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With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used for financial planning of scaling up of similar health services in the urban areas under the aegis of National Health Mission. The estimates would be also useful in undertaking equity analysis and full economic evaluations of the health systems.

Increasing demand for spectrum causes the emergence of technologies like Cognitive Radio (CR). Resources like bandwidth and energy are primarily shared by the primary and secondary users in the CR network. Resource utilization depends on the number of nodes, topology dimension, packet generation rate, and time of channel utilization. Therefore, optimizing resources in CR is a need of the hour. In the presented paper, a PSO-based resource allocation scheme is implemented. The input parameters like the number of secondary user nodes, packet generation rate, dimension of the network, and simulation time are targeted to get optimum results of packet delivery ratio, average throughput, average delay, and energy consumption. To implement CR, NS-2 is used. The fitness equations are obtained by varying the input parameters in a given range. Curve-fitting software is used to get fitness equations. These fitness equations are then used in the PSO algorithm, which is implemented in MATLAB. With implementing a PSO-based resource allocation scheme, the performance of packet delivery ratio, throughput, delay, and energy consumption increased by 22.15 %, 22.15 %, 67.83 %, and 32.18 %, respectively.

Barley stripe rust is caused by Puccinia striiformis f.sp. hordei, (Psh), occurs worldwide, and is a major disease in South Asia. The aim of this work was to identify and estimate effects of loci underlying quantitative resistance to rust at seedling and adult plant stages. HI-AM panel of 261 barley genotypes consisting of released cultivars from North and South America, Europe, Australia, advanced breeding lines, and local landraces from ICARDA barley program were screened at seedling and adult plant stages for resistance to Psh. Seedling resistance was evaluated with the five prevalent Psh races in India. Screening for the adult plant stage resistance was also performed in two different locations by inoculating with a mixture of the five races used for seedling screeing. The panel was genotyped using DaRT-Seq high-throughput genotyping platform. The genome-wide association mapping (GWAM) showed a total of 45 QTL located across the seven barley chromosomes for seedling resistance to the five races and 18 QTL for adult plant stage resistance. Common QTL for different races at seedling stage were found on all chromosomes except on chromosome 1H. Four common QTL associated with seedling and adult plant stage resistance were found on chromosomes 2, 5, and 6H. Moreover, one of the QTL located on the long arm of chromosome 5H showed stable effects across environments for adult plant stage resistance. Several QTL identified in this study were also reported before in bi-parental and association mapping populations studies validating current GWAM. However 15 new QTL were found at adult plant stage on all chromosomes except the 4H, explaining up to 36.79% of the variance. The promising QTL detected at both stages, once validated, can be used for MAS in Psh resistance breeding program globally.

ObjectivesThe Government of India launched the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) to expand access to affordable generics through private retail outlets named as Jan Aushadhi Kendras (JAKs). This study examines the association of PMBJP with out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and impoverishment rate (IR) attributable to medicines.DesignA cross-sectional observational study was conducted across nine Indian states in 2022–2023.SettingOutpatient (OPD) and inpatient (IPD) departments of secondary and tertiary government hospitals, private pharmacies and JAKs in 18 districts of IndiaParticipantsA total of 10 336 patients were recruited from OPD (n=2881) and IPD (n=1009) departments of government hospitals as well as pharmacy settings (n=6446). Data on sociodemographics, disease severity, number of generic prescriptions, source of acquiring medicines and medicine-related OOPE were collected through semistructured interviews and periodic follow-ups.Primary and secondary outcomesPrimary outcomes included mean OOPE on medicines, incidence of CHE (≥40% of non-food consumption expenditure on medicines), IR among JAK and non-JAK users were the primary outcomes of the study. Secondary outcomes comprised awareness of JAKs, generic prescribing rates in hospitals and the factors associated with OOPE, CHE and IR.ResultsPatients procuring medicines exclusively from JAKs reported the lower mean OOPE (OPD: ₹172; IPD: ₹275; pharmacy: ₹307), compared with significantly higher spending at private pharmacies (OPD: ₹1085; IPD: ₹3165; pharmacy: ₹1031). After adjusting for covariates, OOPE among exclusive JAK users was significantly lower relative to private pharmacy users by 60.6%–89.3%. Furthermore, matched analysis confirmed 42% lower expenses, compared with private pharmacies. The likelihood of CHE was also significantly greater among private pharmacy users. However, utilisation of JAKs remained limited, mainly due to low awareness, perceived stock shortages and low rates of generic prescribing.ConclusionPMBJP is associated with significant reduction in OOPE and financial hardship, positioning it as an effective cost-containment intervention within India’s universal health coverage framework. Strengthening supply chains, promoting generic prescribing and integrating JAKs with public facilities would further maximise its impact.

We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India's policy of introducing a second auxiliary nurse midwife (ANM) at the sub-centre compared to scenario of single ANM sub-centre. We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants. Annually it costs INR 1.03 million (USD 19,381), or INR 187 (USD 3.5) per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10) per full ANC care, INR 767 (USD 14) per PNC case registered, INR 974 (USD 18) per DOTS treatment completed and INR 97 (USD 1.8) per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432). Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India's policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective.

Barley production worldwide is limited by several abiotic and biotic stresses and breeding of highly productive and adapted varieties is key to overcome these challenges. Leaf scald, caused by Rhynchosporium commune is a major disease of barley that requires the identification of novel sources of resistance. In this study two subsets of genebank accessions were used: one extracted from the Reference set developed within the Generation Challenge Program (GCP) with 191 accessions, and the other with 101 accessions selected using the filtering approach of the Focused Identification of Germplasm Strategy (FIGS). These subsets were evaluated for resistance to scald at the seedling stage under controlled conditions using two Moroccan isolates, and at the adult plant stage in Ethiopia and Morocco. The results showed that both GCP and FIGS subsets were able to identify sources of resistance to leaf scald at both plant growth stages. In addition, the test of independence and goodness of fit showed that FIGS filtering approach was able to capture higher percentages of resistant accessions compared to GCP subset at the seedling stage against two Moroccan scald isolates, and at the adult plant stage against four field populations of Morocco and Ethiopia, with the exception of Holetta nursery 2017. Furthermore, four machine learning models were tuned on training sets to predict scald reactions on the test sets based on diverse metrics (accuracy, specificity, and Kappa). All models efficiently identified resistant accessions with specificities higher than 0.88 but showed different performances between isolates at the seedling and to field populations at the adult plant stage. The findings of our study will help in fine-tuning FIGS approach using machine learning for the selection of best-bet subsets for resistance to scald disease from the large number of genebank accessions.

Background: Infant mortality is an important health indicator of a population given its strong link to socioeconomic status, health service access, and quality and maternal health. The declining trend of Infant Mortality Rate has been observed in India where it reduced from 89 deaths per 1000 live births in 1990 to 28 deaths per 1000d live births in 2019. Most of the studies regarding the trend of infant mortality are state-based, however, state-level infant mortality has masked the intradistrict clustering of individual infant deaths. Hence, this study was planned with an objective to study the trend of infant mortality at the district level. Material and Methods: A retrospective study was conducted in the district Rohtak of Haryana using the data collected regarding infant deaths. The collected data regarding addresses were geocoded. The resulting layer was then analyzed using QGIS v3.10. The descriptive data was analyzed using SPSS v20.0. Result: In total, 1336 infant deaths during the study period were included. A declining trend of infant mortality was observed over the study period. The number of grids (25 km2) reduced from 18 in 2016 to 10 in 2019 depicting a reduction in the areas with more than expected count. Conclusion: This study emphasizes on the importance of using the geographic information science technique in identifying local hotspots within the district so as to find areas that need more support and observation.

Heat stress at later growth stage is one of the major limitations in achieving potential yield in barley. Incorporation of heat tolerance in the variety development process is an essential task that breeders would like to achieve by exploring new sources of genetic variability and their utilization. A better understanding of genetic variation in existing genotypes under heat stress is required to produce high yielding varieties with improved heat tolerance. An association mapping panel 2017 (AM2017), comprising of 316 genotypes, was evaluated under timely and late sown (heat stress) conditions for two consecutive crop seasons at Hisar in India during 2017–2019. Eight agro-morphological traits, mainly contributing to yield, were considered agro-morphological diversity study. Genetic diversity and population structure were explored by using the 50 K iSelect Illumina Barley SNP array. A set of 36,793 SNP markers, covering a genetic distance of 991.82 cM with an average marker density of 37.09 SNPs/cM, was obtained after quality filtration. The gene diversity (GD) and Polymorphic Information Content (PIC) at genome level was 0.362 and 0.289, respectively. In AM2017, two subpopulations were observed mainly due to the row types. Principal component analysis of agro-morphological traits revealed that days to heading and maturity along with spike length, spikelet number per spike and grain yield per plot were the most important traits in timely and late sown conditions. The information on agro-morphological genetic diversity under heat stress conditions will be useful in identifying heat tolerant genotypes for use in barley breeding programs.

Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India. NCD risk factors survey was conducted among 5078 residents, aged 18-69 years during 2016-17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples. Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3-42.4) and 18.8% (95% CI: 15.8-21.8). One- tenth (11%) (95% CI: 8.6-13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6-37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6-27.8) and 15.5% (95% CI: 11.0-20.0). 91.3% (95% CI: 89.3-93.3) of the population had higher salt intake than recommended 5gms per day. The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.