Integrating an Algorithmic and Health Systems Thinking Approach to Improve the Uptake of Government Antenatal Nutrition Services in Vidisha, Madhya Pradesh (India), 2018 to 2021

In 2018, the Government of Madhya Pradesh initiated the feasibility testing of integrating an algorithmic approach (assess, give, counsel, treat) to strengthen antenatal nutrition services in routine government-funded programmes coupled with a health system thinking approach to strengthen the health service delivery platform. Implementation Phases included - (i) evidence review and stakeholder consultations (April 2018), (ii) health systems strengthening preparedness phase (May-December 2018), pilot testing in Vidisha district (January-December 2019) covering ~54,100 pregnant women, 237 antenatal contact points through 241 Government Auxiliary Nurse Midwives/Staff nurses. During 2020-21, feasibility testing was expanded to additional seven districts. We used programme registers of Auxiliary Nurse Midwives Registers (2019-21) and National Family Health Survey data for 2016 and 2021 to show changes in the Vidisha district and seven expansion districts. We compare the performance of Vidisha district with Ashok Nagar district, where no such intervention occurred. Comparing 2016 and 2021 data, the Vidisha district showed improvements in receipt of antenatal care in the first trimester (29 % to 85%) and four antenatal visits (17% to 54%). Using the difference-in-difference approach, a 42% net increase in first-trimester antenatal checkups in Vidisha as compared to Ashok Nagar is observed. There was also an improvement in the maternal nutrition budget of the state from USD 8.5 million to USD 17.8 million during this period. The Vidisha initiative offers several lessons on time-effective workflow to deliver all constituents of nutrition services at various antenatal contact points through and via routine government health systems. Continued execution of the algorithm for screening, with longitudinal data on the management of all nutrition risks, will be critical to show its long-term impact on maternal morbidities and birth outcomes. Integrating an Algorithmic and Health Systems Thinking Approach to Improve Uptake of Government's Antenatal Nutrition Services in Vidisha, Madhya Pradesh (India), 2018 to 2021.

Corneal curvature and trachoma

In a study of 141 cases in different stages of trachoma, a definite change was observed in the curvature of upper part of cornea, which had become ectatic. The difference in curvature depended on the stage and severity of the trachoma. Most of the patients had fourth stage trachoma. Also, the degree of ectasia was greatest in the late stages of the disease--a point that must be kept in mind when lamellar keratoplasty is done in this type of case.