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Ban on Sale of Tobacco Products



Ban on Sale of Tobacco Products
No comparative data is available on the consumption of cigarettes and other tobacco products in the country. However, as per Global Adult Tobacco Survey (GATS-India 2010), about 35% of the adults in India consume tobacco in some form or the other. The estimated number of tobacco users in India is 27.5 crore, with 16.37 crore users of only smokeless tobacco, 6.9 crore only smokers and 4.23 crore users of both smoking and smokeless tobacco. The prevalence of overall tobacco use among males is 48 percent and that among females is 20 percent. Among both males and females, the prevalence of tobacco use is higher in rural than urban areas. More than half of rural males (52 percent) and 24 percent of rural females use tobacco compared with 38 percent of urban males and 12 percent of urban females.


Published scientific literature suggests that exposure to promotional activities for tobacco leads to initiation and progression of tobacco use among youth and young adults in the country. Research corroborates that exposure to tobacco advertisements and receptivity to tobacco marketing are significantly related to increased tobacco use among students. Further, there is evidence to suggest independent association between tobacco use in Indian movies and ever tobacco use among adolescents in India.

Government of India has banned certain kinds of smokeless tobacco products like gutkha and chewing tobacco through notification issued under the Food Safety and Standards Act, 2006. Other tobacco products are regulated by the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003), which contain provisions, inter alia, relating to ban on sale of tobacco products by/to minors, ban on sale of tobacco products within 100 yards of educational institutions, ban on promotions/advertisements of tobacco products, etc. 

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Mission Indradhanush

Under Mission Indradhanush, districts were categorized into high priority, medium and low priority districts based on the number of eligible children (partially vaccinated or unvaccinated) and full immunization coverage gap.
There is a gap between the target set and achievement made in 480 districts identified for Mission Indradhanush in 2 phases. There is also a difference between number of boys and number of girls vaccinated in the districts. The State/UTs wise achievements are given in the table below.

The Mission focuses on interventions to improve full immunization coverage in India to atleast 90% by 2020. Challenges/hurdles faced for effective implementation of Mission Indradhanush are variable visibility of the program, weak inter-sectoral & inter-departmental convergence and gaps in microplan. The program is focusing on increasing awareness by enhancing Information Education Communication (IEC) activities, oversight of program at highest level, health systems strengthening through revision of microplans and training of health officials & frontline workers for capacity building.

State/UT-wise target and achievement for two phases of Mission Indradhanush (Provisional Report)

S. No
District
Estimated Target for MI
(Phase 1 & 2)
Children fully immunized
(Phase 1 & 2)
% Children fully immunized



Total
Male
Female

1
A&N Islands#
610
0
0
0
0%
2
Andhra Pradesh
335235
32,716
17030
15686
10%
3
Arunachal Pradesh
12891
4,840
2449
2391
38%
4
Assam
225646
68,194
36892
31302
30%
5
Bihar
740467
1,68,789
90041
78748
23%
6
Chandigarh
2197
868
466
402
40%
7
Chhattisgarh
128614
1,19,012
62490
56522
93%
8
D&N Haveli
3666
113
54
59
3%
9
Daman & Diu
658
118
49
69
18%
10
Delhi
88327
2,14,034
114412
99622
242%
11
Goa
1396
220
122
98
16%
12
Gujarat
443660
1,19,293
62521
56772
27%
13
Haryana
219275
1,90,748
102712
88036
87%
14
Himachal Pradesh
32498
4,092
2041
2051
13%
15
Jammu & Kashmir
57419
16,944
9118
7826
30%
16
Jharkhand
166569
1,49,525
78533
70992
90%
17
Karnataka
155626
1,18,825
62285
56540
76%
18
Kerala
68476
16,019
8290
7729
23%
19
Madhya Pradesh
510485
3,40,160
182109
158051
67%
20
Maharashtra
561466
62,835
32553
30282
11%
21
Manipur
15877
6,865
3419
3446
43%
22
Meghalaya
37201
10,497
5409
5088
28%
23
Mizoram
5181
1,035
564
471
20%
24
Nagaland
21098
2,853
1475
1378
14%
25
Odisha
247023
61,150
32394
28756
25%
26
Puducherry
7224
210
124
86
3%
27
Punjab
116304
35,788
19243
16545
31%
28
Rajasthan
329410
3,32,445
175916
156529
101%
29
Sikkim
909
14
7
7
2%
30
Tamil Nadu
443474
1,81,781
95621
86160
41%
31
Telangana
293057
54,155
28426
25729
18%
32
Tripura
27722
2,071
1080
991
7%
33
Uttar Pradesh*
1967470
14,03,652
682034*
576133*
71%
34
Uttarakhand*
28290
36,780
18372*
16248*
130%
35
West Bengal
290310
75,945
39830
36115
26%
36
India
7585731
38,70,447


51%
* Total children vaccinated does not sum upto gender-wise disaggregated data for State of Uttar Pradesh and Uttarakhand as gender disaggregated date not available for April 2015 round..
# In UT of A&N thought the have reached to 32 children but none fully vaccinated.
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Free Diagnostic Schemes
Under the National Health Mission (NHM), support is being provided to States/ UTs for strengthening of their healthcare systems including for Free Diagnostics Service Initiative, based on the proposals in their respective Programme Implementation Plans (PIPs). Guidelines on NHM Free Diagnostics Service Initiative have been shared with all States/ UTs.
The illustrative list of tests as per the said guidelines at various levels of public health facilities is given below.

ILLUSTRATIVE LIST OF FREE INVESTIGATIONS
SUB HEALTH CENTRES
1.      Haemoglobin Estimation (Hb)
2.      Dengue (Rapid test)
3.      Malaria (Rapid test)
4.      Blood Sugar(Glucometer)
5.      Rapid Diagnostic test for Pregnancy(Urine Pregnancy Test)
6.      Urine Albumin/Urine Sugar /Leucocyte Esterase
7.      Visual Inspection Acetic Acid (VIA)

PRIMARY HEALTH CENTRES
·         Clinical Pathology
1.      Hemoglobin Estimation (Hb)
2.      Total Leukocyte Count (TLC)
3.      Dierential Leukocyte Count (DLC)
4.      Platelet count
5.      MP (Slide Method)
6.      ESR
7.      Clotting Time (CT)
8.      Blood Group (ABO-RH typing)


·         Bio Chemistry
9.      Blood sugar
10.  S. Bilirubin

·         Sero-Microbiology
11.  Rapid Plasma Reagin (RPR) Kit Test
12.  HIV Test
13.  Sputum for AFB
14.  Dengue (Rapid test)
15.  Malaria (Rapid test)

·         Urine Analysis
16.  Urine Sugar / Albumin/Leucoyte Esterase
17.  Urine Pregnancy test (UPT)

·         Stool Analysis
18.  Stool for OVA and cyst
19.  Water Quality Testing-H2S Strip test for Faecal Contamination

COMMUNITY HEALTH CENTRES
·         Clinical Pathology
1.      Haemoglobin Estimation (Hb)
2.      Total Leukocyte Count (TLC)
3.      Dierential Leukocyte Count (DLC)
4.      MP (Slide Method)
5.      ESR
6.      PT INR
7.      CBC
8.      Blood Group (ABO-RH typing)
9.      Total Red Blood Cell Count
10.  Platelet count by cell counter
11.  Packed cell volume (PCV)
·         Bio Chemistry
12.  Blood sugar
13.  Blood Urea
14.  S. Creatinine
15.  S. Bilirubin (T)
16.  S. Bilirubin (D)
17.  SGOT
18.  SGPT
19.  S. Alkaline Phosphates
20.  S. Total Protein
21.  S. Albumin
22.  S. Total Cholesterol
23.  S. Triglyceride
24.  S. VLDL
25.  S. HDL
26.  S.Amylase
·         Serology
27.  RPR Rapid Test
28.  HIV Rapid Test
29.  Dengue (Rapid test)
30.  Malaria (Rapid test)
31.  Sputum for AFB
·         Urine
32.  Urine Sugar / Albumin
33.  Urine Pregnancy test (UPT)
34.  Urine Microscopy
35.  Urine Complete by strip method (Bile Salts, Bile Pigment, Ketone bodies & Occult blood, sugar, albumin, Ph, specific gravity) and Leucocyte Esterase.

·         Stool
36.  Stool for OVA and cyst
·         Radiology
37.  X-Ray (With/Without Contrast)
38.  USG

·         Cardiology
39.  ECG

DISTRICT/SUB DISTRICT
·         Clinical Pathology
1.      Haemoglobin Estimation (Hb)
2.      Total Leukocyte Count (TLC)
3.      Dierential Leukocyte Count (DLC)
4.      MP (Slide Method)
5.      ESR
6.      PBF
7.      CBC
8.      Blood Group (ABO-RH typing)
9.      Total Eosinophilic Count (TEC)
10.  Total Red Blood Cell Count
11.  Platelet count by cell counter
12.  Packed cell volume (PCV)
13.  Coomb’s test-Direct
14.  Coomb’s test-Indirect
15.  Prothrombin time test INR
16.  Cell Count and Bio-chemistry (CSF, Pleural and Ascitic fluid)
17.  Semen Analysis sperm count (Manual)
·         Bio Chemistry
18.  Blood sugar
19.  Blood Urea
20.  S. Creatinine
21.  S. Bilirubin (T)
22.  S. Bilirubin (D)
23.  SGOT
24.  SGPT
25.  S. Alkaline Phosphates
26.  S. Total Protein
27.  S. Albumin
28.  S. Calcium/Potassium/Sodium
29.  Troponin I/Troponin T
30.  S. LDH
31.  S. Amylase
32.  S. Uric Acid
33.  S. Total Cholesterol
34.  S. Triglyceride
35.  S. VLDL
36.  S. HDL
37.  TSH

·         Serology
38.  RPR Rapid Test
39.  HIV Rapid Test
40.  Sputum for AFB
41.  Dengue (Rapid) Test
42.  Malaria (Rapid) Test
43.  Rheumatoid Factor (RA)
44.  Anti Streptolysin – O (ASLO
45.  HBsAg (Rapid) test
46.  S. CRP

·         Microbiology
47.  Blood Culture (Bactec)
48.  Urine Culture
49.  Histopathology- Biopsy and / Bone marrow aspiration Exfoliativecytology / cytopathology)

·         Urine Analysis
50.  Urine Complete
51.  Urine Pregnancy test (UPT) @ RDK
52.  Urine Microscopy

·         Stool Analysis
53.  Stool for OVA and cyst

·         Radiology
54.  X-Ray  (With/Without contrast)
55.  USG

·         Cardiology
56.  ECG

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
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Pictorial Warnings on Tobacco Products
Ministry of Health & Family Welfare notified the new health warnings through the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules vide G.S.R-727 dated 15th October 2014. As per the new Rules, pictorial health warnings shall occupy at least eighty five percent (85%) of the principal display area of the package (85% includes 60% of pictorial health warning and 25% of textual health warning).
Ministry of Health & Family Welfare [vide notification G.S.R-739(E) dated 24th September 2015] notified that the new Rules on pictorial health warnings would come into effect from 1st April 2016.
Government has received communications both for and against the new Rules on pictorial health warning on cigarettes and Beedi packets.
The intent and purpose of the pictorial health warnings is to create awareness about the serious and adverse health consequences of tobacco usage among the youth, children, illiterate/semi-literate and the uninitiated, who are either the primary users of tobacco or who may be vulnerable to use tobacco products, so that they are empowered to make an informed choice about such use.
As per the ICMR study “Assessment of Burden of Disease due to Non-Communicable Diseases (2006)”, based on analysis of published literature till 2004, the risk of disease attributable to tobacco use was 78% for stroke, 65.6% for tuberculosis, 85.2% for ischemic heart disease, 52% for acute myocardial infarction, 43% for oesophageal cancer, and 16% for lung cancer, respectively. Essentially all body systems (Nervous, Respiratory, Digestive, Circulatory& Haematological, Immune, Endocrine & Metabolism, Excretory, Reproductive, Sensory, Cutaneous, and Skeletal) are affected by smoking. Consumption of smokeless tobacco products may cause oral cancer, pancreatic cancer, oesophageal cancer, cardiovascular diseases, chronic bronchitis (linked to use of snuff), low birth weight babies and stillbirths, reduced fertility in men, retarded wound healing, periodontal diseases, halitosis (bad breath), and oral infections.
Tobacco is the foremost preventable cause of death and disease in the world today. As per the report of Tobacco Control in India (2004), nearly 8-9 lakh people die every year due to diseases attributable to tobacco use. A nationally representative study on smoking and death in India (published in 2008) found that smoking causes a large and growing number of premature deaths in the country. The study estimated that in 2010, the annual number of deaths from smoking in India would be around 10 lakhs.
As per Sections 7(2) and (3) of the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act 2003 (COTPA 2003), no tobacco products can be sold without the specified pack warnings.
Section 7(2) of the Act lays down as under:
No person shall carry on trade or commerce in cigarettes or any other tobacco products unless every package of cigarettes or any other tobacco products sold, supplied or distributed by him bears thereon, or on its label, the specified warning.”
Section 7(3) of the Act lays down as under:
No person shall import cigarettes or any other tobacco products for distribution or supply for a valuable consideration or for sale in India unless every package of cigarettes or any other tobacco products so imported by him bears thereon, or on its label, the specified warning.”

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

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Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
The Government has initiated implementation of the following projects under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) in the State of Andhra Pradesh:

(i) Upgradation of Sri Venkateswara Institute of Medical Sciences, Tirupati with estimated cost of Rs.120 crore (Central Share Rs.60 crore for procurement of Medical equipments including consultancy fee and Institute Share Rs. 60 crore) under Phase 1 of PMSSY.

(ii) Upgradation of Govt. Medical College, Anantapur and Siddhartha Medical College, Vijayawada with an approved cost of Rs.150 crore (Central share- Rs.120 crore and State share- Rs.30 crore) per Institute under Phase III of PMSSY.

(iii) The Cabinet has approved setting up of new AIIMS in Andhra Pradesh on 7th October 2015. Accordingly, establishment of new AIIMS at Mangalagiri in Andhra Pradesh is being implemented. The MoU has been signed between the Government of India and Government of Andhra Pradesh. Taking over of the land at Andhra Pradesh has been done. Soil survey, topographical survey has been completed. Tender for boundary wall has been awarded.

Initial project funds at the rate of 3% i.e. Rs.2.40 crore of the total cost of civil works for each Government Medical College has been released to HITES, the Executing Agency in respect of Government Medical College, Anantpur and HSCC (India) Ltd. in respect of Siddhartha Medical College, Vijayawada.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today. 
  

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