
stagnation and several other factors10. In some cases
201 Sarkar A: Climate Change and Health
these may have more influence than global climate
trends, particularly in small spatial scales. Studies
carried out in Ethiopia reflect that malaria epidemics
were significantly preceded by abnormally high
minimum temperature in the previous three months
than based on random chance. However, abnormal
increases of maximum temperature and rainfall had
no positive association with the epidemics. Interestingly,
the study also found that a period of low incidence
during previous transmission seasons might have
aggravated the events, possibly due to low levels of
immunity among affected populations 11. Dengue,
which is known as an urban problem and a climate
sensitive disease, has been identified in rural India due
to changing rural landscape and housing patterns12.
Urban sprawls and its influence on housing, availability
and consumption of urban amenities in rural India and
population mobility are believed to be responsible for
spreading of dengue in rural India. Similarly, heat wave
related deaths, which is apparently seen as direct cause-
effect relations are also determined by social security,
governance and individual behaviour. For instance,
heat waves in southern India in 2002 killed people
from lower socioeconomic backgrounds having no
option but to work outdoors under all conditions. Even
in developed nations such as France, heat waves in
2003 took thousands of lives, mostly elderly people
living alone or socially isolated13. A study conducted
in 12 cities in the USA shows that the temperature
threshold for mortality varies between the locations,
suggesting the wide range of acclimatization and
adaptation capacity of people to climatic conditions14.
However, the limits to this adaptive capacity have not
been quantified, nor having a large population based
study. It is likely that the process of population
acclimatization and adaptation (increased use of air-
coolers, additional intake of fluids, changed work
hours, better building insulation and design, access to
electricity and emergency health care settings etc) will
affect the estimate of future heat and cold deaths.
Unlike resource constraint countries, in the developed
countries with better governance, these factors can
strongly influence public health policy and planning,
such as development of heat forecasting and
emergency response systems, heat-related illness
management plans, energy efficiency and building
code guidelines, and education for behavioural
changes.
Precipitation, flood / water logging and
subsequent outbreak of waterborne diseases are not
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
linear in relation. Floods and stagnation of water are
the result of interaction of precipitation, surface runoff,
evaporation, wind, sea level, local topography,
catchments size, urbanization, land use and water
resource management (including large dams) and
drainage systems. Out break of waterborne diseases
due to flood is related to sanitation facility available
during the disaster period, pre-emptive measure and
disaster management (including supply of potable
water, disinfection of water sources, evacuation of
affected population, medical care, food and shelter)
and equitable access to the emergency services. Even
during periods of normal rainfall, there is also evidence
of unusual occurrence of floods in many parts of India.
This unprecedented natural disaster usually occurs due
to construction of large dams or extensive diversion of
water though canals in the upper riparian areas. The
sluggish flow of water in lower riparian areas results in
riverbed rise due to accumulation of silt, and decline
of water carrying capacity of rivers and drainage
systems.
There is the limited presence of some social issues
that are very important for preparedness towards
climate related changes, such as role of public
awareness, equitable distribution and use of resources,
governance, and community participation4, 9. For
instance, relatively fewer casualties in Cuba due to
Caribbean hurricanes are the result of better
preparedness. Public awareness and good coordination
among Cuban National Forecast Center, Civil Defense
Organization, Ministry of Public Health and the
community significantly reduced vulnerability15. Good
agriculture production does not ensure food security
as it is also determined by equitable access, gender,
purchase capacity and market force. It is a challenging
task to address these non-climatic issues in the currently
research framework on climate change and health. It
is important to account for the non-climatic influences
and to develop projections of non-climatic effects on
specific diseases in the respective locations. There are
some non-climatic risk factors that vary over time (and
may be associated with weather conditions), and these
are the potential confounders. Such factors include
seasonal infections, air pollution, dietary patterns, and
have to be incorporated as explanatory factors in the
analysis. Abeku et al16 have utilized the Autoregressive
Integrated Moving Average (ARIMA) model to forecast
malaria incidence from historical morbidity patterns
in epidemic-prone areas of Ethiopia. The authors
suggest that simple methods such as seasonal
301 Sarkar A: Climate Change and Health
adjustments perform better than the more advanced
ARIMA method, although they are themselves not
accurate enough for forecasting epidemic early warning
system. They cautioned of gross underestimation of
the true number of cases by health service data,
especially during epidemics, when the health workers
travel in remote rural areas, far away from health
facilities and distribute anti-malarial drugs. In such
house-to-house visits, the numbers of reported cases
are greater than the morbidity data of the health
facility16. The climatic parameter/s (either high or low)
on one day tends to be associated with morbidity or
mortality on the same day or several days, or even
weeks, later. Therefore, to establish the association
between climate change and health investigation of
this varying time ‘Lags’ is necessary. The ‘Lags’ are
explained from environmental and biological
perspectives, such as rate of multiplication of microbes
in certain temperature, individuals’ susceptibility and
coping mechanism. To investigate such relationships
entails fitting daily temperature with varying time lags.
While the mortality on a particular day is found to be
influenced by cold temperatures over the preceding
two weeks or so, the lags might be just one or two
days for heat impacts 6 . However, health-seeking
behaviour of a particular community, gender or age
group and their linkage with reporting to health facilities
(particularly during epidemic period) are also important
determining factors of establishing ‘Lags’. In order to
explore the research issues related to impact of climate
change on water borne diseases, a pilot study was
conducted by The Energy and Resources Institute
(TERI) in 2007. It showed that the time lags between
the onset of disease and the reporting of diarrhoea to
the health facility is linked with the role of informal
private health care (traditional healers, non-qualified
doctors) and health seeking behaviour of the
community17.
The burden of diseases is growing fastest in low
and middle-income countries 18 . The adaptation
measures specific to climate variability have been
developed and implemented within and beyond the
health sectors are mostly in the rich nations. The IPCC
report has stated that world wide, 840 million people
living in developing nations are under nourished and
becoming more vulnerable to morbidity and mortality1.
Perhaps the major methodological constraint to
carrying out climate change and health research in a
developing country is the availability of information,
poor health care delivery system, extreme inequity and
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
existing complex confounding factors and effect
modifiers (which are difficult to control with existing
epidemiological methods). Take an example of a study
conducted in five Australian cities on the effect of
temperature on salmonellosis notifications over the
period 1991 to 2001. Monthly salmonellosis
notifications in terms of calendar time and monthly
average temperatures fitted for each city were taken
for the study. The results show a significant positive
association between mean temperature of the previous
month and the number of Salmonellosis notifications
in the current month19. Another study conducted in
three Australian cities showed that higher temperature
and humidity in the previous week were associated
with a decrease in rotavirus diarrhoeal admission. The
data on daily admission of diarrhoea was collected
from state health departments, and meteorological data
was collected from central monitoring stations in each
city20. Is it possible to conduct similar studies in
developing countries where hospital records and
surveillance data are scattered, health seeking
behaviour is not properly documented and
meteorological stations are not appropriately located?
Indeed, despite all difficulties some developing
countries conducted researches on climate change and
waterborne diseases, such as in India, Bangladesh,
China, Fiji, Cuba and Peru21- 26. Except in Fiji and
Cuba, all studies were conducted in the urban setup,
which cannot represent the whole country. On the other
hand, perhaps the smaller size of Fiji and Cuba was
an advantage for collection of national level data,
which may be challenging for large countries with wide
climatic and social diversity. Furthermore, assessments
of the impacts of climate change on incidence of
waterborne diseases are based mostly on temperature
change and precipitation and these are likely to be
underestimates.
Public health service and current practice of
epidemiology
In India, interdisciplinary approach in public
health planning and implementation has not received
adequate attention. Therefore, health professionals
essentially dominate the public health service and there
is no indication of bringing about changes in order to
balance representation from various backgrounds in
the foreseeable future. The health professionals and
the Indian administrative service officials are the
principal decision makers in the field of India’s public
health27.
401 Sarkar A: Climate Change and Health
Current standalone programmes of epidemiology
in India are primarily impar ted by Centre for
Epidemiology, National Institute of Communicable
Diseases (NICD), New Delhi and National Institute of
Epidemiology (NIE), Chennai. The epidemiology
division of NICD is engaged in training, surveillance,
outbreak investigation & post-disaster health
assessment services, and operational research. It
coordinates the Integrated Disease Surveillance Project
(IDSP) launched in 2004. The division now conducts
training for identified states to implement IDSP. The
Division also focuses on developing skilled manpower
in epidemiology urgently required for strengthening the
epidemiological capability in the whole entire country
and also the South-East Asian Region. NICD has
launched a two-year Master in Public Health (MPH)
in field epidemiology program to provide
epidemiological support to the IDSP and the various
national health programmes. NIE also offers two-year
field epidemiology training program focusing on public
health professionals who are practitioners of
epidemiology at the field level. Both the programmes
focus on mainstream public health agenda, laid down
by the Government of India, and trainees are mostly
state and district health officials, however,
environmental dimension of epidemiology have been
given lesser importance. There is not enough progress
being made in India in the context of climate change
and health research. Under UN Framework Convention
on Climate Change (UNFCCC), India’s National
Communication (NATCOM) to UNFCCC was initiated
and out of forty-eight network research institutions,
Malaria Research Centre (Delhi) was the only one such,
engaged in health related activity. The MRC has
highlighted that the dominant role of temperature and
relative humidity in malaria transmission. However,
the extent of vulnerability due to malaria also depends
on non-climatic determinants such as environmental
factors, the vector and parasite development rates, and
the adaptive capacity of the human population28.
Climate epidemiology: a need for future
Developing nations will bear the major burden
of diseases due to climate change, as warned by IPCC1.
To establish appropriate public policy to reduce disease
burden, there is a pressing need for conducting research
on advanced modelling, applying projections at local
and regional level, incorporating broad range of social
dimensions, prospective longitudinal health studies.
Analysis of existing researches have already highlighted
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
the influence of health system, vector resistance to
insecticides, drug resistant microbes, food and nutrition
security, equity, environmental factors on disease
burden attribute to climate change 29. However, a
majority of the resource constraint countries have little
institutional capacity to conduct such a trans-
disciplinary research.
I believe that introduction of climate epidemiology
in the public health institutional infrastructure can solve
the existing huge research gap and policy dilemma.
This proposed concept can be broadly defined as, study
of distribution and determinants of disease due to
climate change. Environmental epidemiology is
perhaps closest to climate epidemiology, but it has a
major methodological constraint of non-inclusion of
non-environmental factors, such as health service and
manpower management, population behaviour, in-
depth social and equity analysis. Climate epidemiology
is expected to overcome the existing shortcomings by
delineating the theory of global environmental change,
social and behavioural science, vulnerability and
adaptation, health service and community health and
health economics; in addition to the theory and
methods of environmental epidemiology. The broad
objectives would be, to develop new methods of
estimating the impacts of future threats and more
sophisticated approach to uncertainty assessment
(including statistical sources of error and judgments),
to reorient the health strategy and public policy at large.
Due to better inter-sectoral coordination and
excellent infrastructure (health service and institution),
researchers from developed nations are at a definite
advantage over their counterparts in developing
nations. Moreover, in developing nations, the
competent researchers from non-health background
hardly get any attention even at macro level of health
policy. Therefore targeting new breed of
epidemiologists in public health institutions to give
climate epidemiology perspective can be the only
available solution. For example, in India the only
cer tified epidemiologists (precisely field
epidemiologists), who are posted in the periphery and
engaged in disease surveillance, epidemic control,
reporting and data analysis, can be the potential
candidates for orientation course of climate
epidemiology in the beginning. The definite advantage
of imparting training on climate epidemiology would
be the generation of good quality data and subsequent
analysis at micro level, and this in turn would help
501 Sarkar A: Climate Change and Health
develop a national level scenario. Gradually, the
climate epidemiology training program can be
extended to the postgraduate institutes offering
programmes in Social and Preventive Medicine and
MPH. The added advantage of giving new term (i.e.
climate epidemiology) is opening of new career
prospect for the young epidemiologists, who would
wish to study further and to establish themselves as
the experts in climate change and health.
Conclusion
The concept of climate epidemiology can be a
new frontier for health advocacy in the larger context
of global environmental change. This proposed
discipline is expected to cater to the needs of
developing countries bearing the major brunt of climate
change. Climate epidemiology will provide more
accurate estimations of disease burden, vulnerability,
adaptation capacity and forecasting, which would in
turn help in appropriate resource allocation for all pre-
emptive measures. However, there is a need of
networking and international cooperation to improvise
it further in order to make relevant to the current
context.
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Reduction. Available from: URL: http://
www.unisdr.org/ppew/newsletter/ppew-02-
2004.pdf
16. Abeku TA, de Vlas SJ, Borsboom G,
Teklehaimanot A, Kebede A, Olana D et al.
Forecasting malaria incidence from historical
morbidity patterns in epidemic-prone areas of
Ethiopia: a simple seasonal adjustment method
perfor ms best. Trop Med Int Health
2002;7(10):851-57.
17. Reisinger A, Dogra NK. Protecting human health
from climate change – some key findings from
fourth assessment report of the Intergovernmental
Panel on Climate Change. Reg Health Forum –
WHO SEA Region 2008;12 (1):1-10.
18. Mascie-Taylor CG, Karim E. The burden of
chronic disease. Science 2003;302:1921-22.
19. Becker N. Does ambient temperature affects the
incidence of salmonella infection? In: National
Symposium on Climate Change and Health:
Research Methods and Policy Issues. Canberra
(Australia). 2003 Sep 29 - Oct 2, Available
from:URL: http://nceph.anu.edu.au/Envir_Collab/
SC1_presentations.php
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20. D’Souza RM, Hall G, Becker NG. Climatic factors
associated with hospitalizations for rotavirus
diarrhoea in children under 5 years of age.
Epidemiol Inf 2008;136 (1):56-64.
21. Purohit SG, Kelkar SD, Simha VK. Time series
analysis of patients with rotavirus diarrhoea in
Pune, India. J Diarrhoeal Dis Res 1998;16(2):74-
83.
22. Hashizume M, Armstrong B, Hajat S, Wagatsuma
Y, Faruque AS, Hayashi T et al. Association
between climate variability and hospital visits for
non-cholera diarrhoea in Bangladesh: effects and
vulnerable groups. Int J Epidemiol
2007;36(5):1030-7.
23. Zhang Y, Bi P, Hiller JE, Sun Y, Ryan P. Climate
variations and bacillary dysentery in northern and
southern cities of China. J Inf 2007;55(2):194-
200.
24. Singh RBK, Hales S, deWet N, Raj R, Hearnden
M, Weinstein P. The influence of climate variation
and change on diarrhoeal disease in the pacific
islands. Env Health Persp 2001;109(2):155-9.
25. Bulto PLO, Rodriguez AP, Valencia AR, Vega NL,
Gonzalez MD, Carrera AP. Assessment of human
health vulnerability to climate variability and
change in Cuba. Env health Persp
2006;114(12):1942-9.
26. Checkley W, Epstein LD, Gilman RH, Figueroa
D, Cama RI, Patz JA et al. Effects of El Nino and
ambient temperature on hospital admissions for
diarrhoeal diseases in Peruvian children. Lancet
2000 Feb 5;355:442-50.
27. Banerji D. Politics of rural health in India. Ind J
Pub Health 2005;49(3):113-22.
28. Bhattacharya S, Sharma C, Dhiman RC, Mitra
AP. Climate change and malaria in India. Curr
Science 2006;90(3):369-75.
29. Sunyer J, Grimalt J. Global climate change,
widening health inequalities and epidemiology,
(Editorial). International Journal of Epidemiology
2006; 35:213-16.
701

Short Communication
Leptospirosis among Patients with Pyrexia of Unknown
Origin in a Hospital in Guwahati, Assam
Juri B Kalita1, *H. Rahman2

Summary
Leptospirosis is one of the important zoonoses of man and animals. In recent years, it has
increasingly been reported from different parts of the world including India. Sera from 536
individuals with pyrexia of unknown origin (PUO) belonging to different age group, sex and
occupation and having varying levels of exposure to animals, forest and flood were examined
for the presence of antibodies to pathogenic Leptospira by commercially available kit. Overall
22.57% individuals with PUO were found to be positive for leptospirosis with 27.93% among
male and 11.79% among female patients. This difference among genders was statistically
significant. The seropositivity was higher among patients in the age groups of 21 –30 years
followed by 31-40 and 41-50 years. Seropositivity was higher among individuals having contact
with animals, working in forest and flood affected areas.

Leptospirosis is a zoonotic disease of global
significance; caused by infection with pathogenic
Leptospira spp. Leptospires are bacteria, which can
be either having the potential to cause disease in
humans and animals or free living and generally
considered not to cause disease. The spectrum of
human diseases caused by leptospirosis is extremely
wide-ranging from sub-clinical infection to a severe
syndrome of multi-organ involvement with high
mortality1, 2. Animals may also suffer from clinical
disease or remain asymptomatic carriers excreting the
organism in large numbers and may act source of
infection for man and other animals3, 4. In India, where
an eco-system with inter dependence of humans and
animals sharing the same source of food, water and
shelter exists, there is abundant opportunity for cross-
infection from animals to humans5. Though leptospiral
infections have been reported from different parts of
India 6-10 , infor mation on the prevalence of
leptospirosis in northeastern part of India is very
meagre11, 12. This investigation was undertaken to
report on the seropositivity of leptospirosis amongst
individuals with pyrexia of unknown origin (PUO) in a
hospital in northeastern region.
We conducted a hospital based descriptive study
in Down Town Hospital, Guwahati, Assam.
Patients with pyrexia of unknown origin (POU)
presented for microbiological investigation in the
Microbiology department of the hospital during the
period 2003-2005 from different parts of northeast
India comprised the study population. Thus a total of
536 serum samples comprising 358 male and 178
female patients with pyrexia of unknown origin (POU)
were collected and included in this study. The
preliminary case selection criterion was guided by
clinical manifestations like fever, jaundice, myalgia,
conjunctival suffusion, meningitis and renal failure.
Information regarding the age, sex, and occupation
with regard to level of exposure to animals, forest, water
(flood), etc. was also collected. The serum samples
were stored at –200C until tested.
Leptospirosis was detected by commercially
available leptospira-specific immunoassay kit,
LeptoTek Dri-Dot (Biomerieux, The Netherlands). The
kit has been developed in collaboration with the Royal
Tropical Institute, Amsterdam for rapid screening for
leptospirosis and claimed to have an overall sensitivity
of 90 per cent and an overall specificity of 92 per cent
in comparison to microscopic agglutination test (MAT).
In brief, 10 µl of serum was placed on the specified
area of the agglutination card and mixed with the latex
particles by slowly rotating the card and looked for

1 Microbiologist, Department of Microbiology, Down Town Hospital, Guwahati, Assam, 2Joint Director, ICAR Research

Complex for NEH Region, Tadong, Gangtok - 737 102, Sikkim. *Corresponding author: hr19@rediffmail.com

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801 Kalita JB et al: Leptospirosis among Patients with PUO in Assam
the agglutination. The result was recorded within 30
seconds.
Of the 536 serum samples from individuals with
PUO, 121 (22.57%) were positive for leptospirosis. The
seropositivity was higher among males (100, 27.93%)
than that in female (21, 11.97%). This difference
among genders was statistically significant (p< 0.05).
The reason might be that females are less involved in
agricultural and animal husbandry related activities,
as animals are the major sources of infection for
humans. The proportion of leptospirosis was higher
among the individuals in their thirties (24.79%)
followed by forties (23.14%) and twenties (21.48%)
(Table 1). This could probably due to the fact that
Table 1. Distribution of seropositive
leptospirosis patients in relation to age of
the patients (n=121)
Age group Seropositives
(Years) No (%)
1-10 3 (2.5)
11-20 14 (11.6)
21-30 26 (21.5)
31-40 30 (24.8)
41-50 28 (23.1)
51-60 14 (11.6)
≥ 61 6 (4.9)
Total 121
individuals with these age groups (21 – 50 yr) are
actively involved with various activities like rearing of
animals, working in the forest, etc. Low proportion
among other age groups could probably be because
of less exposure to animals and other predisposing
factors. It is generally accepted that occurrence of any
infection in population depends on geographic,
climatic, hygienic, and socio-economic conditions, as
well as on the lifestyle of the population6. Further
studies would be needed to elucidate epidemiological
factor(s) relating to its seroprevalence among these
groups.
Since animals are the major transmitters of the
infection, the population under study was reclassified
on the basis of the possibility of the access of these
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
people to animal population (Table 2). It has been
reported that the level of sero-positivity was higher
amongst the population involved in frequent handling
of the animals, as against those that were not regularly
exposed to the livestock6, 10. Our study also revealed
higher sero-positivity amongst the groups that were in
regular contact with the animals (30.58%), worked with
animals and forests (24.79%) and exposed to forest
(19.01%) as against the other population that is not
regularly exposed to the animals (Table 2). Further
analysis revealed that fever (100%) was the commonest
manifestation followed by jaundice (66.92%), renal
failure (20.66%) and meningitis (3.31%).
Table 2. Distribution of seropositive
leptospirosis patients in relation to the
occupational condition (n=121)
Working condition Positives for
leptospirosis
No (%)
With water 19 (15.7)
With animals 37 (30.6)
With forest 23 (19.0)
Water and animals 30 (24.8)
With water and forest 7 (5.8)
Not regularly exposed
to animals/forest 5 (4.1)
Incidence of leptospirosis in man and animals
are increasingly reported in India in recent times. In
an eco-system where inter dependence of man and
animals is indispensable and rodent population is
unavoidable, each sharing the same source of food,
water and shelter, an increase in the incidence of
leptospirosis is obvious. Despite all the modern
technologies inducted into agriculture operations,
storage of the agricultural produce is too primitive and
provides opportunities enough and more for the rodent
population to flourish. Rodents are the most prolific
spreaders of leptospirosis in the world4. The level of
exposure of the population to these predisposing factors
is a major criterion for the prevalence of infection in
that population. It is therefore imperative that the
seroprevalence studies for leptospirosis in a population
should be supplemented with the information like
901 Kalita JB et al: Leptospirosis among Patients with PUO in Assam
socio-cultural status, hygienic standards, climatic and
geographical features related to the population under
study to get a clearer epidemiological picture. A further
complicating factor is the practice of bare foot working
of the Indian farmer. This perhaps adequately explains
the occurrence of leptospirosis in a diverse range of
individuals. The results of the study indicated that
leptospirosis is fairly common in northeastern India.
Thus, leptospirosis should be considered whenever an
individual is affected with POU having fever, jaundice,
renal failure and meningitis.
Although the occurrence of leptospirosis in
outbreak form is not uncommon, it frequently occurs
as sporadic cases all over the country both in man and
animals. Most often they are not diagnosed but treated
with antibiotics. These cases go unreported and least
documented. Despite a good public health system
existing, threat due to leptospirosis has been
overlooked. This is probably because leptospirosis
normally mimics the symptoms of other infections and
escapes early differential diagnosis, not many
laboratories are working on leptospirosis, the
preliminary diagnostic tests are not simple and not easy
to perform at the field level, the organism is difficult to
isolate and maintain, and has a bio-hazard potential
and requires trained personnel to work with. However,
a number of immunological and molecular assays like
ELISA, PCR have been developed and evaluated for
detection of leptospirosis. These assays may easily be
employed for the diagnosis of leptospirosis3, 8, 14.
Acknowledgements
Authors thank the Chairman cum Managing
Director, Down Town Hospital, and Guwahati, Assam
for providing facilities for the present study.
References:
1. Winslow WE, Merry DJ, Pirc ML, Devine PL.
Evaluation of a commercial enzyme-linked
immunosorbent assay for detection of
immunoglobulin M antibody in diagnosis of
human leptospiral infection. J Clin Microbiol.
1997; 35:1938-42.
2. Kariv R, Klempfner R, Barnea A, Sidi Y, Schwartz
E. The changing epidemiology of leptospirosis in
Israel. Emerg Infect Dis. 2001; 7: 990-2.
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
3. Harkin KR, Roshto YM, Sullivan JT, Purvis TJ,
Chengappa MM. Comparison of polymerase
chain reaction assay, bacteriologic culture, and
serologic testing in assessment of prevalence of
urinary shedding of leptospires in dogs. J Am Vet
Med Assoc. 2003; 222:1230-3.
4. Gulubev MV, Litvin V. Population ecology of
leptospires – an experience with evaluation of
leptospira count in carrier and intensity of
elimination in urine. Zh Microbiol Epidemiol
Immunobiol. 1983; 6: 60 – 63.
5. Gangadhar NL, Rajasekhar M, Smythe LD, Norris
MA, Symonds ML, Dohnt MF. Reservoir hosts of
Leptospira inadai in India. Rev Sci Tech. 2000;
19:793-9.
6. Ratnam S. Leptospirosis: an Indian perspective.
Ind J Med Microbiol. 1994; 12: 228–39.
7. Sehgal SC. Leptospirosis in the horizon. Natl Med
J India. 2000; 13:228–30.
8. Pooja Sharma M, Sud A, Sethi S. Serological
evidence of leptospirosis by IgM ELISA and IgM
dipstick in patients of acute febrile illness. In:
XXVth National Congress of Indian Association
of Medical Microbiologists; Nov. 21–25New Delhi,
India, 2001.
9. Chaudhry R, Premlatha MM, Mohanty S, Dhawan
B, Singh KK, Dey AB. Emerging leptospirosis,
North India. Emerg Infect Dis. 2002; 8:1526-7.
10. Vinetz JM. Detection of leptospirosis in India. Arch
Dis Child. 2003; 88:1033.
11. Barua HC, Biswas D, Mahanta J. Clinico-
epidemiological study on leptospirosis in certain
parts of northeastern region. J Commun Dis.
1999; 31:201-2.
12. Karmakar N. Weil’s disease in a tea garden in
Assam. Indian Med J. 1965; 59: 118-9.
13. Snedecor GW, Cochran WG. Statistical Methods.
1st edn, East West Press Pvt. Ltd., New Delhi,
1994.
14. Cumberland P, Everard CO, Levett PN.
Assessment of the efficacy of an IgM-ELISA and
microscopic agglutination test (MAT) in the
diagnosis of acute leptospirosis. Am J Trop Med
Hyg. 1999; 61:731-4.
011

Letter to The Editor

Presence of Food-Borne Microorganisms in Milk
in and Around Guwahati city
Dear Editor, The results confirm that the milk was of poor
The threat posed by diseases spread through quality that might have been contaminated either at
contaminated milk is well known and the production level or during handling and distribution
epidemiological impact of such diseases is well level. Thus regular cleaning of equipments, general
considerable1. Hence assessment of the extent of practice of hygiene, health education to vendors, and
contamination of milk by pathogenic microbes is of properly pasteurized milk will ensure the maximum
paramount importance. This study was conducted in reduction of microbial counts and thus improving its
20 no. of milk samples to assess the bacterial load and quality and safety to the consumers.
antibiogram including mycobacteria, collected Table 1: Bacteria isolate from milk
randomly from in and around Guwahati city, the capital
of Assam. It was done in serial dilution with normal samples (n=20)
saline. The organisms were identified by morpho-
logical, cultural and biochemical tests. However, for Microorganisms Positive Mean
mycobacteria the milk samples were centrifuged and isolated samples bacterial count/ml
acid fast straining was carried out. Sensitivity of the
isolates was determined using standard discs. Staphylococcus aureus 20 4.60x104
A total of 60 bacterial isolates were recovered Staphylococcus albus 10 1.30x103
from milk samples (Table 1). Streptococcus pyogenes 15 4.42x104
Antibiotic susceptibility test results indicated that E. coli 12 4.12x104
the strains were resistant either one or multiple agents.
Maximum resistant of Staphylococcus aurious was Pseudomonas 2 1.10x103
obser ved against ampicillin, streptomycin and Klebsiella 1 1.10x104
amoxicillin. On the other hand E. coli, Klebsiella and AFB 0 —
Pseudomonas species were resistant to ampicillin,
amoxicillin, penicillin and tetracycline. However, most
of the isolates were high to moderately sensitive (65.61 References
to 97.83%) to ofloxacin, gentamicin, ciprofloxacin, 1. Forster EM. Perennial issues in food safety. In :
lincomycin and chloramphenicol. Food borne diseases Clever DO (Ed) Academic
It was reported that prevalence of Staphylococcus press, San Diego 1990;369-381.
aureus found to be 46.23% in Assam from 43 cows2. 2. Tiwari JG and Tiwari HK. Staphylococcal
The maximum of the milk samples from distribution zoonoses on dairy farms in Assam and
cans were positive for Staphylococci and Streptococci Meghalaya. Indian J. of Public Health 2007; 51:
indicating that these organisms are comparatively more 97-100.
abundant. Higher bacterial counts in the whole milk
samples indicate that the milk was of poor quality that A.G. Baruah1, A.Z. Das 2,
might have been contaminated either at production Chandana C. Barua 3, B. Nath 4
level or during handling. Presence of E. coli, Klebsiella 1 Assistant Professor, Department of Veterinary Public
is also significant as these organisms are implicated in
food poisoning outbreaks with diarrhea and extra Health, 2 PhD Scholar, Department of Livestock Products
intestinal diseases. High resistance shown against Techno, 3Associate Professor, Department of Veterinary
different antibiotics reflects indiscriminative use of these Pharmacology and Toxicology, 4MVSc student,
drugs in chemotherapeutics practices. Handling of Department of Veterinary Microbiology, College of
infected cow, contaminated milk/cans were stated to Veterinary Science, Assam Agricultural University,
be the most important route by which the organisms Guwahati-781 022.
may reach man. Correspondence: chanacin@satyam.net.in

8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI

111
Letter to the Editor
Salmonella Paratyphi A: An Important Cause of
Typhoid Fever in Ludhiana
Dear Editor,
Enteric fever,though classically caused by
Salmonella enterica serotype typhi,isolation of
Salmonella enterica serotype paratyphi-A also showed
a increasing trend from 2003-2005 and then a
decreasing trend in 2006. Since 1996, an increasing
trend in isolation of S.paratyphi-A causing enteric fever
has been noticed in North India1, 2. Between 2001 to
2004,an unusually high rate in isolation of S.paratyphi
A was also reported from Nagpur(46.15%), Sevagram
(53.33%) and Rourkela(55.29%)3. Blood cultures of
19935 OPD and IPD patients suffering from PUO or
septicaemia in CMC and Hospital Ludhiana were
processed by standard methods during 2003-2006.
Phage typing and biotyping was done at the National
Salmonella phage typing centre, Lady Hardinge
Medical College,New Delhi. Out of a total of 486
isolates of Salmonellae, S.typhi was the predominant
subtype in the years 2003, 2004, 2006 while in 2005,
Sal.paratyphi-A out numbered S.typhi (Table-1).
Table 1: Isolates of Salmonella enterica
serotypes in CMC, Ludhiana: 2003-2006
2003 2004 2005 2006
Blood cultures
received 4500 5204 6571 3660
S.typhi 80 97 80 50
S.paratyphi A 28 36 90 23
S.typhimurium 1 1 Nil Nil
Total Salmonella 109 134 170 73
Salmonella paratyphi A showed 100%
susceptibility to Ciprofloxacin,Cefotaxime and
Gentamycin. Chloramphenicol sensitivity was 90%. All
isolates of S.typhi showed 100% sensitivity to 3rd and
4th generation Cephalosporins and Aminoglycosides
while Chloramphenicol and Ciprofloxacin sensitivity
ranged from 64-73%, 79%-80% respectively. Phage
typing of the isolates showed that E 1 was the
predominant phage type 66.01%, O 18.8%,
UVS17.5%, followed by D1 3.4% and untypable 11.3%
in 2003 while in 2004, the pattern was slightly different
E1 36.6%, D2 20%,E 13.33%,UVS1 3.33% followed
by untypable 30%. In 2005 this difference was more
prominent O 64%, 18% D1 16% E9, 2% E1 and 24
8002 ,enuJ -lirpA 2.oN 25.loV htlaeH cilbuP fo lanruoJ naidnI
strains out of 38 were of biotype II. In 2003, phage
pattern of S. paratyphi A was 8.6% phage I, 8.6%
phage 5 and 82.6% untypable. In 2004 71.4% were
of phage type I, and 28.57% were untypable while in
2005,39% were of phage type I, 39% untypable, 22%
of phage type 4.
In the present study enteric fever due to
Salmonella enterica paratyphi A type showed a steady
increase from 25.68% in 2003 to 52.94% in 2005, S
enterica serotype typhi again became the predominant
causative agent of enteric fever in 2006(68.5%). In
the present study Ampicillin sensitivity was 95% where
as it was 57.1% in Pune and 66.67% in Nagpur3.
Sensitivity to Chloraomphenicol was 91.48% in
Rourkela3 study that is comparable to our study.
Hundred percent sensitivity shown to Ciprofloxacin,
Cefotaxime, Gentamycin in our study was also
comparable to other studies from Rourkela and
Nagpur. Majority of isolates (39%) of S.paratyphi A
belonged to phage type I while most of the isolates
was of phage type 6 in Rourkela3. So, serotypes, phage
types and drug susceptibility pattern varies in different
parts of India. Although S.paratyphi A causes a milder
disease than S.typhi yet, continuous monitoring is the
need of hour and present communication also endores
that S.paratyphi A is also a rapidly emerging pathogen
of enteric fever,almost all strains of S.paratyphi A are
sensitive to routinely used flouroquinolones and 3rd &
4th generation Cephalosporins.
References:
1. Sood S, Kapil A, Dash N, Das BK,Goel V,Seth P.
Paratyphoid fever in India. An emerging problem.
Emerg. Infect Dis. 1999,5: 483-4.
2. Chandel DS, Chaudhary R, Dhawan B, Pandey
A, Dey AB. Drug resistant Salmonella enterica
serotype paratyphi A in India. Emerg Infect Dis.
2000; 6:420-1.
3. Bhattacharya SS, Dash Usha. A sudden Rise in
Occurrence of Salmonella parayphi A infection
in Rourkela,Orissa. Indian J Med. Microbiol 2007;
25:78-79.
*Aroma Oberoi1, Aruna Aggarwal2
1Reader, 2Professor;Department of Microbiology,
Christian Medical College and Hospital, Ludhiana-
141008. *Correspondence: draromaoberoi@yahoo.com
 211

53rd Annual National Conference of IPHA

Organized by
Department of Community Medicine
Kempegowda Institute of Medical Sciences (KIMS), Bangalore - 560 070
Theme : Changing Public Health Scenario in the 21st century
Dates : 8th January, 2009 - Preconference CME
(Thursday)
9th -11th January, 2009 - Conference
(Friday, Saturday& Sunday)
Venue : Kempegowda Institute of Medical Sciences (KIMS), Bangalore.

Registration fees
Only A/c Payee Demand Draft will be accepted, cheques will not be accepted. Demand Draft shall be in the
name of “53rd National Conference of IPHA”, payable at Bangalore. Please write your name, place, IPHA
membership number (for members) and mobile number on the reverse of the bank draft.
Category Before 01-11-2008 Spot 5
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1. Quote IPHA membership number.

2. Recommendation letter from Head of Department / Head of Institution is compulsory.
3. Recommendation letter from Head of Department and only for those whose papers are accepted for
presentation.
4. Or equivalent Indian currency.
5. Conference kit will be provided subject to availability.
6. Conference kit will not be provided.
Contact : Dr. B G Parasuramalu, Professor & Head
Organizing Secretary - 53rd Annual National Conference of IPHA,
Department of Community Medicine,
Kempegowda Institute of Medical Sciences (KIMS),
BSK 2nd Stage, Bangalore - 560070.
(M) 0-99860-03467
Email: iphacon09@kimsbangalore.edu.in
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