WAY TO DETERMINE SIZE OF THE HOSPITAL

Hospital bed requirement is directly proportional to the population it caters. Simple way to determine the number of bed required for a Government hospital would be as follows.

Lets assume the average size of a district as one million population.

Lets assume the annual rate of admission as 1 per 50 population and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be as follows:

The total number of admission per year = 10,00,00 x 1/50 = 20,000

Beds per year = 20,000 x 5 = 1,00,000

Total number of beds required when occupancy is 100% = 1,00,000/365 = 275 beds
Total number of beds required when occupancy is 80% = 1,00,000/365 x 80/100 = 220 beds.

NATIONAL IMMUNIZATION SCHEDULE FOR INFANTS, CHILDREN AND PREGNANT WOMEN

Immunization programme provides vaccination against seven vaccine preventable diseases

Vaccine	When to give	Dose	Route	Site
For Pregnant Women
TT-1	Early in pregnancy	0.5 ml	Intra-muscular	Upper Arm
TT-2	4 weeks after TT-1	0.5 ml	Intra-muscular	Upper Arm
TT- Booster	If received 2 TT doses in a pregnancy within the last 3 yrs	0.5 ml	Intra-muscular	Upper Arm
For Infants
BCG	At birth or as early as possible till one year of age	0.1ml (0.05ml til 1 month age)	Intra-dermal (inj. at 150 angle)	Left Upper Arm
Hepatitis B-0	At birth or as early as possible within 24 hours	0.5 ml	Intra-muscular (inj. at 900 angle)	Antero-lateral side of mid-thigh
OPV-0	At birth or as early as possible within the first 15 days	2 drops	Oral	Oral
OPV 1,2 & 3	At 6 weeks, 10 weeks & 14 weeks	2 drops	Oral	Oral
DPT 1,2 & 3	At 6 weeks, 10 weeks & 14 weeks	0.5 ml	Intra-muscular	Antero-lateral side of mid thigh
HepatitisB 1, 2 & 3	At 6 weeks, 10 weeks & 14 weeks	0.5 ml	Intra-muscular	Antero-lateral side of mid-thigh
Measles	9 completed months-12 months. (give up to 5 years if not received  at 9-12 months age)	0.5 ml	Sub-cutaneous (inj. at 450  angle)	Right upper Arm
Vitamin A (1stdose)	At 9 months with measles	1 ml ( 1 lakh  IU)	Oral	Oral
For Children
DPT booster	16-24 months	0.5 ml	Intra-muscular	Antero-lateral side of mid-thigh
OPV Booster	16-24 months	2 drops	Oral	Oral
Japanese Encephalitis	16-24 months with DPT/OPV booster	0.5 ml	Sub- cutaneous	Left Upper Arm
Vitamin A (2nd to 9th dose)	16 months with DPT/OPV booster Then, one dose every 6 months up to the age of 5 years.	2 ml (2 lakh  IU)	Oral	Oral
DPT Booster	5-6 years	0.5 ml.	Intra-muscular	Upper Arm
TT	10 years & 16 years	0.5 ml	Intra-muscular	Upper Arm

PLIGHT OF POLITICALLY DRIVEN PUBLIC HEALTH DECISION MAKING PROCESS

In the last couple of weeks everyone' attention capturing issue was Pioglitazone causing bladder cancer among Diabetes. Pioglitazone an oral anti diabetic drug was banned on June 18, 2013 stating its cause for bladder cancer among diabetes patients.

The Evidence Union Ministry has was "Eight cases" of bladder cancer in patients who are on Pioglitazone. The immediate reaction was BAN THE DRUG as any panicked would do. In the next month the Ban was revoked! Wow what a surprise, plus the Ministry ordered to label the box as harmful drug.

Based on this Eight cases the Ministry had Banned a drug over night. The only Indian study available was on 958 patients who are on Pioglitazone with no cancer after two years. This is the only scientifically valid data currently available.

This decision make process evokes the dubitable skill of the Ministry. Why is that there is no scientific search process behind a major decision? If the clause it to BAN something on its immediate cause and effect for a disease, why not BAN Cigarettes/Tobacco?

If by going with facts, 80% of the people with Type 2 Diabetes are over weight and most of them are smokers/Tobacco consumers. Why not BAN them? Smoking is considered to be a the major cause for Lung Cancer, TB and what not. Isn't this laymen statistics enough to BAN it? Unless a decision is taken rationally for a country with 110+ crore population, Irrational decisions like these in Public Health is equal to nurture a Wolf to grow in Kindergarden. 

DILEMMA'S IN IMMUNIZATION

           Immunization is a critical part of quality health care and should be accomplished through routine & intensive vaccination programs. When we think of immunization there has been confrontation in my mind and I am sure many of us too have it in us regarding certain aspects of immunization. There are only 43% Indian children who are fully immunized in age group of 12-23 months (NFHS -3).

The schedule for immunization is governed by the thoughts of MOHFW&WHO in one end and IAP at the other end.

Vaccines	IAP	MOHFW
Upper limit for BCG	Advocates till age of 7 years or beyond	12 months
DPT	Up to 5 years	Up to 24 months beyond which DT to be administered
At 5 years	DPT and OPV Booster	•DT •New recommendations says DPT(Booster 2) •What about OPV(Booster 2)?

Vaccine	IAP	BSPM(Bal Swasth Poshan Mah) or Child Health and Nutrition Months
VitaminA	18 months and there after every 6 months till 5 years	In the months of June and December only

E.g. If any child receives Measles and 1st dose of Vit A at 9 months in February 2nd dose along with DPT (Booster 1) will be given in November. But as per BSPM the same dose should be given in December. 

When the goal of these bodies is to achieve universal immunization coverage why do they follow different paths and routes? This becomes difficult for the health workers who manage immunization camps which are jointly held by various agencies and organisations. It’s very important to develop a consensus pertaining to immunization in the interest of children’s, health workers and others involved in immunization.

Thiru