Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.

Introduction: Vitiligo is an acquired depigmentary condition caused by inactivation or destruction of melanocytes in epidermis and hair follicle. Worldwide incidence of 1% has been reported; similar to various dermatological clinics in India. Widespread prejudice, ignorance, taboos, lack of scientific appraisal, and confusion of vitiligo with leprosy makes it an immense psychological stress. Aim: To know the clinical profile of vitiligo patient with associated cofactors. Materials and Methods: Total 1,010 patients of vitiligo attended in outpatient department at Shree Krishna Hospital (SKH) and Matar camp, Gujarat over 1 year period from August 2011 to July 2012 were included in this study. Detail history and clinical examination of patients were done. Results: Out of 1,010 patients 57.3% were females and 42.7 % were males. Most cases developed vitiligo by 2 ^nd decade of life. Progressive course was found in 60.9 % of patients. Vitiligo vulgaris (57.8%) was most common morphological type. Most common site of onset (41.5%) and involvement (75.7%) was lower limb. Family history was present in 20.4%. Conclusions: Vitiligo constitutes important dermatological disease especially in India. The data suggest that local epidemiological behavior of vitiligo need not be the same across different regions. Vitiligo differs substantially in various clinical aspects.

Context: The Food Safety and Standards Act have redefined the roles and responsibilities of food regulatory workforce and calls for highly skilled human resources as it involves complex management procedures. Aims: 1) Identify the competencies needed among the food regulatory workforce in India. 2) Develop a competency-based training curriculum for food safety regulators in the country. 3) Develop training materials for use to train the food regulatory workforce. Settings and Design: The Indian Institute of Public Health, Hyderabad, led the development of training curriculum on food safety with technical assistance from the Royal Society for Public Health, UK and the National Institute of Nutrition, India. The exercise was to facilitate the implementation of new Act by undertaking capacity building through a comprehensive training program. Materials and Methods: A competency-based training needs assessment was conducted before undertaking the development of the training materials. Results: The training program for Food Safety Officers was designed to comprise of five modules to include: Food science and technology, Food safety management systems, Food safety legislation, Enforcement of food safety regulations, and Administrative functions. Each module has a facilitator guide for the tutor and a handbook for the participant. Essentials of Food Hygiene-I (Basic level), II and III (Retail/ Catering/ Manufacturing) were primarily designed for training of food handlers and are part of essential reading for food safety regulators. Conclusion: The Food Safety and Standards Act calls for highly skilled human resources as it involves complex management procedures. Despite having developed a comprehensive competency-based training curriculum by joint efforts by the local, national, and international agencies, implementation remains a challenge in resource-limited setting.

Background: Contamination of water, food, and environment with antibiotic-resistant bacteria poses a serious public health issue. Objective: The objective was to study the bacterial pollution of the natural sources of water in east Sikkim and to determine the antimicrobial profile of the bacterial isolates. Materials and Methods: A total of 225 samples, 75 each during winter, summer, and monsoon season were collected from the same source in every season for bacteriological analysis by membrane filtration method. Antibiotic susceptibility test was performed using standard disc diffusion method. Results: A total of 19 bacterial species of the genera Escherichia, Klebsiella, Proteus, Salmonella, Shigella, Enterobacter, Citrobacter, Morganella, Pseudomonas, Acinetobacter, Flavobacterium, and Serratia were isolated and their antimicrobial sensitivity tested. Generally, most bacterial isolates except Salmonella and Shigella species were found resistant to commonly used antibiotics such as ampicillin (57.5%), trimethoprim/sulfamethoxaole (39.1%), amoxicillin/clavulanic acid (37.4%), cefixime (34.5%), tetracycline (29.1%), ceftazidime (26.3%), ofloxacin (25.9%), amikacin (8.7%), and gentamicin (2.7%) but sensitive to imipenem and piperacillin/tazobactam. Conclusion: Natural sources of water in east Sikkim are grossly contaminated with bacteria including enteropathogens. The consumption of untreated water from these sources might pose health risk to consumers.

Background: Importance of nutrition in human immunodeficiency virus (HIV) is well-established; however, the information regarding the diet quality of people living with HIV (PLHIV) especially in India is lacking. Objectives: The objective of this study is to assess the anthropometric and nutritional profile of Indian PLHIV. Material and Methods: The study was performed on 400 adult PLHIV registered at the Antiretroviral Center (ART) center in New Delhi, India. Anthropometric data including height, weight, waist, hip, mid arm, and calf circumferences, were collected; 1-day 24-h dietary recall was done to gather nutrient intake from which nutrient adequacy ratios were computed. Mini Nutritional Assessment (MNA) was also conducted. Results: The mean body mass index (BMI) of the sample was 19.73 ± 3.55 kg/m ² with around 40% having BMI <18.5 kg/m ² . All anthropometric measurements were found to correlate positively and significantly with CD4 count (P < 0.05). The sample consumed poor quality of diet as they could not meet even the 2/3 ^rd of the Indian Council of Medical Research (2010) requirements for energy, protein, calcium, iron, riboflavin, niacin, folic acid, B12, copper, and zinc. Classification of subjects according to MNA indicated that more than 50% of the sample was at-risk of malnutrition and 34% were malnourished. With 40% of sample having BMI less than normal, 50% at risk of malnutrition together with poor nutrient intakes over a long period of time could contribute to further worsening of the nutritional status. Conclusion: There is a need to develop a database on nutritional profile of PLHIV in India which reinforces the need for development of effective strategies to improve their nutritional status.

Context: Assam's main lifeline, the Brahmaputra river, braided nature created numerous sand bars and islands known as chars/sapories. They are home to more than 3 million people. Over 90% of the cultivated land on the river islands is flood-prone; the flood leaves the islands completely separated from mainland, preventing access to health infrastructure and services. Aims: To assess the nutritional status of under 5 children residing in the char areas of Dibrugarh district and to identify the factors influencing their nutritional status. Settings and Design: A community-based cross-sectional study conducted in the riverine areas of Dibrugarh district of Assam. Materials and Methods: Nutritional status was assessed using anthropometry. Undernutrition was classified using World Health Organization (WHO) recommended Z- score system. Data collection was done by house to house visit of all chars using proportionate allocation. Statistical Analysis Used: Rates, ratios, proportions, and chi-square test. Results: Overall prevalence of underweight, stunting, and wasting was 29%, 30.4%, and 21.6%, respectively. Prevalence of underweight and stunting was less than the prevalence of underweight (36.4%) and stunting (46.5%) in Assam, but the prevalence of wasting was more than that of Assam (13.7%) as observed in National Family Health Survey-3. Significant association was observed between the prevalence of undernutrition and socioeconomic status, literacy status of parents, infant, and young child feeding practices and size of the family (P < 0.05). Conclusions: Special focus is needed for nutritional improvement of under 5 living in char areas to prevent preventable morbidities and to achieve optimum development.

Call center sector in India is a relatively new industry and one of the fastest growing sectors driving employment and growth in modern India today. While employment in the business process outsourcing (BPO) sector has meant that young adults are reaching their career milestones and financial goals much earlier than before, surveys and anecdotal evidence show that workers in the BPO sector experience high levels of stress and its related disorders, primarily due to its contemporary work settings. Safeguarding the health of youngsters employed in this new, growing economy becomes an occupational health challenge to public health specialists.

Background: The mobile-health approach is currently knocking the doors of public health to make use of this rapidly advancing technology in developing countries; therefore, it needs a critical look on its capacity in improving health system of developing countries. Materials and Methods: A systematic review of studies in literature published till 31 ^st October 2013 of last 10 years on key search word: "Capacity of mobile-health in improving health system of developing countries" was done from medical search engines abstracting databases such as Pub-med, WHO, Cochrane database, Google scholar, and Bio-med Central. Both types of studies elucidating utility and no benefit of mobile-health in developing countries were included as main criteria for deciding the capacity of mobile-health approach in health system of developing countries. M-health studies on areas of impact, effectiveness, and evaluation and previous reviews, conferences data, and exploratory studies were the main study designs incorporated. Studies on m-health in developed world, Indian studies as well data from thesis or dissertation were excluded in this review. Discussion: Multi-faceted mobile-health applications, strategies, and approaches currently lack proper regulation and standardization from health care authorities, and currently their results also vary from good to no beneficial effects as found in this review. Conclusion: Umbrella of mobile-health approaches must be used intelligently, keeping in mind the fact that, it can provide a greater access and quality health care to larger segments of a rural population and its potential to improve the capacity of health system in developing countries.

Context: Blood can save lives; however, it can be a source of transfusion transmitted diseases if proper screening of donated blood is not done. It is now mandatory to screen all donated blood units, whether replacement or voluntary for five transfusion transmitted diseases-namely human immunodeficiency virus (HIV), hepatitis B and C, syphilis, and malaria. Aims: The present study was done to study the prevalence of infectious disease markers among donors at the blood bank of a tertiary care center. Settings and Design: A total of 53,069 donors donated blood over 11 years. The number of replacement and voluntary donors was 41,710 and 11,359, respectively. Materials and Methods: Screening of blood units was done by enzyme-linked immunosorbent assay (ELISA) method for HIV and hepatitis B and C. HIV testing was done using fourth generation ELISA kits. Syphilis was tested by latex agglutination assay and malaria was tested using slide method up to the year 2008-2009 and by rapid immunochromatographic assay after that. Results: The mean percentage of these infections per year was found to be 0.2, 1.2, 0.9, 0.3, and 0.002% for HIV, hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), syphilis, and malarial parasite (MP), respectively. Conclusions: The risk of transfusion transmissible infection (TTI) today is low but supply of safe blood depends on proper donor selection and sensitive screening tests.